Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study
Abstract Study Objective To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical manageme...
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| Veröffentlicht in: | Journal of pediatric & adolescent gynecology 2017-06, Vol.30 (3), p.405-412 |
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| creator | Stanković, Zoran B., PhD Sedlecky, Katarina, PhD Savić, Djordje, PhD Lukač, Branislav J., MD Mažibrada, Ilijana, MD, MSc Perovic, Svetlana, MD, MSc |
| description | Abstract Study Objective To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. Design A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. Setting Mother and Child Health Institute of Serbia ‘Dr Vukan Čupić’ (Belgrade, Serbia). Participants Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. Interventions and Main Outcome Measures Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity ( P |
| doi_str_mv | 10.1016/j.jpag.2017.01.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1863220125</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1083318816302509</els_id><sourcerecordid>1863220125</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-214f57363ecd28498f73ed6711befde3cf708517c3fc48014d6c7c8bd47f04853</originalsourceid><addsrcrecordid>eNp9kcFqFTEUhgdRbK2-gAvJ0s2MOUlmkooIpWorFFrodR1yk5OScSZzTWYu3LdvhltduOgqh_D9P8l3quo90AYodJ_6pt-Zh4ZRkA2FhlL1ojoFJXktOGcvy0wVrzkodVK9ybmnlMq2U6-rE6aAS9Hy02pzuzcpmEjuEmZMezOHKRKfppFslnFKmZjoyKYM5T6TEMlVSEP-XPgp79DOYY_kWzAPccpzsOR-XtzhbfXKmyHju6fzrPr14_vm8rq-ub36eXlxU1sBMNcMhG8l7zhax5Q4V15ydJ0E2KJ3yK2XVLUgLfdWKArCdVZatXVCeipUy8-qj8feXZr-LJhnPYZscRhMxGnJGlTHWdHDVpQdUVvenRN6vUthNOmggerVpu71alOvNjUFXWyW0Ien_mU7ovsX-auvAF-OAJZf7gMmnW3AaNGFVNxoN4Xn-7_-F7dDiMGa4TceMPfTkmLxp0Fnpqm-X_e5rhM6TllLz_kj9CGazw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1863220125</pqid></control><display><type>article</type><title>Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Stanković, Zoran B., PhD ; Sedlecky, Katarina, PhD ; Savić, Djordje, PhD ; Lukač, Branislav J., MD ; Mažibrada, Ilijana, MD, MSc ; Perovic, Svetlana, MD, MSc</creator><creatorcontrib>Stanković, Zoran B., PhD ; Sedlecky, Katarina, PhD ; Savić, Djordje, PhD ; Lukač, Branislav J., MD ; Mažibrada, Ilijana, MD, MSc ; Perovic, Svetlana, MD, MSc</creatorcontrib><description>Abstract Study Objective To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. Design A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. Setting Mother and Child Health Institute of Serbia ‘Dr Vukan Čupić’ (Belgrade, Serbia). Participants Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. Interventions and Main Outcome Measures Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity ( P < .05). Results No malignancy was found in the group of 1236 patients selected according to the DTS rule 1. Torsion was confirmed in 36% of surgically treated masses (n = 115). The OCS was present in 96% of benign masses in the non-emergency group (n = 149) and in three with microscopic malignancy. In predicting malignancy, the DTS (rules 2 and 3) showed a sensitivity of 93 (95% confidence interval [C.I.]: 82–98); and a specificity of 97 (C.I.: 95–99). Ovarian tissue was preserved from benign (n = 254, 93%) and malignant tumors (n = 3, 7%). Only five (2%) uncomplicated ovarian cysts were surgically treated. Conclusion The DTS with 3 rules is a very accurate diagnostic tool in the differentiation between benign and malignant ovarian masses. The DTS rule 1 reduces the number of surgical procedures on functional cysts, rules 2 and 3 are very useful in choosing the optimal treatment of adnexal masses, whether or not they are twisted.