Diagnosis and Treatment of Adnexal Masses in Children and Adolescents

Abstract

Adnexal masses in children are rare, and most are benign. It has been common practice to perform a single-sided oophorectomy in children with an ovarian mass because of concern over possible malignancy. The negative consequences of oophorectomy in children and adolescents are well known. Ovarian surgery in pediatric patients with adnexal masses has become more conservative in the last 10 years, and ovarian-sparing surgery has increased. However, too many unnecessary oophorectomies are performed. The aim of this retrospective cohort study was to evaluate the diagnosis and treatment decisions made in children and adolescents with an adnexal mass. Preoperative factors were examined that influenced the decision for an ovary-sparing procedure. Patients younger than 18 years were diagnosed with or treated for an adnexal mass at an academic hospital in Nijmegen, The Netherlands between 1999 and 2013. Data extracted from electronic and paper hospital patient records included imaging reports, laboratory results, pathology reports, age at presentation, presenting signs and symptoms, type of surgery performed, surgeon specialty, and histological diagnosis. A predictive model was used to characterize adnexal masses as benign using preoperative criteria: diameter of less than 10 cm as measured by ultrasound, absence of solid components on ultrasound, and absence of positive tumor markers. A total of 144 patients were identified. Of these, 29 were excluded for not having an adnexal mass and 4 for absence of medical records, leaving 111 for the final analysis. Mean patient age was 10.2 ± 5.6 years (range, 0–17 years). A malignancy was diagnosed in 28 patients (25.2%). Surgery was performed for 83.1% of the benign masses and 100% of the malignant masses. Preoperative classification was 40.9% sensitive and 100% specific for identifying benign masses. In 46.4% of the benign masses, oophorectomy was performed. The presence of a gynecologic surgeon was the only factor significantly associated with a reduced probability of oophorectomy for a benign mass; the odds ratio was 0.14, with a 95% confidence interval of 0.04 to 0.47. Most girls in this cohort with an adnexal mass were treated surgically. Only 1 in 4 patients had a malignancy. However, oophorectomy was performed in almost half of the benign masses. The authors recommend treatment in a multidisciplinary team when dealing with adnexal masses in children to improve the rate of minimally invasive and ovary-sparing procedures.