Preoperative risk stratification of children with ovarian tumors

Arin L Madenci; Bat-Sheva Levine; Marc R Laufer; Theonia K Boyd; Stephen D Voss; David Zurakowski; A Lindsay Frazier; Christopher B Weldon

doi:10.1016/j.jpedsurg.2016.05.004

Preoperative risk stratification of children with ovarian tumors

J Pediatr Surg. 2016 Sep;51(9):1507-12. doi: 10.1016/j.jpedsurg.2016.05.004. Epub 2016 May 31.

Authors

Arin L Madenci¹, Bat-Sheva Levine², Marc R Laufer³, Theonia K Boyd⁴, Stephen D Voss⁵, David Zurakowski⁶, A Lindsay Frazier⁷, Christopher B Weldon⁸

Affiliations

¹ Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: amadenci@partners.org.
² Division of Endocrinology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
³ Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁵ Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA.
⁸ Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA.

PMID: 27289417
DOI: 10.1016/j.jpedsurg.2016.05.004

Abstract

Background: The appropriate operative approach to pediatric patients with ovarian tumors must balance real risk of malignancy with maximal preservation of reproductive potential. We evaluate preoperative risk of malignancy in order to more precisely guide treatment, so as to err on the side of ovarian preservation if at all possible.

Methods: We retrospectively reviewed the records of all patients undergoing surgical intervention for ovarian tumors at a single institution. The primary endpoint was ovarian malignancy.

Results: Of 502 patients who underwent surgery for ovarian tumors, 44 (8.8%) had malignancies. Malignancy rate (95% confidence interval) was low for cystic lesions <9cm (0.0%, 0.0-2.9%) and for tumor marker-negative heterogeneous lesions <9cm (2.3%, 0.4-12.1%). High-risk profiles for malignancy included tumor marker-positive heterogeneous lesions (66.7%, 35.4-87.9%) and solid tumors ≥9cm (69.2%, 16.2-40.3%). Intermediate risk tumors included cystic tumors ≥9cm (6.8%, 3.5-20.7%), tumor marker-negative heterogeneous lesions ≥9cm (31.2%, 18.0-48.6%), and solid tumors <9cm (11.1%, 4.4-25.3%).

Conclusions: We developed a decision strategy to help determine who may and may not require an ovarian-sparing approach, which warrants prospective application and validation. Ultimately, the decision to pursue an oncologic surgery with oophorectomy and staging (as opposed to fertility-preserving surgery) should be made after individualized discussion involving the surgeon, patient, and family.

Keywords: Fertility; Oophorectomy; Ovarian cysts; Ovarian diseases; Ovarian neoplasms.

MeSH terms

Adolescent
Child
Child, Preschool
Clinical Decision-Making / methods*
Diagnosis, Differential
Female
Fertility Preservation / methods*
Follow-Up Studies
Humans
Infant
Infant, Newborn
Ovarian Diseases / diagnosis
Ovarian Diseases / surgery
Ovarian Neoplasms / diagnosis*
Ovarian Neoplasms / surgery
Ovariectomy / methods*
Preoperative Care / methods*
Retrospective Studies
Risk Assessment
Young Adult