Faculty Collaboration Database

Factors Associated with Torsion in Pediatric Patients with Ovarian Masses. J Surg Res 2021 Jul;263:110-115

Date

03/02/2021

Pubmed ID

33647800

DOI

10.1016/j.jss.2020.12.058

Scopus ID

2-s2.0-85101540967 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Management of ovarian torsion has evolved toward ovarian preservation regardless of ovarian appearance during surgery. However, patients with torsion and an ovarian neoplasm undergo a disproportionately high rate of oophorectomy. Our objectives were to identify factors associated with ovarian torsion among females with an ovarian mass and to determine if torsion is associated with malignancy.

METHODS: A retrospective review of females aged 2-21 y who underwent an operation for an ovarian cyst or neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariate logistic regression was used to assess factors associated with torsion. Imaging data were assessed for sensitivity, specificity, and predictive value in identifying ovarian torsion.

RESULTS: Of 814 girls with an ovarian neoplasm, 180 (22%) had torsion. In risk-adjusted analyses, patients with a younger age, mass size >5 cm, abdominal pain, and vomiting had an increased likelihood of torsion (P < 0.01 for all). Patients with a mass >5 cm had two times the odds of torsion (odds ratio: 2.1; confidence interval: 1.2, 3.6). Imaging was not reliable at identifying torsion (sensitivity 34%, positive predictive value 49%) or excluding torsion (specificity 72%, negative predictive value 87%). The rates of malignancy were lower in those with an ovarian mass and torsion than those without torsion (10% versus 17%, P = 0.01). Among the 180 girls with torsion and a mass, 48% underwent oophorectomy of which 14% (n = 12) had a malignancy.

CONCLUSIONS: In females with an ovarian neoplasm, torsion is not associated with an increased risk of malignancy and ovarian preservation should be considered.

Author List

Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Aldrink JH, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright TN, Minneci PC, Deans KJ, Midwest Pediatric Surgery Consortium

Authors

Christina Bence MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Cystadenoma
Diagnosis, Differential
Female
Humans
Organ Sparing Treatments
Ovarian Cysts
Ovarian Neoplasms
Ovariectomy
Ovary
Retrospective Studies
Risk Factors
Teratoma
Tomography, X-Ray Computed
Ultrasonography
Young Adult