Abstract
Study Objective
To evaluate the diagnostic performance of the Decision Tree System (DTS) rules 2 and
3 for surgically managed adnexal masses in the North American population and to compare
it with the risk stratification criteria used at The Hospital for Sick Children (≥8 cm
and complex/solid).
Design
A retrospective cohort study of patients who presented with adnexal masses and were
surgically treated between April 2011 and March 2016.
Setting
The Hospital for Sick Children (Toronto, Ontario, Canada).
Participants
Patients 1-18 years of age with adnexal masses who underwent surgical treatment.
Interventions and Main Outcome Measures
Main outcome measures included diagnostic performance (preoperative sensitivity, specificity,
positive predictive value [PPV], and negative predictive value [NPV] for malignancy)
of the DTS rules 2 and 3 and ≥8 cm and complex/solid criteria.
Results
The malignancy rate was 10.4%. The DTS rules 2 and 3 had a sensitivity of 84% (95%
confidence interval [CI], 79-90), specificity of 77% (95% CI, 71-83), PPV of 30% (95%
CI, 17-42), and NPV of 98% (95% CI, 94-100). The 8 cm or larger and complex/solid
criteria had a sensitivity of 89% (95% CI, 85-94), specificity of 71% (95% CI, 64-77),
PPV of 27% (95% CI, 16-38), and NPV of 98% (95% CI, 96-100).
Conclusion
Our study showed that DTS rules 2 and 3 had similar diagnostic performance as the
8 cm or larger and complex/solid criteria in the same population, with a very high
NPV and a low PPV. Future prospective investigations should be conducted to further
assess how DTS components can be incorporated into future algorithms for the management
of adnexal masses in the pediatric population.
Key Words
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Article info
Publication history
Published online: July 19, 2019
Footnotes
The authors indicate no conflicts of interest.
These findings were presented, in part, at the North American Society for Pediatric and Adolescent Gynecology 32nd Annual Clinical and Research Meeting. West Palm Beach, Florida, April 12-14, 2018, and the Society of Obstetricians and Gynaecologists of Canada Annual Clinical and Scientific Conference, Victoria, British Columbia, Canada, June 25-29, 2018.
Identification
Copyright
© 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
