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.
Keywords
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References
- Ovarian torsion in pediatric and adolescent patients: a systematic review.J Pediatr Surg. 2018; 53: 1387-1391
- Ovarian torsion.Semin Pediatr Surg. 2005; 14: 86-92
- Acute ovarian torsion in children.Am J Surg. 2000; 180: 462-465
- Ovarian torsion in children: management and outcomes.J Pediatr Surg. 2013; 48: 1946-1953
- Management of pediatric ovarian torsion: evidence of follicular development after ovarian preservation.Surgery. 2018; 163: 547-552
- Factors associated with management of pediatric ovarian neoplasms.Pediatrics. 2019; 144: e20182537
- Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000–2006.Pediatrics. 2010; 125: 532-538
- Pediatric ovarian neoplastic tumors: incidence, age at presentation, tumor markers and outcome.Acta Obstet Gynecol Scand. 2015; 94: 425-429
- Sonographic diagnosis of ovarian torsion.J Ultrasound Med. 2011; 30: 1205-1210
- Usefulness of Doppler sonography in the diagnosis of ovarian torsion.Fertil Sterility. 2000; 73: 1047-1050
- US findings of adnexal torsion in children and adolescents: size really does matter.Pediatr Radiol. 2007; 37: 1013-1019
- Cannot exclude torsion—a 15-year review.J Pediatr Surg. 2009; 44: 1212-1217
- The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population.J Pediatr Adolesc Gynecol. 2012; 25: 109-113
- Pediatric ovarian torsion.Surg Clin. 2017; 97: 209-221
- National trends in the surgical treatment of ovarian torsion in children: an analysis of 2041 pediatric patients utilizing the nationwide inpatient sample.Am Surgeon. 2015; 81: 844-848
- Current trends in the surgical treatment of pediatric ovarian torsion: we can do better.J Pediatr Surg. 2015; 50: 1374-1377
- Using quality improvement methodology to improve ovarian salvage for benign ovarian masses.J Pediatr Surg. 2018; 53: 67-72
- Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance.J Pediatr Surg. 2010; 45: 135-139
Article info
Publication history
Published online: February 26, 2021
Accepted:
December 26,
2020
Received in revised form:
December 17,
2020
Received:
July 22,
2020
Identification
Copyright
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