title: Pediatric risk of malignancy index for preoperative evaluation of childhood ovarian tumors.
abstract: OBJECTIVE
  This study aimed to develop and provisionally validate a novel scoring index for preoperative cancer-risk prediction in childhood ovarian tumors.
  
  
  METHODS
  Fifty-five girls aged 18 and below underwent surgery for ovarian masses between 2004 and 2009. Benign or non-benign histological diagnoses (the latter including all malignant and borderline tumors and tumors containing immature components) were correlated with clinical and biochemical parameters, and blinded scores of ultrasound and computed-tomography using multivariate logistic regression. Regression coefficients were used as weighting factors to create an additive index. This index was validated prospectively against 23 consecutive adnexal masses operated in 2010.
  
  
  RESULTS
  In total, 67 tumors were benign and 11 non-benign. Non-benign diagnosis was independently associated with the maximum diameter of the largest solid component (score = value in cm), the presence of sex hormone-related symptoms (score = +6), and enhancement or flow in a septum or solid papillary projection (score = +4). The novel scoring index was calculated as the total score of these three parameters. A cutoff score of 7 gave a specificity of 97.9% and sensitivity of 87.5% for the training data set, and specificity and sensitivity of 100% for the pilot testing set.
  
  
  CONCLUSIONS
  The novel pediatric risk-of-malignancy index is able to accurately discriminate between benign and non-benign ovarian tumors in children and adolescents. Its preoperative application may guide surgical management decisions before the availability of histological confirmation.
authors.affiliation: Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. amos.loh.hp@kkh.com.sg
authors.forename: Amos Hong Pheng
authors.initials: AH
authors.lastname: Loh
authors.forename: Chiou Li
authors.initials: CL
authors.lastname: Ong
authors.forename: Shu Lin
authors.initials: SL
authors.lastname: Lam
authors.forename: Joyce Horng Yiing
authors.initials: JH
authors.lastname: Chua
authors.forename: Chan Hon
authors.initials: CH
authors.lastname: Chui
mesh_terms: D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D010052:Ovariectomy; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color