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 journalArticle

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Abstract

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
DOIs
StatePublished - Jan 1 2019

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Pediatrics
Neoplasms
Operative Surgical Procedures
Ovariectomy
Tumor Biomarkers
Routine Diagnostic Tests
Cysts

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Madenci, A. L., Vandewalle, R. J., Dieffenbach, B. V., Laufer, M. R., Boyd, T. K., Voss, S. D., ... Weldon, C. B. (2019). Multicenter pre-operative assessment of pediatric ovarian malignancy. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2019.02.019

Multicenter pre-operative assessment of pediatric ovarian malignancy. / Madenci, Arin L.; Vandewalle, Robert J.; Dieffenbach, Bryan V.; Laufer, Marc R.; Boyd, Theonia K.; Voss, Stephan D.; Frazier, A. Lindsay; Billmire, Deborah F.; Rescorla, Frederick; Weil, Brent R.; Weldon, Christopher B.

In: Journal of Pediatric Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Madenci, AL, Vandewalle, RJ, Dieffenbach, BV, Laufer, MR, Boyd, TK, Voss, SD, Frazier, AL, Billmire, DF, Rescorla, F, Weil, BR & Weldon, CB 2019, 'Multicenter pre-operative assessment of pediatric ovarian malignancy', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2019.02.019
Madenci, Arin L. ; Vandewalle, Robert J. ; Dieffenbach, Bryan V. ; Laufer, Marc R. ; Boyd, Theonia K. ; Voss, Stephan D. ; Frazier, A. Lindsay ; Billmire, Deborah F. ; Rescorla, Frederick ; Weil, Brent R. ; Weldon, Christopher B. / Multicenter pre-operative assessment of pediatric ovarian malignancy. In: Journal of Pediatric Surgery. 2019.
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AU - Madenci, Arin L.

AU - Vandewalle, Robert J.

AU - Dieffenbach, Bryan V.

AU - Laufer, Marc R.

AU - Boyd, Theonia K.

AU - Voss, Stephan D.

AU - Frazier, A. Lindsay

AU - Billmire, Deborah F.

AU - Rescorla, Frederick

AU - Weil, Brent R.

AU - Weldon, Christopher B.

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N2 - 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.

AB - 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.

KW - Fertility

KW - Oophorectomy

KW - Ovarian cysts

KW - Ovarian diseases

KW - Ovarian neoplasms

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