title: Preoperative risk stratification of adnexal masses: can we predict the optimal surgical management?
abstract: OBJECTIVE
  To characterize preoperative risk stratification with aim of identifying the accurate surgical approach of benign and malignant adnexal masses in pediatric patients.
  
  
  METHODS
  A retrospective chart review of all cases of adnexal masses surgically managed between January 2001 and December 2006.
  
  
  METHODS
  The Hospital for Sick Children, Toronto, Canada.
  
  
  METHODS
  129 cases of 126 pediatric and adolescent patients who underwent operative management of their adnexal masses.
  
  
  METHODS
  Ultrasonographic characteristics (cyst size and character), surgical approach (laparoscopy vs laparotomy) and method of cyst removal (cystectomy vs oophorectomy). Data was assessed with a Fisher Exact test where appropriate (P < .05).
  
  
  RESULTS
  Malignancies were more frequently treated by laparotomy (n = 14, 98.6%, P < .001), and benign cases by laparoscopy (n = 78, 97%, P < .001). On ultrasonography, malignant masses were more often complex (n = 16, 100%, P = .006) and ≥8 cm (n = 16, 100%, P < .001) than benign masses (≥8 cm n = 60, 53%, complex n = 76, 67%). Combining ultrasonographic measurements of ≥8 cm and complexity identified 100% of malignant masses (n = 16) and 36% of benign masses (n = 41, P < .001, PPV = 37.1, NPV = 100%). Additional imaging including CT/MRI was ordered by pediatric surgeons (n = 17, 77%) more often than pediatric gynecologists (n = 44, 41%, P = .002). Furthermore, pediatric surgeons managed adnexal masses by oophorectomy (n = 12, 55%) more often as compared to pediatric gynecologists (n = 19, 18%, P < .001).
  
  
  CONCLUSIONS
  Using preoperative characteristics of complexity and ≥8 cm reduces the number of benign masses treated with laparotomy while ensuring malignant masses are managed with an open approach.
authors.affiliation: Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Electronic address: erogers@qmed.ca.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Rogers
authors.affiliation: Division of General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Giovanny
authors.initials: G
authors.lastname: Casadiego Cubides
authors.affiliation: Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Judith
authors.initials: J
authors.lastname: Lacy
authors.affiliation: Division of General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: J Ted
authors.initials: JT
authors.lastname: Gerstle
authors.affiliation: Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Sari
authors.initials: S
authors.lastname: Kives
authors.affiliation: Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D014408:Biomarkers, Tumor / Q000097:blood*; D002648:Child; D005260:Female; D006176:Gynecology; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D010048:Ovarian Cysts / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor
keywords: Adnexal mass; Benign; Laparoscopy; Laparotomy; Malignant