A pre-operative scoring system for adnexal mass in children and adolescents to preserve their future fertility

International audience ; STUDY OBJECTIVE: To develop a predictive score for ovarian malignancy to avoid unnecessary adnexectomy in cases of adnexal mass in pediatric and adolescent girls.DESIGN: A population-based retrospective study on girls who underwent surgery for an ovarian mass with normal levels of human chorionic gonadotrophin (hCG) and alpha fœtoprotein (aFP) between 1996 and 2016.SETTING: Rennes University Hospital, Rennes, France.PARTICIPANTS: Eighty-one patients operated on for ovarian tumor.MAIN OUTCOME MEASURES: The main outcome measure was the rate of malignant and borderline tumor. A pre-operative scoring system was constructed after multivariate analysis.RESULTS: The rate of malignant ovarian tumor was 7%, borderline tumor was 9% (i.e., outcome measure: 16%), and benign tumor was 84%. In a univariate analysis, the characteristics significantly associated with malignancy were early puberty, palpable mass, size and content of the tumor, and positive epithelial tumor markers [CA 125, CEA, and CA 19-9]. The predictive malignancy score was based on two variables obtained after multivariate analysis: tumor size and cystic content. The score defined 3 groups at risk for malignancy: low risk, middle-risk and high-risk. The sensitivity for detecting malignancy was 1.3% (95%CI: 0.1–18.4), 26.2% (95%CI: 11.6-49.0) and 53.1% (95%CI: 29.1–75.8), respectively.CONCLUSION: We set up a simple predictive score of malignancy based on objective criteria to help decision making on whether or not ovarian-sparing surgery is feasible in case of children and adolescents with ovarian tumors and normal hCG and aFP levels while ensuring oncologic safety.