Predictors of outcome patterns in infants diagnosed with congenital ovarian cysts
Notice bibliographique
Résumé
Introduction: Variable management practices complicate the identification of the optimal treatment strategy for infants diagnosed with ovarian cysts during the fetal period. Most fetal ovarian cysts remain asymptomatic in the neonatal period. However, they have been associated with complications including ovarian torsion and subsequent loss of the ovary. Early surgical intervention has been proposed to mitigate the risk of ovarian loss. Alternatively, ovarian cysts have also been observed to regress spontaneously after birth using serial ultrasounds. Without a standardized observation period or strict indications for surgical intervention, many patients with congenital ovarian cysts undergo surgery despite their benign nature. This thesis sought to identify the incidence and predictors of spontaneous resolution of congenital ovarian cysts, to describe factors associated with surgical management, and to evaluate whether surgical or non-surgical management is associated with an increase in ovarian preservation. Methods: There are two main studies in this thesis: a systematic review and a pan-Canadian retrospective cohort study. The systematic review was performed to examine the incidence and predictors of spontaneous resolution of congenital ovarian cysts within the first year of life. The impact of surgical or non-surgical management on ovarian preservation was also described. The national pan-Canadian retrospective cohort study was then conducted at ten pediatric surgical institutions to evaluate the effects of various treatment strategies on outcomes of patients with congenital ovarian cysts. Prenatal and postnatal sonographic cyst characteristics were collected and compared between patients who underwent surgical management versus observation for a minimum of 3 months, and Kaplan-Meier analysis was used to assess the overall time to cyst resolution. Stepwise multivariate logistic regression analysis was used to determine independent clinical predictors of surgical management. Multivariate logistic regression was also used to compare the incidence of ovarian preservation between patients who were initially observed and those who underwent early surgery. Results: Seventy studies including 1,635 patients were included in the systematic review. A meta-analysis was not performed due to heterogeneity in the management strategies and reporting of results. The systematic review revealed that surgery was more likely to be performed in patients with complex ovarian cysts or cysts with diameters >40mm. The majority of surgical interventions resulted in oophorectomy, or loss of the ovary. Approximately 80% of ovaries with complex cysts managed non-surgically were not detected on follow-up ultrasound, indicating inevitable ovarian loss. These findings call into question whether early surgery in patients with congenital ovarian cysts does in fact mitigate the risk of ovarian loss. However, most studies were underpowered with high heterogeneity and numerous biases. The incidence of spontaneous ovarian cyst resolution at one year of age in our Canadian sample of 189 patients was 61.9%. Median time to postnatal cyst resolution was 124 days (95% CI 111 – 166 days). A total of 57 patients underwent surgical intervention for an ovarian cyst, 43 of whom underwent an oophorectomy. No significant difference was found in the odds of ovarian preservation between patients who underwent early surgery and those who were initially observed (OR 3.06, 95% CI 0.86 – 13.2), regardless of sonographic complex features or size. Conclusions: There is limited high-quality evidence and substantial heterogeneity in the management strategies employed to treat congenital ovarian cysts. Study findings suggest the majority of congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not seem to increase the incidence of ovarian preservation, and observation may be a safe management strategy
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,006 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».