title: Poor adherence to staging guidelines for children with malignant ovarian tumors.
abstract: OBJECTIVE
  Historically, surgical staging practices for pediatric malignant ovarian tumors mirrored adult guidelines. In 2004, the Children's Oncology Group (COG) developed guidelines specific to pediatric patients with ovarian germ cell tumors. We sought to characterize the operative management of pediatric ovarian lesions and adherence to COG surgical staging guidelines.
  
  
  METHODS
  We conducted a single institution, retrospective study of pediatric patients who underwent surgical intervention for ovarian lesions between 1995 and 2012. The primary outcome was adherence to COG staging guidelines.
  
  
  RESULTS
  Among 502 patients, 44 (8.8%) had malignant ovarian tumors. Two patients (2/44, 4.5%) underwent correct surgical staging. Therefore, 95.5% (42/44) underwent incorrect surgical staging by omitting recommended maneuvers (surgical understaging) or performing clinically unnecessary surgical staging steps (surgical overstaging). Of the 42 patients with incorrect surgical staging, 85.7% (36/42) were surgically overstaged and 76.2% (32/42) were surgically understaged. In the entire cohort, 12 (27.3%) patients had complete staging procedures, including 10 surgically overstaged patients (10/12, 83.3%). Staging practices were not significantly different before and after the release of the 2004 COG guidelines.
  
  
  CONCLUSIONS
  Incorrect surgical staging of pediatric ovarian malignancies is commonplace. These data stress the need for greater education among all surgeons caring for children with malignant ovarian tumors.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: amadenci@partners.org.
authors.forename: Arin L
authors.initials: AL
authors.lastname: Madenci
authors.affiliation: Division of Endocrinology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Bat-Sheva
authors.initials: BS
authors.lastname: Levine
authors.affiliation: Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Laufer
authors.affiliation: Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Theonia K
authors.initials: TK
authors.lastname: Boyd
authors.affiliation: Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Voss
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA.
authors.forename: A Lindsay
authors.initials: AL
authors.lastname: Frazier
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Weldon
mesh_terms: D000293:Adolescent; D001900:Boston; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010052:Ovariectomy; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
keywords: Neoplasm staging; Oophorectomy; Ovarian cysts; Ovarian diseases; Ovarian neoplasms; Pediatrics