Can we preoperatively risk stratify ovarian masses for malignancy?

Oltmann, Sarah C.; Garcia, Nilda M.; Barber, Robert; Huang, Rong; Hicks, Barry; Fischer, Anne C.

doi:10.1016/j.jpedsurg.2009.10.022

Cited by 139 publications

(113 citation statements)

References 17 publications

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“…8 Tumor markers were only elevated in 54% of the malignancies in this cohort, and 6.5% of benign masses. 8 These data support using 8 cm as a diameter criterion, but diminish the impact of tumor markers on stratification. It should also be noted that criteria such as these often perform less well when replicated, but a sensitivity between 0.4 and 0.6 can be expected.…”

mentioning

confidence: 64%

“…Internal morphology consistent with a heterogeneous or solid mass is more indicative of malignancy than a unilocular, homogenous cyst. 8 Serum markers are also used to identify malignancy to help with surgical planning and management; certain markers can help delineate type of tumor as well (Table 2). CA-125, used in monitoring of epithelial ovarian cancer in older women, is limited by the lack of specificity in this age group, as epithelial ovarian carcinomas are rare in children and adolescents.…”

Section: Diagnosismentioning

confidence: 99%

“…2,11 To address this dilemma, criteria have been proposed to risk-stratify ovarian masses in order to facilitate the use of ovarian-conserving surgical techniques such as cystectomy. 2,5,7,8,14 These criteria aim to identify masses most likely to be benign and therefore are candidates for laparoscopic surgery with ovarian conservation. Papic and colleagues identified three criteria to isolate benign masses preoperatively, based on ultrasonography and serum markers: 1) maximum diameter less than 10 cm, 2) no solid components present on imaging studies, and 3) normal serum tumor markers, specifically alpha-fetoprotein (AFP, OR 9.60), beta human chorionic gonadotropin (βHCG, OR 5.93), and lactate dehydrogenase (LDH, OR 225).…”

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confidence: 99%

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Management of Adnexal Masses in Children and Adolescent Populations: Advocating for Ovarian Conservation

Kinson¹,

Spiryda

Spiryda³

2016

Surg Res Open J

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confidence: 64%

Section: Diagnosismentioning

confidence: 99%

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confidence: 99%

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Management of Adnexal Masses in Children and Adolescent Populations: Advocating for Ovarian Conservation

Kinson¹,

Spiryda

Spiryda³

2016

Surg Res Open J

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“…20 In Oltmann's 424 patient series, the mean age was 12.5±0.26 years, the malignancy rate was 11% and 114 of these patients had torsion (26%). 1,21 The mean age of the torsion patients was 10 ± 0.53. Four of the torsion patients' tumours were malignant (3.5%) and 26 were benign (24%), while the remainder were functional lesions (72.5%).…”

Section: Discussionmentioning

confidence: 99%

“…The etiologies of ovarian enlargement in childhood include functional cysts, ovarian torsion and malignant and benign neoplasms. 1 Ovarian lesions come to hospital in a variety of ways.…”

Section: Introductionmentioning

confidence: 99%

Ovarian masses in infant-juvenile age

Sönmez

Türkyılmaz

Karabulut

et al. 2018

Arch Argent Pediatr

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Introduction.The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. Patients and methods. A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. Results. Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18±4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46±6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. Conclusion. Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.

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Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients

Minneci,

Bergus,

Lutz

et al. 2023

JAMA

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ImportanceAlthough most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health.ObjectiveTo evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies.Design, Setting, and ParticipantsPre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children’s hospitals in the United States between August 2018 and January 2021, with 1-year follow-up.InterventionImplementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons.Main Outcomes and MeasuresUnnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution.ResultsA total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%.Conclusions and RelevanceUnnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.

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Can we preoperatively risk stratify ovarian masses for malignancy?

Cited by 139 publications

References 17 publications

Management of Adnexal Masses in Children and Adolescent Populations: Advocating for Ovarian Conservation

Management of Adnexal Masses in Children and Adolescent Populations: Advocating for Ovarian Conservation

Ovarian masses in infant-juvenile age

Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients

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