Purpose or Case Report: Accurate diagnosis of Polycystic Ovary syndrome (PCOS) in adolescents relies on clinical, biochemical and radiographic criteria. The traditionally utilized Rotterdam criteria define polycystic ovarian morphology (PCOM) as the presence of 12 or more follicles, measuring 2-9 mm in either ovary and/or an ovarian volume >10 cm³. Due to advancement in imaging techniques and resolution, it has been proposed by the Androgen Excess Society Taskforce to update criteria for diagnosis of PCOM to presence of 25 or more follicles per ovary. The aim of this study was to correlate the diagnosis of PCOM using ovarian volume and follicle number criteria in adolescents with confirmed PCOS based on NIH criteria. The NIH criteria are stringent and require the presence of both menstrual irregularity and clinical or biochemical evidence of hyperandrogenism for a diagnosis of PCOS.
Methods & Materials: Adolescent girls aged 13-18 years newly diagnosed with PCOS between January 2013-December 2015 were identified. Clinical, biochemical and radiographic variables were reviewed to confirm a diagnosis of PCOS using NIH criteria. Ultrasound studies were re-read by study investigator H.M. to determine ovarian volume and number of follicles per ovary. A McNemar’s/Bowker’s test was used to compare the accuracy of the Rotterdam and AE-PCOS criteria in identification of PCOM in these adolescents.
Results: Based on NIH criteria, 65 adolescents with PCOS were identified. Mean age of the subjects was 16.3 ± 1.46 years with a mean body mass index of 30.2 ± 8.3 kg/m². Given the young age of the subjects, more ultrasounds were conducted transabdominally. Based on ovarian volume greater than 10 cm³, 46/65 (70.7%) adolescents with confirmed PCOS were accurately labeled with PCOM. Accurate follicle number determination was possible in 43/65 subjects (66%). Among this subset, criteria for ovarian volume > 10 cm^3, were met by 33/43 (76.7%) subjects. Use of the Rotterdam criteria based on follicle number (≥12 per ovary) identified 20/43 patients (46.5%), while the AE-PCOS criteria based on follicle count (≥25 per ovary) predicted only 5/43 subjects (11.6%) with confirmed PCOS (P=0.0001).
Conclusions: In adolescents with confirmed PCOS based on NIH criteria, ovarian volume may be able to detect PCOM most reliably, followed by Rotterdam criteria of 12 or more follicles per ovary. Use of the AE-PCOS criteria for 25 or more follicle number per ovary may result in an unacceptably high rate of missed diagnosis of PCOM in adolescents with PCOS.