Trial reportJAMA2023
Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients.
Trial report in JAMA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 25 citations in OpenAlex.
- Performance of International Ovarian Tumor Analysis Simple Rules and Ovarian-Adnexal Reporting and Data System for classifying benign and malignant pediatric adnexal lesions using ultrasound.Pediatric radiology · 2026Article
- Challenging the size: ovarian-sparing surgery in borderline huge pediatric ovarian tumors.Pediatric surgery international · 2026Article
- Ultrasonographic assessment of pediatric adnexal lesions: validation of the O-RADS system and development of a simplified C-CAS framework.Quantitative imaging in medicine and surgery · 2026Article
- Management of a Uterosacral Ligament Ectopic Pregnancy With Presence of an Intrauterine Device.O&G open · 2026Article
- Minimally invasive surgery (robot-assisted or laparoscopic) versus open surgery for presumed benign ovarian tumours.The Cochrane database of systematic reviews · 2026Article
- Laparoendoscopic single-site surgery for ovarian mature teratomas in children and adolescents: a retrospective cohort study.Gynecology and pelvic medicine · 2026Article
- Age-stratified diagnostic performance of the ovarian-adnexal reporting and data system for adnexal masses: a focus on school-age children, early, and middle adolescents.Frontiers in pediatrics · 2026Article
- Ovarian Torsion Secondary to a Mature Cystic Teratoma in a Four-Year-Old Girl: A Case Report.Cureus · 2025Article
- Elevating and empowering reproductive futures: Pediatric and adolescent gynecology's specialized care across the globe.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- The Optimal Age for Oophorectomy in Women with Benign Conditions: A Narrative Review.Journal of personalized medicine · 2025Review
- Direct balloon trocar technique for closed decompression of large predominantly cystic ovarian tumors in adolescents.Pediatric surgery international · 2025Article
- Oophorectomy Rates in Pediatric and Adolescent Patients with Adnexal Torsion in US Emergency Departments.Journal of pediatric and adolescent gynecology · 2025Article
- Van Wyk-Grumbach Syndrome and Gonadectomy.Children (Basel, Switzerland) · 2024Article
- Prognosis and postoperative surveillance of benign ovarian tumors in children: a single-center retrospective study.Jornal de pediatriaArticle
Corrections and comments
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Authors and funding
31 authors at 18 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health. Objective: To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies. Design, Setting, and Participants: Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up. Intervention: Implementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons. Main Outcomes and Measures: Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution. Results: A total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%. Conclusions and Relevance: Unnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.
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