</description><identifier>ISSN: 1083-3188</identifier><identifier>EISSN: 1873-4332</identifier><identifier>DOI: 10.1016/j.jpag.2017.01.008</identifier><identifier>PMID: 28137453</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adnexal Diseases - surgery ; Adnexal mass ; Adolescent ; Benign ; Child ; Female ; Humans ; Laparoscopy ; Malignant ; Obstetrics and Gynecology ; Organ Sparing Treatments - methods ; Ovarian crescent sign ; Ovarian Diseases - surgery ; Pediatrics ; Prospective Studies ; Sensitivity and Specificity ; Serbia ; Ultrasonography ; Ultrasound</subject><ispartof>Journal of pediatric & adolescent gynecology, 2017-06, Vol.30 (3), p.405-412</ispartof><rights>North American Society for Pediatric and Adolescent Gynecology</rights><rights>2017 North American Society for Pediatric and Adolescent Gynecology</rights><rights>Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-214f57363ecd28498f73ed6711befde3cf708517c3fc48014d6c7c8bd47f04853</citedby><cites>FETCH-LOGICAL-c411t-214f57363ecd28498f73ed6711befde3cf708517c3fc48014d6c7c8bd47f04853</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1083318816302509$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28137453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stanković, Zoran B., PhD</creatorcontrib><creatorcontrib>Sedlecky, Katarina, PhD</creatorcontrib><creatorcontrib>Savić, Djordje, PhD</creatorcontrib><creatorcontrib>Lukač, Branislav J., MD</creatorcontrib><creatorcontrib>Mažibrada, Ilijana, MD, MSc</creatorcontrib><creatorcontrib>Perovic, Svetlana, MD, MSc</creatorcontrib><title>Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study</title><title>Journal of pediatric & adolescent gynecology</title><addtitle>J Pediatr Adolesc Gynecol</addtitle><description>Abstract Study Objective To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. Design A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. Setting Mother and Child Health Institute of Serbia ‘Dr Vukan Čupić’ (Belgrade, Serbia). Participants Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. Interventions and Main Outcome Measures Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity ( P < .05). Results No malignancy was found in the group of 1236 patients selected according to the DTS rule 1. Torsion was confirmed in 36% of surgically treated masses (n = 115). The OCS was present in 96% of benign masses in the non-emergency group (n = 149) and in three with microscopic malignancy. In predicting malignancy, the DTS (rules 2 and 3) showed a sensitivity of 93 (95% confidence interval [C.I.]: 82–98); and a specificity of 97 (C.I.: 95–99). Ovarian tissue was preserved from benign (n = 254, 93%) and malignant tumors (n = 3, 7%). Only five (2%) uncomplicated ovarian cysts were surgically treated. Conclusion The DTS with 3 rules is a very accurate diagnostic tool in the differentiation between benign and malignant ovarian masses. The DTS rule 1 reduces the number of surgical procedures on functional cysts, rules 2 and 3 are very useful in choosing the optimal treatment of adnexal masses, whether or not they are twisted.</description><subject>Adnexal Diseases - surgery</subject><subject>Adnexal mass</subject><subject>Adolescent</subject><subject>Benign</subject><subject>Child</subject><subject>Female</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Malignant</subject><subject>Obstetrics and Gynecology</subject><subject>Organ Sparing Treatments - methods</subject><subject>Ovarian crescent sign</subject><subject>Ovarian Diseases - surgery</subject><subject>Pediatrics</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Serbia</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><issn>1083-3188</issn><issn>1873-4332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFqFTEUhgdRbK2-gAvJ0s2MOUlmkooIpWorFFrodR1yk5OScSZzTWYu3LdvhltduOgqh_D9P8l3quo90AYodJ_6pt-Zh4ZRkA2FhlL1ojoFJXktOGcvy0wVrzkodVK9ybmnlMq2U6-rE6aAS9Hy02pzuzcpmEjuEmZMezOHKRKfppFslnFKmZjoyKYM5T6TEMlVSEP-XPgp79DOYY_kWzAPccpzsOR-XtzhbfXKmyHju6fzrPr14_vm8rq-ub36eXlxU1sBMNcMhG8l7zhax5Q4V15ydJ0E2KJ3yK2XVLUgLfdWKArCdVZatXVCeipUy8-qj8feXZr-LJhnPYZscRhMxGnJGlTHWdHDVpQdUVvenRN6vUthNOmggerVpu71alOvNjUFXWyW0Ien_mU7ovsX-auvAF-OAJZf7gMmnW3AaNGFVNxoN4Xn-7_-F7dDiMGa4TceMPfTkmLxp0Fnpqm-X_e5rhM6TllLz_kj9CGazw</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Stanković, Zoran B., PhD</creator><creator>Sedlecky, Katarina, PhD</creator><creator>Savić, Djordje, PhD</creator><creator>Lukač, Branislav