Factors Associated with Torsion in Pediatric Patients with Ovarian Masses

J Surg Res. 2021 Jul:263:110-115. doi: 10.1016/j.jss.2020.12.058. Epub 2021 Feb 26.

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: Pediatric gynecology; Pediatric ovarian mass; Pediatric ovarian torsion; Pediatric surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cystadenoma / complications
  • Cystadenoma / diagnosis
  • Cystadenoma / epidemiology*
  • Cystadenoma / surgery
  • Diagnosis, Differential
  • Female
  • Humans
  • Organ Sparing Treatments / statistics & numerical data
  • Ovarian Cysts / complications
  • Ovarian Cysts / diagnosis
  • Ovarian Cysts / epidemiology*
  • Ovarian Cysts / surgery
  • Ovarian Neoplasms / complications
  • Ovarian Neoplasms / diagnosis
  • Ovarian Neoplasms / epidemiology*
  • Ovarian Neoplasms / surgery
  • Ovarian Torsion / epidemiology*
  • Ovarian Torsion / etiology
  • Ovarian Torsion / pathology
  • Ovarian Torsion / surgery
  • Ovariectomy / statistics & numerical data
  • Ovary / diagnostic imaging
  • Ovary / pathology
  • Ovary / surgery
  • Retrospective Studies
  • Risk Factors
  • Teratoma / complications
  • Teratoma / diagnosis
  • Teratoma / epidemiology*
  • Teratoma / surgery
  • Tomography, X-Ray Computed
  • Ultrasonography
  • Young Adult