Predictors of outcome patterns in infants diagnosed with congenital ovarian cysts
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".