J., MD</creator><creator>Mažibrada, Ilijana, MD, MSc</creator><creator>Perovic, Svetlana, MD, MSc</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study</title><author>Stanković, Zoran B., PhD ; Sedlecky, Katarina, PhD ; Savić, Djordje, PhD ; Lukač, Branislav J., MD ; Mažibrada, Ilijana, MD, MSc ; Perovic, Svetlana, MD, MSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-214f57363ecd28498f73ed6711befde3cf708517c3fc48014d6c7c8bd47f04853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adnexal Diseases - surgery</topic><topic>Adnexal mass</topic><topic>Adolescent</topic><topic>Benign</topic><topic>Child</topic><topic>Female</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Malignant</topic><topic>Obstetrics and Gynecology</topic><topic>Organ Sparing Treatments - methods</topic><topic>Ovarian crescent sign</topic><topic>Ovarian Diseases - surgery</topic><topic>Pediatrics</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Serbia</topic><topic>Ultrasonography</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stanković, Zoran B., PhD</creatorcontrib><creatorcontrib>Sedlecky, Katarina, PhD</creatorcontrib><creatorcontrib>Savić, Djordje, PhD</creatorcontrib><creatorcontrib>Lukač, Branislav J., MD</creatorcontrib><creatorcontrib>Mažibrada, Ilijana, MD, MSc</creatorcontrib><creatorcontrib>Perovic, Svetlana, MD, MSc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric & adolescent gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stanković, Zoran B., PhD</au><au>Sedlecky, Katarina, PhD</au><au>Savić, Djordje, PhD</au><au>Lukač, Branislav J., MD</au><au>Mažibrada, Ilijana, MD, MSc</au><au>Perovic, Svetlana, MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study</atitle><jtitle>Journal of pediatric & adolescent gynecology</jtitle><addtitle>J Pediatr Adolesc Gynecol</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>30</volume><issue>3</issue><spage>405</spage><epage>412</epage><pages>405-412</pages><issn>1083-3188</issn><eissn>1873-4332</eissn><abstract>Abstract Study Objective To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. Design A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. Setting Mother and Child Health Institute of Serbia ‘Dr Vukan Čupić’ (Belgrade, Serbia). Participants Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. Interventions and Main Outcome Measures Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity ( P < .05). Results No malignancy was found in the group of 1236 patients selected according to the DTS rule 1. Torsion was confirmed in 36% of surgically treated masses (n = 115). The OCS was present in 96% of benign masses in the non-emergency group (n = 149) and in three with microscopic malignancy. In predicting malignancy, the DTS (rules 2 and 3) showed a sensitivity of 93 (95% confidence interval [C.I.]: 82–98); and a specificity of 97 (C.I.: 95–99). Ovarian tissue was preserved from benign (n = 254, 93%) and malignant tumors (n = 3, 7%). Only five (2%) uncomplicated ovarian cysts were surgically treated. Conclusion The DTS with 3 rules is a very accurate diagnostic tool in the differentiation between benign and malignant ovarian masses. The DTS rule 1 reduces the number of surgical procedures on functional cysts, rules 2 and 3 are very useful in choosing the optimal treatment of adnexal masses, whether or not they are twisted.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28137453</pmid><doi>10.1016/j.jpag.2017.01.008</doi><tpages>8</tpages></addata></record> |
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| subjects | Adnexal Diseases - surgery Adnexal mass Adolescent Benign Child Female Humans Laparoscopy Malignant Obstetrics and Gynecology Organ Sparing Treatments - methods Ovarian crescent sign Ovarian Diseases - surgery Pediatrics Prospective Studies Sensitivity and Specificity Serbia Ultrasonography Ultrasound |
| title | Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study |
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