Preoperative risk stratification of children with ovarian tumors.
BACKGROUND
The appropriate operative approach to pediatric patients with ovarian tumors must balance real risk of malignancy with maximal preservation of reproductive potential. We evaluate preoperative risk of malignancy in order to more precisely guide treatment, so as to err on the side of ovarian preservation if at all possible.


METHODS
We retrospectively reviewed the records of all patients undergoing surgical intervention for ovarian tumors at a single institution. The primary endpoint was ovarian malignancy.


RESULTS
Of 502 patients who underwent surgery for ovarian tumors, 44 (8.8%) had malignancies. Malignancy rate (95% confidence interval) was low for cystic lesions <9cm (0.0%, 0.0-2.9%) and for tumor marker-negative heterogeneous lesions <9cm (2.3%, 0.4-12.1%). High-risk profiles for malignancy included tumor marker-positive heterogeneous lesions (66.7%, 35.4-87.9%) and solid tumors ≥9cm (69.2%, 16.2-40.3%). Intermediate risk tumors included cystic tumors ≥9cm (6.8%, 3.5-20.7%), tumor marker-negative heterogeneous lesions ≥9cm (31.2%, 18.0-48.6%), and solid tumors <9cm (11.1%, 4.4-25.3%).


CONCLUSIONS
We developed a decision strategy to help determine who may and may not require an ovarian-sparing approach, which warrants prospective application and validation. Ultimately, the decision to pursue an oncologic surgery with oophorectomy and staging (as opposed to fertility-preserving surgery) should be made after individualized discussion involving the surgeon, patient, and family.
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.
Arin L
AL
Madenci
Division of Endocrinology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Bat-Sheva
BS
Levine
Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Marc R
MR
Laufer
Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Theonia K
TK
Boyd
Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Stephen D
SD
Voss
Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
David
D
Zurakowski
Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA.
A Lindsay
AL
Frazier
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.
Christopher B
CB
Weldon
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010049:Ovarian Diseases / Q000175:diagnosis / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000601:surgery; D010052:Ovariectomy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
Fertility; Oophorectomy; Ovarian cysts; Ovarian diseases; Ovarian neoplasms