ArticlePediatric surgery international2026
Save the ovary: evaluating the diagnostic accuracy of the pediatric risk of malignancy index (PRMI) to prevent unnecessary oophorectomy in girls.
Article in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to validate the diagnostic accuracy of the Pediatric Risk of Malignancy Index (PRMI) for distinguishing benign from malignant ovarian lesions in the pediatric and adolescent population, and to model its potential role in avoiding unnecessary oophorectomies.
methodsWe conducted a retrospective study of females aged ≤18 years who underwent oophorectomy with histopathology between 2006 and 2016 at a UK tertiary hospital. Only patients with preoperative imaging were included. PRMI scores were retrospectively calculated, with a cut-off ≥7 indicating high malignancy risk. Diagnostic performance was assessed against final histology using standard accuracy measures.
resultsOf 265 ovarian specimens, 44 met inclusion criteria; 9 (20.5%) were malignant and 35 (79.5%) benign. PRMI showed a sensitivity of 77.8% (95% CI 45.2-94.4%), specificity 74.3% (95% CI 56.4-86.4%), positive predictive value 43.8%, and negative predictive value 92.9%. Positive and negative likelihood ratios were 3.03 (95% CI 1.45-6.35) and 0.30 (95% CI 0.09-0.99), indicating moderate clinical utility. Notably, 79.5% of oophorectomies were performed for lesions that were ultimately proven benign. If PRMI had been used to guide management, 26/35 (74.3%) benign oophorectomies could potentially have been avoided.
conclusionThe PRMI demonstrated moderate accuracy and a high negative predictive value in this cohort, supporting its potential role as an adjunctive tool in preoperative risk stratification of pediatric ovarian masses. Greater emphasis on ovary-sparing strategies is warranted to mitigate long-term reproductive and hormonal consequences in young patients.
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