Abstract
Purpose: to determine management problems of ovarian masses in girls in order to form a baseline for prospective randomized studies of the established topics and quality improvement of our management. Materials and Methods: We performed a national analysis of clinical aspects of ovarian masses in girls operated on in Poland, analyzed retrospectively medical files of all consecutive patients aged 0–18 who underwent surgeries for ovarian lesions between 2012 and 2017 at 17 pediatric surgical departments and complemented the analysis with a scoping review of a recent primary research related to ovarian masses in children. Results: The study group comprised 595 patients. Forty-four (7.39%) girls were diagnosed with malignant tumors. The overall preservation rate was 64.54%. The analysis revealed that positive tumor markers (OR = 10.3), lesions larger than 6 cm (OR = 4.17) and solid mass on ultrasound examination (OR = 5.34) are interdependent variables differentiating malignant tumors from non-malignant lesions ( = 79.1; p = 0.00000). Our scoping review revealed 10 major branches of research within the topic of ovarian masses in pediatric population. Conclusions: We have developed an overview of the field with the emphasis on the local environment. Our next step is a multi-institutional prospective study of a quality improvement project implementation based on the obtained knowledge.
Highlights
An important measure of general health and social well-being is overall reproductive health
We considered them to be helpful as, to our knowledge, these are the only systematic reviews regarding all kinds of ovarian masses in the last 10 years, and this type of research has a higher level of evidence (Level V) than any separate retrospective study [2,4,6,7,11–24]
Some other results raised questions that need to be answered. They were either different from other studies or not discussed by them at all: What is the cut-off size of the lesion indicating malignant tumor?; What is the significance of additional imaging and when is it indicated?; How should the presence of bilateral lesion change our approach?; Why was the preservation rate notably low in children who had laparotomy?; Why was the preservation rate higher for ovarian torsion cases in older children when laparotomy was chosen as the operative technique?
Summary
An important measure of general health and social well-being is overall reproductive health. For this reason, it is of great importance to preserve fertility in children suffering from ovarian lesions and undergoing treatments affecting ovaries. The overarching question inseparably linked to the treatment of ovarian masses in children is how to perform ovarian sparing surgery in every possible case without compromising oncologic principles when needed. All those who provide health care to children strive to ensure the highest possible quality of care. To improve care for our patients, it is necessary to find the best evidence and link that evidence of best care with specific knowledge of the local system where that care is provided [5]
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