Clinical Predictors of Surgical Intervention and Ovarian Torsion in Adolescents With Ovarian Cystic Lesions

Abstract

Aim

To identify clinical and ultrasonographic (US) factors associated with surgical intervention and ovarian torsion in adolescents with ovarian cystic lesions and to evaluate an exploratory clinical risk stratification framework.

Methods

This retrospective cohort study included 112 adolescents with ovarian cystic lesions > 30 mm managed at a tertiary pediatric surgery center between January 2023 and January 2026. Clinical presentation, US characteristics, management, and outcomes were evaluated. Height and weight measurements were retrospectively retrieved when available, and body mass index (BMI) was calculated and analyzed as a continuous variable. Multivariable logistic regression was used to identify factors independently associated with surgical intervention and ovarian torsion. Receiver operating characteristic (ROC) analysis was used to determine the optimal lesion diameter threshold for surgical intervention. A exploratory three-level clinical risk stratification framework was subsequently developed using the ROC-derived 60-mm lesion diameter threshold and the presence of abdominal/pelvic pain.

Results

Among 112 patients, 26 (23.2%) underwent surgical intervention, whereas 86 (76.8%) were managed conservatively. Surgical indications included ovarian torsion, complex adnexal masses, and persistent or enlarging cysts. Maximum lesion diameter was the strongest independent predictor of both surgical intervention and ovarian torsion. BMI was available for 95 patients (84.8%) and was not independently associated with surgical intervention or significantly different according to ovarian torsion status. The 60-mm threshold provided the best discrimination for surgical intervention. Surgical intervention occurred in 5/75 (6.7%), 2/8 (25.0%), and 19/29 (65.5%) patients in the low-, intermediate-, and high-risk groups, respectively (Fisher–Freeman–Halton exact test, p < 0.001). Ovarian torsion occurred in 2/75 (2.7%), 0/8 (0%), and 11/29 (37.9%) patients, respectively (Fisher–Freeman–Halton exact test, p < 0.001).

Conclusions

Maximum lesion diameter was the strongest independent predictor of surgical intervention and ovarian torsion. BMI was not significantly associated with either outcome in the available anthropometric data. The new exploratory risk stratification framework showed distinct clinical patterns across risk categories but requires prospective external validation before clinical use.