Pediatric risk of malignancy index for preoperative evaluation of childhood ovarian tumors

Abstract

The novel pediatric risk-of-malignancy index is able to accurately discriminate between benign and non-benign ovarian tumors in children and adolescents. Its preoperative application may guide surgical management decisions before the availability of histological confirmation.

Ovarian pathologies in childhood

“…Due to risk of malignancy of the mass caused ovarian torsion and systemic effects of necrotic tissue, torsioned ovary with a restraint blood supply is treated with oopherectomy [7]. However, in the purpose of preserving the fertility, ovarysparing methods are trended up recently [8,14,15]. In the recent period, even for the ovaries with necrotic appearances, oopherectomy is abstained [16,17].…”

Childhood Ovarian Malignancy

“…Recently, some authors considered a score for preoperative evaluation to predict malignant potential as histopathological diagnosis is always postoperative. The features are maximum diameter of solid component on radiology, presence of sex hormone-related symptoms, and enhancement of flow in a septum or solid papillary projection on CT scan [4]. …”

Re: External validation of the Paediatric Risk of Malignancy Index

“…We appreciate the external validation of the Paediatric Risk of Malignancy Index (PRMI) reported by Hermans et al, 1,2 and are pleased that the results of the index were reproducible in a different ethnic population. Interestingly, a higher rate of false positives was encountered due to large mature teratomas with large solid components (Table 1).…”

“…We recognised only soft tissue solid components in our measurements, and did not include hyperechoic contents as solid components. Posterior acoustic shadowing and solid hyperechoic components as described in common ultrasound terminology have been shown to be benign features that are negatively predictive for malignancy, 2,3,4 and less specific for malignancy. Including bony structures or Rokitansky nodules that may be seen on computed tomography (CT) imaging as solid components may have accounted for these differences in results.…”

“…1,2 As the original article described only the maximum diameter of the largest 'solid component' as a factor we measured the largest diameter of the area described as solid component by the radiologist. When detailed information …”