{"doi":"10.1001/jama.2023.17183","title":"Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients","abstract":"<jats:sec id=\"ab-joi230104-4\"><jats:title>Importance</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-5\"><jats:title>Objective</jats:title><jats:p>To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-6\"><jats:title>Design, Setting, and Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-7\"><jats:title>Intervention</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-8\"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-9\"><jats:title>Results</jats:title><jats:p>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%]; <jats:italic>P</jats:italic> = .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%.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-10\"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>","journal":"JAMA","year":2023,"id":636023,"datarank":0.5050943744979712,"base_score":3.367295829986474,"endowment":3.367295829986474,"self_citation_contribution":0.5050943744979712,"citation_network_contribution":0.0,"self_endowment_contribution":0.5050943744979712,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":28,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1650354,"name":"Katherine C. Bergus","orcid":null,"position":1,"is_corresponding":false},{"id":673525,"name":"Carley Lutz","orcid":"0000-0002-0816-323X","position":2,"is_corresponding":false},{"id":1650355,"name":"Jennifer Aldrink","orcid":null,"position":3,"is_corresponding":false},{"id":1650357,"name":"Christina Bence","orcid":null,"position":4,"is_corresponding":false},{"id":962062,"name":"Lesley Breech","orcid":null,"position":5,"is_corresponding":false},{"id":1490692,"name":"Patrick A. Dillon","orcid":null,"position":6,"is_corresponding":false},{"id":1650361,"name":"Cynthia Downard","orcid":null,"position":7,"is_corresponding":false},{"id":342732,"name":"Peter F. Ehrlich","orcid":"0000-0001-6161-1815","position":8,"is_corresponding":false},{"id":1650365,"name":"Mary Fallat","orcid":null,"position":9,"is_corresponding":false},{"id":1490292,"name":"Jason D. Fraser","orcid":"0000-0002-5498-9980","position":10,"is_corresponding":false},{"id":648595,"name":"Julia Grabowski","orcid":"0000-0002-8284-1801","position":11,"is_corresponding":false},{"id":1254407,"name":"Michael Helmrath","orcid":null,"position":12,"is_corresponding":false},{"id":1650370,"name":"Paige Hertweck","orcid":null,"position":13,"is_corresponding":false},{"id":505527,"name":"Geri Hewitt","orcid":null,"position":14,"is_corresponding":false},{"id":905604,"name":"Ronald B. Hirschl","orcid":null,"position":15,"is_corresponding":false},{"id":905605,"name":"Rashmi Kabre","orcid":null,"position":16,"is_corresponding":false},{"id":905208,"name":"Dave R. Lal","orcid":"0000-0002-8074-985X","position":17,"is_corresponding":false},{"id":1650379,"name":"Matthew Landman","orcid":null,"position":18,"is_corresponding":false},{"id":1650380,"name":"Charles Leys","orcid":null,"position":19,"is_corresponding":false},{"id":1650382,"name":"Grace Mak","orcid":null,"position":20,"is_corresponding":false},{"id":1650383,"name":"Troy Markel","orcid":null,"position":21,"is_corresponding":false},{"id":1650384,"name":"Joseph Pressey","orcid":null,"position":22,"is_corresponding":false},{"id":1650385,"name":"Manish Raiji","orcid":null,"position":23,"is_corresponding":false},{"id":737028,"name":"Beth Rymeski","orcid":"0000-0002-9891-1405","position":24,"is_corresponding":false},{"id":1650386,"name":"Jacqueline Saito","orcid":null,"position":25,"is_corresponding":false},{"id":905207,"name":"Thomas T. Sato","orcid":"0000-0001-6547-6403","position":26,"is_corresponding":false},{"id":1650387,"name":"Shawn D. St Peter","orcid":null,"position":27,"is_corresponding":false},{"id":252160,"name":"Jennifer Cooper","orcid":"0000-0003-4703-2109","position":28,"is_corresponding":false},{"id":1650388,"name":"Katherine Deans","orcid":null,"position":29,"is_corresponding":false},{"id":1650389,"name":"Gail Besner","orcid":null,"position":31,"is_corresponding":false},{"id":1650390,"name":"Jessica Kandel","orcid":null,"position":32,"is_corresponding":false},{"id":1650391,"name":"Frederick Rescorla","orcid":null,"position":33,"is_corresponding":false},{"id":537259,"name":"Daniel