Predictors of ovarian malignancy in children: Overcoming clinical barriers of ovarian preservation

• Published in: Journal of pediatric surgery 2014, Vol.49 (1), p.144-148
• Main Authors: Papic, Jonathan C, Finnell, S. Maria E, Slaven, James E, Billmire, Deborah F, Rescorla, Frederick J, Leys, Charles M
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - epidemiology; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adolescent; Biomarkers, Tumor - blood; Calcinosis - epidemiology; Calcinosis - etiology; Child; Child, Preschool; Children; Cystadenoma - diagnosis; Cystadenoma - epidemiology; Cystadenoma - pathology; Cystadenoma - surgery; Female; Fertility Preservation; Fertility sparing; Fibroma - diagnosis; Fibroma - epidemiology; Fibroma - pathology; Fibroma - surgery; Humans; Infant; Infertility, Female - prevention & control; Laparoscopy; Neoplasms, Germ Cell and Embryonal - diagnosis; Neoplasms, Germ Cell and Embryonal - epidemiology; Neoplasms, Germ Cell and Embryonal - pathology; Neoplasms, Germ Cell and Embryonal - surgery; Organ Sparing Treatments; Ovarian Cysts - diagnosis; Ovarian Cysts - epidemiology; Ovarian Cysts - pathology; Ovarian Cysts - surgery; Ovarian malignancy; Ovarian mass; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Ovarian preservation; Ovariectomy - adverse effects; Ovariectomy - methods; Pediatrics; Predictive Value of Tests; Retrospective Studies; Sex Cord-Gonadal Stromal Tumors - diagnosis; Sex Cord-Gonadal Stromal Tumors - epidemiology; Sex Cord-Gonadal Stromal Tumors - pathology; Sex Cord-Gonadal Stromal Tumors - surgery; Surgery; Torsion Abnormality - epidemiology; Torsion Abnormality - etiology; Tumor Burden
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.09.068

Abstract Background/Purpose Ovarian preservation is desirable in girls with benign ovarian masses. We aimed to 1) identify clinical predictors of malignant ovarian masses, 2) investigate how often ovarian tissue is present to preserve in benign masses, and 3) identify factors associated with successful ovarian preservation. Methods Retrospective analysis (1997–2012) of girls age 1–18 years with an ovarian mass managed operatively. Data on presenting symptoms, imaging, biochemical markers, treatment, outcome, and pathology were extracted. Results We identified 150 patients. Large mass size, solid components, and elevated tumor markers (AFP, βHCG, and/or LDH) were significantly predictive of malignancy. All masses < 10 cm, predominantly cystic, and with negative tumor markers were benign. Masses with all three of these characteristics would decrease a 20% malignancy pretest probability to a posttest probability of 0.25%. Benign masses managed by oophorectomy contained normal ovarian tissue in 76% of the specimens. For benign masses, successful ovarian preservation was significantly associated with size < 10 cm, predominantly cystic, laparoscopy, and absence of torsion or calcifications. Conclusion Ovarian masses that are < 10 cm, primarily cystic, and have negative tumor markers are most likely benign. Viable ovarian tissue is frequently present in benign masses, so significant efforts should be made for ovarian preservation.