Multicenter pre-operative assessment of pediatric ovarian malignancy

Arin L. Madenci, Robert J. Vandewalle, Bryan V. Dieffenbach, Marc R. Laufer, Theonia K. Boyd, Stephan D. Voss, A. Lindsay Frazier, Deborah F. Billmire, Frederick Rescorla, Brent R. Weil, Christopher B. Weldon

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: The purpose of this study was to develop a pre-operative risk assessment tool for childhood and adolescent ovarian malignancy, in order to guide operative management of pediatric ovarian masses. Methods: We conducted a retrospective analysis of patients < 18 years old who underwent ovarian surgery at two quaternary care pediatric centers over 4 years (1/1/13–12/31/16). Probability of malignancy was estimated based on imaging characteristics (simple cyst, heterogeneous, or solid), maximal diameter, and tumor markers (α-fetoprotein, β-human chorionic gonadotropin). Results: Among 188 children with ovarian masses, 11% had malignancies. For simple cysts, there were no malignancies (0/24, 95% CI = 0–17%). Among solid lesions, 44% (15/34, 95% CI = 28–62%) were malignant. Among marker-elevated heterogeneous masses, 40% (2/5, 95% CI = 12–77%) were malignant. Conversely, small (≤ 10 cm) and large (> 10 cm) marker-negative heterogeneous lesions had malignancy proportions of 0% (0/39, 95% CI = 0–11%) and 5% (2/40, 95% CI = 1–18%), respectively. Conclusions: Given the malignancy estimates identified from these multi-institutional data, we recommend an attempt at ovarian-sparing resection for simple cysts or tumor marker-negative heterogeneous lesions ≤ 10 cm. Oophorectomy is recommended for solid masses or heterogeneous lesions with elevated markers. Finally, large (> 10 cm) heterogeneous masses with non-elevated markers warrant a careful discussion of ovarian-sparing techniques. Complete surgical staging is mandatory regardless of operative procedure. Type of Study: Study of Diagnostic Test. Level of Evidence: Level I.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
StatePublished - Jan 1 2019


  • Fertility
  • Oophorectomy
  • Ovarian cysts
  • Ovarian diseases
  • Ovarian neoplasms

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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