title: Can we preoperatively risk stratify ovarian masses for malignancy?
abstract: OBJECTIVE
  Given a 10% malignancy rate in pediatric ovarian masses, what preoperative factors are helpful in distinguishing those at higher risk to risk stratify accordingly?
  
  
  METHODS
  After institutional review board approval (IRB#022008-095), a 15(1/2)-year retrospective review of operative ovarian cases was performed.
  
  
  RESULTS
  A total of 424 patients were identified, with a mean age 12.5 years (range, 1 day to 19 years), without an age disparity between benign (12.54 years, 89%) and malignant (11.8 years, 11%) cases. The 1- to 8-year age group had the highest percentage of malignancies (22%; odds ratio [OR], 3.02; 95% confidence interval [CI], 1.33-6.86). A chief complaint of mass or precocious puberty versus one of pain had an OR for malignancy of 4.84 and 5.67, respectively (95% CI, 2.48-9.45 and 1.60-20.30). Imaging of benign neoplasms had a mean size of 8 cm (range, 0.9-36 cm) compared with malignancies at 17.3 cm (6.2-50 cm, P < .001). An ovarian mass size of 8 cm or longer on preoperative imaging had an OR of 19.0 for malignancy (95% CI, 4.42-81.69). Ultrasound or computed tomographic findings of a solid mass, although infrequent, were most commonly associated with malignancy (33%-60%), compared with reads of heterogeneous (15%-21%) or cystic (4%-5%) lesions. The malignancies (n = 46) included germ cell (50%, n = 23), stromal (28%, n = 13), epithelial (17%, n = 8), and other (4%, n = 2). Tumor markers obtained in 71% of malignancies were elevated in only 54%, whereas 6.5% of those sent in benign cases were similarly elevated. Elevated beta-human chorionic gonadotropin (beta-HCG), alpha fetoprotein (alphaFP), and cancer antigen 125 (CA-125) were significantly associated with malignancy (P < .02) and an elevated carcinoembryonic antigen (CEA) was not (P = .1880).
  
  
  CONCLUSIONS
  This reported series of pediatric ovarian masses demonstrates that preoperative indicators that best predict an ovarian malignancy are a complaint of a mass or precocious puberty, a mass exceeding 8 cm or a mass with solid imaging characteristics. Those patients aged 1 to 8 years have the greatest incidence of malignancy. Tumor markers, positive or negative, were not conclusive in all cases but useful for postoperative surveillance.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: Nilda
authors.initials: N
authors.lastname: Garcia
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.forename: Barry
authors.initials: B
authors.lastname: Hicks
authors.forename: Anne
authors.initials: A
authors.lastname: Fischer
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D000367:Age Factors; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D009367:Neoplasm Staging; D009369:Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010053:Ovary / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011629:Puberty, Precocious / Q000175:diagnosis; D018570:Risk Assessment
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D002272:Carcinoembryonic Antigen