Preoperative assessment of adnexal mass in adolescent patients

Our aim was to assess preoperatively the adnexal mass in adolescent patients. The diagnosis and assessment of these lesions is not easy. That is why we treid to evaluate our results in preoperative assessment of adnexal mass and to compare them with the results of other researchers and clinics working in this field.

We evaluated for 20 years period -550 adolescent patients. We used: biochemical markers, pelvic ultrasound as a second line-test, panel of markers, proteomics, metabolomics, epigenetics, morphological markers, vascular markers and some mathematical models.

For the screening of our patients we used mostly combination between Ca125 and ultrasound. Adjuvant chemotherapy was administered in 385 patients (70%). The overall mean follow up was 60 months. We had 66 recurrences (12%) and 16 deaths (3%). The survival rate for patients with with stage I disease was 97% (426 patients) and for patients with advanced stage disease 85% (102 patients). During chemotherapy 70% (269 patients) developed amenorrhea but 93% (358) of these adolescent patients returned to normal function after completion of chemotherapy. 119 healthy live births were recorded in the group with chemotherapy without documentated birth effects. There were only 7 cases with infertility (2%).

The surgical approach in adolescent patients with adnexal mass confined to a single ovary should try to preserve fertility. Advanced stages are not always accompanied by huge and extensive pelvic disease and the uterus and contralateral ovary should be preserved. With the appropriate adjuvant platinum-based combination chemotherapy these adolescent patients have an excellent prognosis and have normal ovarian function and deliver healthy babies. Future studies will give additional light in this field.