New algorithm to identify benign lesions developed

Contemporary OB/GYN:

Hi, I'm Celeste Krewson with Contemporary OB/GYN and I'm here with Dr. Minneci to discuss a recent study evaluating an algorithm for identifying benign lesions. Do you want to introduce yourself?

Peter Minneci, MD, MHSc:

Sure, I'm Peter Minneci, I'm the chair of surgery at Nemours Children's Health Delaware Valley and the lead author on the study.

Contemporary OB/GYN:

So, to get started, can you give a brief overview on how benign ovarian masses impact children and adolescents?

Peter Minneci, MD, MHSc:

Yes. So, ovarian masses can occur in young females and then throughout their life, and the biggest issue is determining whether those masses are benign or malignant. And in children and adolescents, the masses are 90% of the time going to be benign, whereas in adults, they're much more likely to be malignant. So, having a way to identify children and adolescents with ovarian masses and to identify the probability or the likelihood that it's going to be benign, then allows us to do the type of surgery we call an ovary sparing surgery where rather than take the entire ovary out, we can just take out the mass itself and leave the rest of the ovary in place. Which then, is very important because removing ovaries unnecessarily can have sort of lifelong consequences as these children then grow up into adulthood.

Contemporary OB/GYN:

And can you expand on these consequences?

Peter Minneci, MD, MHSc:

Sure. So, an unnecessary oophorectomy, so taking out an ovary that maybe didn't need to come out or losing an ovary pretty much for any reason, can lead to early menopause and premature ovarian failure. And it's the premature ovarian failure which is really critical because the ovaries do more than just reproductive health, they protect women against heart disease, neurologic diseases. So, if you take out an ovary unnecessarily, you can have impaired sexual health, you can have earlier menopause, you have higher rates of neurologic disease and cardiovascular disease, because the hormones that the ovaries present protect against that. You also have reproductive health, you can have harder rates of getting pregnant, and then actually worse responses to in vitro fertilization. And then the hidden risk is if you actually have an ovary taken out early on in life, there's a 10% to 20% chance that another ovarian mass would develop in the other ovary and if it isn't a liquid, then it would have to come out. So essentially, you would have surgical castration at that point.

Contemporary OB/GYN:

Thank you for going over that, that definitely makes detection of benign lesions important. So how does this new algorithm identify benign lesions.

Peter Minneci, MD, MHSc:

So, what it does is it basically takes the way the patient presents, so their symptoms, their radiologic imaging findings, and their laboratory tests, and helps us categorize them in a way so that if certain symptoms aren't there, and the mask looks very specific ways, and the laboratory values are not abnormal, we know that that particular lesion has a very high likelihood of being benign. And it allows the practicing surgeon who's at the bedside to say —quickly kind of following this algorithm —this is likely to be benign, I can do an ovary sparing surgery. And then it also is very sensitive to picking up any lesion that has an increased risk of potentially being malignant. And so, what the algorithm does is if you have an abnormal finding, that puts you into the other part of the algorithm, the high risk algorithm, triage is huge, what we would call a multidisciplinary team discussion, which is that we would, if you have one of these features that increases the risk, then a team of doctors would talk about your case and decide whether you should have the whole ovary out or whether ovary sparing surgery is still reasonable because the likelihood of malignancy is lower. And then the overall impact of the algorithm that we hope is it decreases variability in the care that we were seeing. We were seeing what we would call unnecessary oophorectomy rates for benign disease anywhere from 15% to 75% across institutions. We want to remove that variability and try to standardize it in a way that those who are safer ovary sparing surgery can be quickly identified, and someone who has something that's concerning, would get triaged to a multidisciplinary team discussion with surgeons, gynecologist, medical oncologist, radiologists to look a little more in depth at how they presented, and then determine should they have the ovary out or is it still reasonable to do an ovary sparing surgery?

Contemporary OB/GYN:

That's all really interesting, thank you. We're just about ready to wrap up but is there anything you want to add first?

Peter Minneci, MD, MHSc:

No, I think the biggest thing that I was surprised by with the study and that I was happy with is the real teamwork and collaboration between our different specialties. So, between surgery and gynecology and radiology and medical oncology, and that the algorithm was actually very well followed. It was 95% compliance, which meant that was pretty easy for the practitioners to use.

Contemporary OB/GYN:

Well, thank you again for joining me today.

Peter Minneci, MD, MHSc:

Thank you very much. It's a pleasure.