Optimizing care for children with ovarian masses: development and evaluation of a multidisciplinary management algorithm

Ovarian masses in children between 0 and 18 years old are usually benign, although 10% are malignant. To avoid unnecessary oophorectomies and ensure the best possible outcome, we aimed to develop and validate a management algorithm for accurate diagnosis, referral and management of children with ovarian masses.

A management algorithm was developed based on a systematic review of studies that provided recommendations for the diagnostic approach and management of pediatric ovarian masses. Subsequently, this management algorithm was validated in a retrospective cohort of patients, aged 6 months to 18 years, with an ovarian mass who were treated between 2019 and 2022 with a sufficient follow-up at the Princess Máxima Center for Pediatric Oncology and/or the Wilhelmina Children's Hospital, The Netherlands. Medical records were searched for clinical characteristics, diagnostic findings, treatment and outcome.

Fifteen studies were included in the design of our management algorithm. The validation cohort included fifty-five patients with an ovarian mass, of which 8 were suspected of ovarian torsion. All malignant tumors were complex/solid on ultrasound and, after a multidisciplinary team (MDT) meeting, had been referred to the pediatric oncology center for individualized treatment. Of the ovarian masses that were suspected benign based on our algorithm, benign histology was confirmed and an ovarian sparing surgery was performed when feasible.

The proposed algorithm appears clinically applicable for the accurate management of pediatric ovarian masses. This standardized approach seems helpful to accurately stratify benign and malignant ovarian masses and will prevent over- or undertreatment.