von Allmen","orcid":null,"position":34,"is_corresponding":false},{"id":1650392,"name":"Brad Warner","orcid":null,"position":35,"is_corresponding":false},{"id":1650393,"name":"Thomas Inge","orcid":null,"position":36,"is_corresponding":false},{"id":1650394,"name":"Steven Kasten","orcid":null,"position":37,"is_corresponding":false},{"id":1650395,"name":"George Holcomb","orcid":null,"position":38,"is_corresponding":false},{"id":1650396,"name":"David Gourlay","orcid":null,"position":39,"is_corresponding":false},{"id":1650397,"name":"Petros Anagnostopoulos","orcid":null,"position":40,"is_corresponding":false},{"id":905211,"name":"Sarah Fox","orcid":"0000-0001-5156-7830","position":41,"is_corresponding":false},{"id":1650398,"name":"Cory Criss","orcid":null,"position":42,"is_corresponding":false},{"id":1650399,"name":"Elizabeth Speck","orcid":null,"position":43,"is_corresponding":false},{"id":1650400,"name":"Samir Gadepalli","orcid":null,"position":44,"is_corresponding":false},{"id":1650401,"name":"Kyle Van Arendonk","orcid":null,"position":45,"is_corresponding":false},{"id":1650402,"name":"Katherine Flynn-O'Brien","orcid":null,"position":46,"is_corresponding":false},{"id":1650403,"name":"Alan Ladd","orcid":null,"position":47,"is_corresponding":false},{"id":1650404,"name":"Seth Goldstein","orcid":null,"position":48,"is_corresponding":false},{"id":1650405,"name":"Mehul Raval","orcid":null,"position":49,"is_corresponding":false},{"id":1189022,"name":"Tiffany Wright","orcid":"0000-0002-5314-9832","position":50,"is_corresponding":false},{"id":1650406,"name":"Stewart Carter","orcid":null,"position":51,"is_corresponding":false},{"id":426833,"name":"Peter C. Minneci","orcid":"0000-0002-8916-3732","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients","abstract":"<jats:sec id=\"ab-joi230104-4\"><jats:title>Importance</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-5\"><jats:title>Objective</jats:title><jats:p>To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-6\"><jats:title>Design, Setting, and Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-7\"><jats:title>Intervention</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-8\"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-9\"><jats:title>Results</jats:title><jats:p>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%]; <jats:italic>P</jats:italic> = .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%.</jats:p></jats:sec><jats:sec id=\"ab-joi230104-10\"><jats:title>Conclusions and Relevance</jats:title><jats:p>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.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":3.367295829986474,"endowment":3.367295829986474,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37787794","pmcid":"PMC10548301","openalex_id":"https://openalex.org/W4387297149","authors":[],"funders":[],"total_grants":0,"fwci":5.6945,"citation_percentile":0.96803021,"influential_citations":0,"citation_trend":[{"year":2024,"count":8},{"year":2025,"count":14},{"year":2026,"count":6}],"oa_status":"green","license":null,"oa_locations":[{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10548301","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10548301","host_type":"repository"},{"url":"https://jamanetwork.com/journals/jama/articlepdf/2810032/jama_minneci_2023_oi_230104_1696283236.09541.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1001/jama.2023.17183","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37787794","host_type":"repository"}],"fields_of_study":["Ovarian cancer diagnosis and treatment","Reproductive Biology and Fertility","BRCA gene mutations in cancer"],"mesh_terms":["White","Adolescent","Algorithms","Black or African American","Child","Female","Hospitalization","Humans","Ovarian Neoplasms","Ovariectomy","Predictive Value of Tests","Preoperative Care","Retrospective Studies","Risk Assessment","Unnecessary Procedures","Young Adult"],"keywords":["Medicine","Cohort","Oophorectomy","Ovarian cancer","Pediatrics","Surgery","Cancer","Internal medicine","Hysterectomy"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Reduced inequalities"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T16:01:30.598499Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}