Ovarian Cysts in the Adolescent Patient Population. Determining Expectant vs. Surgical Management: A Retrospective Analysis

Abstract

Although laparoscopy for surgical intervention of ovarian cysts in adolescents has been well studied and is the preferred surgical approach, indications for management of ovarian cysts in this age group are not well defined. The aim of this study was to determine the rate of spontaneous resolution of ovarian cysts in adolescents as well as determine the predictive characteristics that would aid in safe observation and expectant management versus surgical intervention. Additionally, we seek to determine the pathology consistent with the characteristics requiring surgical management. With approval of the Institutional Review Board, all charts of adolescent females thirteen to eighteen years who were given a diagnostic ICD-9 code consistent with ovarian cyst or mass were reviewed. Subjects without documented resolution or documented surgical intervention for non-resolution were excluded. In addition, patient age, race, cyst size, laterality, and level of cyst complexity were recorded. Histopathology typing was included if surgical excision was performed. A multiple logistic regression analysis was conducted to determine clinical, as well as demographic characteristics of ovarian cyst resolution. Of the 342 charts reviewed, 151 met all inclusion criteria. 91 (60.3%) achieved resolution of their cysts, 60 (39.7%) did not. Only cyst side (right) and right cyst largest diameter (<7cm) were predictors of resolution. Neither cyst type nor levels of complexity were predictors of spontaneous resolution. The most common histopathology found at surgical excision for non resolution was serous cystadenoma. No malignancies were diagnosed. The majority of ovarian cysts in the adolescent population resolves or persists with no definitive characteristic associated with either outcome. A conservative approach to the treatment of such cysts in the form of clinical observation is recommended when the clinical scenario allows.