{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:21Z","timestamp":1787013861295,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["852002128"],"award-info":[{"award-number":["852002128"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004622","name":"KWF Kankerbestrijding","doi-asserted-by":"publisher","award":["12694"],"award-info":[{"award-number":["12694"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Increasing evidence shows that conservative management of ovarian tumors classified as benign, based on ultrasound assessment, is safe. Therefore, conservative management has been adopted as the preferred strategy for certain ovarian tumors assessed as benign in the Dutch national guideline on enlarged ovaries in 2013. The aim of this study was to examine whether implementation of this guideline has led to changes in the number of women\/100\u2009000 women undergoing surgery for an ovarian tumor in the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>Histopathology reports were requested for all examinations of ovarian and fallopian tube specimens (including cyst enucleations) registered in Palga, the Dutch nationwide pathology databank, from 2011 (before guideline adaptation) and 2019 (after guideline adaptation). Reports on prophylactically removed adnexa, removal for other primary tumors (eg endometrial carcinoma), and for patients under 18\u2009years of age, were excluded from the analysis. Interobserver agreement for the inclusion and classification of reports was assessed using Cohen's Kappa analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 34\u2009932 reports were retrieved, 13\u2009917 of which were included in the analysis. In 2011 and 2019, respectively, 96.3\/100\u2009000 vs 68.8\/100\u2009000 women aged \u226518 underwent surgery for benign ovarian tumors, and 19.6\/100\u2009000 vs 18.3\/100\u2009000 for borderline and malignant tumors combined. The number of women\/100\u2009000 who had surgery for a benign ovarian tumor per 100\u2009000 women declined by 28.5% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) between 2011 and 2019. The largest difference between 2011 and 2019 was observed in the number of women per 100\u2009000 women who underwent surgery for a serous cystadenoma (\u221240.7%; 20.8\/100\u2009000 vs. 12.3\/100\u2009000), followed by endometrioma (\u221233.2%; 14.7\/100\u2009000 vs. 9.8\/100\u2009000), simple epithelial cyst (\u221257.3%; 8.4\/100\u2009000 vs. 3.6\/100\u2009000), and corpus luteum cyst (\u221257.0%; 4.0\/100\u2009000 vs. 1.7\/100\u2009000). Cohen's Kappa for the interobserver agreement was 0.96.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The number of women\/100\u2009000 undergoing surgery for a benign ovarian tumor has substantially decreased in the Netherlands when comparing data before and after implementation of the national guideline in 2013, while the number of women\/100\u2009000 undergoing surgery for a malignant or borderline tumor remained the same. These findings suggest successful implementation of the updated guideline, and a measurable effect on increased adoption of conservative management for benign\u2010looking ovarian tumors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.14912","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T01:44:17Z","timestamp":1722303857000},"page":"2183-2192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Do we more often opt for conservative management of ovarian tumors after changing the Dutch national guideline on enlarged ovaries? A nationwide cohort study"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4495-9622","authenticated-orcid":false,"given":"Esther","family":"Lems","sequence":"first","affiliation":[{"name":"M\u00e1xima Medical Center  Veldhoven the Netherlands"},{"name":"Maastricht University GROW School for Oncology and Reproduction  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna H.","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Department of Pathology, Center of Gynecologic Oncology Amsterdam, Location Antoni van Leeuwenhoek Netherlands Cancer Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Armbrust","sequence":"additional","affiliation":[{"name":"M\u00e1xima Medical Center  Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaklien C.","family":"Leemans","sequence":"additional","affiliation":[{"name":"M\u00e1xima Medical Center  Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlies Y.","family":"Bongers","sequence":"additional","affiliation":[{"name":"M\u00e1xima Medical Center  Veldhoven the Netherlands"},{"name":"Maastricht University GROW School for Oncology and Reproduction  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Leon\u2010Castillo","sequence":"additional","affiliation":[{"name":"Department of Pathology, Center of Gynecologic Oncology Amsterdam, Location Antoni van Leeuwenhoek Netherlands Cancer Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christianne A. R.","family":"Lok","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Department of Pathology, Center of Gynecologic Oncology Amsterdam, Location Antoni van Leeuwenhoek Netherlands Cancer Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy M. A. J.","family":"Geomini","sequence":"additional","affiliation":[{"name":"M\u00e1xima Medical Center  Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Laura AdhikariLAH.PathologyOutlines.com Ovary general WHO classification.https:\/\/www.pathologyoutlines.com\/topic\/ovarytumorwhoclassif.html. 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