title: Pediatric ovarian malignancies: how efficacious are current staging practices?
abstract: OBJECTIVE
  Conventional staging is not routinely practiced because of a lack of preoperative indicators for pediatric ovarian malignancy. Children's Oncology Group (COG) developed guidelines for germ cell tumors to revise staging to correlate with primary pediatric ovarian pathology. Are COG guidelines being used, and are they applicable to all pediatric ovarian malignancies?
  
  
  METHODS
  A 15(1/2)-year retrospective review of operative ovarian masses from a single academic center was performed.
  
  
  RESULTS
  There were 424 patients identified, with 46 malignancies (11%). Most were stage I (73%). Complete COG staging was performed in 24%. Each staging component performed was as follows: oophorectomy (91%), examination with or without biopsy of omentum (72%), peritoneum (67%), retroperitoneum (63%), contralateral ovary (56%), and washings (46%). Advanced stages had visible findings at exploration to guide biopsies. Of site-directed biopsies, 40.5% were positive, whereas all random biopsies (n = 38) were negative. Two recurrences and all mortalities (n = 4) had complete initial COG operative staging. Mean duration of follow-up was 3.62 +/- 0.365 years.
  
  
  CONCLUSIONS
  The COG staging is not consistently followed. All cases of advanced disease were visibly obvious and confirmed with site-directed biopsies. Random samplings were all negative and did not impact stage. Negative outcomes reflected inherent tumor biology not deviation from COG staging. The COG guidelines appear to be sufficient for all pediatric ovarian malignancies.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. anne.fischer@childrens.com
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: Nilda M
authors.initials: NM
authors.lastname: Garcia
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.forename: Barry
authors.initials: B
authors.lastname: Hicks
authors.forename: Anne C
authors.initials: AC
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D009367:Neoplasm Staging / Q000379:methods*; D009919:Orchiectomy / Q000379:methods; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult