Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms

Abstract

Purpose: The purpose of this study was to determine the diagnostic accuracy of tumor markers for malignancy in girls with ovarian neoplasms. Methods: A retrospective review of girls 2-21 years who presented for surgical management of an ovarian neoplasm across 10 children's hospitals between 2010 and 2016 was performed. Patients who had at least one concerning feature on imaging and had tumor marker testing were included in the study. Sensitivity, specificity, and negative and positive predictive values (PPV) of tumor markers were calculated. Results: Our cohort included 401 patients; 22.4% had a malignancy. Testing for tumor markers was inconsistent. AFP had high specificity (98%) and low sensitivity (42%) with a PPV of 86%. The sensitivity, specificity, and PPV of beta-hCG was 44%, 76%, and 32%, respectively. LDH had high sensitivity (95%) and Inhibin A and Inhibin B had high specificity (97% and 92%, respectively). Conclusions: Tumor marker testing is helpful in preoperative risk stratification of ovarian neoplasms for malignancy. Given the variety of potential tumor types, no single marker provides enough reliability, and therefore a panel of tumor marker testing is recommended if there is concern for malignancy. Prospective studies may help further elucidate the predictive value of tumor markers in a pediatric ovarian neoplasm population. Type of Study: Retrospective Cohort Review. Level of Evidence: Level III.

Large mesenteric cyst mimicking an ovarian cyst in an 8-year-old: A case report

“…This patient had a slightly increased CA-125, a biomarker of ovarian cancer [29] as well as prognostic indicator for other malignancies [30] , [31] . This marker can be used as useful adjuncts in the pediatric population to assess for ovarian neoplasms [32] , pediatric lymphomas and leukemias [33] , [34] , and germ cell tumors [35] . While the patient's CA-125 was elevated, she had not malignancy.…”

Standardizing the surgical management of benign ovarian tumors in children and adolescents: A best practice Delphi consensus statement

“…Any patient with a complex ovarian lesion or simple ovarian cyst > 5 cm should have the serum tumor markers alpha fetoprotein (AFP) and beta human chorionic gonadotropin (beta‐HCG) assayed. In a postpubertal female patient, the serum cancer antigen 125 (Ca125) should be added 23–25 Additional tumor markers such as Inhibin, LDH, CEA, and Ca19.9 may be useful and may be obtained in addition to the above at the discretion of the treating clinician, but there is currently insufficient evidence to recommend their routine use in the assessment of a suspected benign pediatric ovarian tumor 23,24,25 …”

“…In a postpubertal female patient, the serum cancer antigen 125 (Ca125) should be added 23–25 Additional tumor markers such as Inhibin, LDH, CEA, and Ca19.9 may be useful and may be obtained in addition to the above at the discretion of the treating clinician, but there is currently insufficient evidence to recommend their routine use in the assessment of a suspected benign pediatric ovarian tumor 23,24,25 The management of a female pediatric patient with a suspected ovarian mass should always be discussed in the oncology multidisciplinary team meeting (MDT) prior to surgical intervention.…”

“…Any patient with a complex ovarian lesion or simple ovarian cyst > 5 cm should have the serum tumor markers alpha fetoprotein (AFP) and beta human chorionic gonadotropin (beta‐HCG) assayed. In a postpubertal female patient, the serum cancer antigen 125 (Ca125) should be added 23–25 …”

Imaging Appearance of Nongerminoma Pediatric Ovarian Germ Cell Tumors Does Not Discriminate Benign from Malignant Histology

“…Simple cysts beyond the neonatal period may present with pain due to hemorrhage or torsion but are clearly recognized by their simple wall, unilocular appearance and absence of any solid components. True neoplastic lesions account for approximately 73% of masses and 16-22% of these are malignant [2,3]. Since the majority of neoplastic lesions are benign teratomas (also called dermoid cysts) which have a mixed cystic and solid appearance and frequently have calcifications, surgeons may assume that this finding on imaging indicates a benign tumor.…”