Ovarian Neoplasm Publications

Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric and Adolescent Patients

Lin AM, Bergus KC, Bricker J, Fallat M, Hertweck SP, Hewitt G, Lutz C, Aldrink JH, Bence C, Breech L, Dillon PA, Downard C, Ehrlich PF, Gadepalli S, Fraser JD, Grabowski J, Helmrath M, Hirschl RB, Kabre R, Lal DR, Landman M, Leys C, Cherney-Stafford L, Mak G, Markel T, Pressey JG, Raiji M, Rymeski B, Saito J, St Peter SD, Asti L, Deans K, Minneci PC; Midwest Pediatric Surgery Consortium. Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric and Adolescent Patients. J Surg Res. 2025 Nov 3;315:839-846. doi: 10.1016/j.jss.2025.09.084. Epub ahead of print. PMID: 41187700.

Abstract
Introduction: Pediatric and adolescent patients with ovarian masses undergo radiographic and serologic workup to determine malignancy risk before surgery. Commonly examined tumor markers for detecting malignancy among these patients are α-fetoprotein, β-human chorionic gonadotropin (β-HCG), cancer antigen-125, inhibin A, and lactate dehydrogenase. This study investigated the diagnostic performance of these tumor markers, individually and in combination, to assess malignancy risk in pediatric and adolescent patients with ovarian masses.
Methods: This was a planned secondary analysis of a multi-institutional interventional study investigating a consensus-based, preoperative risk stratification algorithm in patients aged 6-21 y, undergoing surgery for an ovarian mass between August 2018 and February 2021 at 11 children's hospitals. All included patients underwent preoperative assessment with ≥ 1 tumor marker(s). Individual and all combinations of tumor marker performance were analyzed. A priori clinical consensus was that the optimal combination of tumor markers should minimize the misclassification of patients with malignancy (maximize negative predictive value).
Results: Tumor markers were assessed in 309 out of the 519 patients, and malignancy was found in 25 patients. β-HCG was present among all the best-performing combinations. The most accurate combination was β-HCG/inhibin A/lactate dehydrogenase (accuracy = 0.951). Three combinations did not misclassify any malignant lesions as likely benign (100% negative predictive value), and the most accurate of these three combinations was α-fetoprotein/β-HCG/cancer antigen-125/inhibin A (accuracy = 0.862).
Conclusions: Tumor markers can support preoperative risk stratification for malignancy to determine which patients may benefit from ovary-sparing surgery and minimize those undergoing an unindicated oophorectomy or oophorectomy for benign disease.
Cite
Lin AM, Bergus KC, Bricker J, Fallat M, Hertweck SP, Hewitt G, Lutz C, Aldrink JH, Bence C, Breech L, Dillon PA, Downard C, Ehrlich PF, Gadepalli S, Fraser JD, Grabowski J, Helmrath M, Hirschl RB, Kabre R, Lal DR, Landman M, Leys C, Cherney-Stafford L, Mak G, Markel T, Pressey JG, Raiji M, Rymeski B, Saito J, St Peter SD, Asti L, Deans K, Minneci PC; Midwest Pediatric Surgery Consortium. Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric and Adolescent Patients. J Surg Res. 2025 Nov 3;315:839-846. doi: 10.1016/j.jss.2025.09.084. Epub ahead of print. PMID: 41187700.

Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms.

Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Overman RE, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright T, Minneci PC, Deans KJ, Aldrink JH; Midwest Pediatric Surgery Consortium. Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms. J Pediatr Surg. 2020 Jan;55(1):122-125. doi: 10.1016/j.jpedsurg.2019.09.062. Epub 2019 Oct 25. PMID: 31677824; PMCID: PMC7181461.

Abstract
Purpose: The purpose of this study was to determine the diagnostic accuracy of tumor markers for malignancy in girls with ovarian neoplasms.
Methods: A retrospective review of girls 2-21 years who presented for surgical management of an ovarian neoplasm across 10 children's hospitals between 2010 and 2016 was performed. Patients who had at least one concerning feature on imaging and had tumor marker testing were included in the study. Sensitivity, specificity, and negative and positive predictive values (PPV) of tumor markers were calculated.
Results: Our cohort included 401 patients; 22.4% had a malignancy. Testing for tumor markers was inconsistent. AFP had high specificity (98%) and low sensitivity (42%) with a PPV of 86%. The sensitivity, specificity, and PPV of beta-hCG was 44%, 76%, and 32%, respectively. LDH had high sensitivity (95%) and Inhibin A and Inhibin B had high specificity (97% and 92%, respectively).
Conclusions: Tumor marker testing is helpful in preoperative risk stratification of ovarian neoplasms for malignancy. Given the variety of potential tumor types, no single marker provides enough reliability, and therefore a panel of tumor marker testing is recommended if there is concern for malignancy. Prospective studies may help further elucidate the predictive value of tumor markers in a pediatric ovarian neoplasm population.
Type of study: Retrospective Cohort Review.
Level of evidence: Level III.
Cite
Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Overman RE, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright T, Minneci PC, Deans KJ, Aldrink JH; Midwest Pediatric Surgery Consortium. Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms. J Pediatr Surg. 2020 Jan;55(1):122-125. doi: 10.1016/j.jpedsurg.2019.09.062. Epub 2019 Oct 25. PMID: 31677824; PMCID: PMC7181461.

Laparoscopy versus laparotomy for pediatric ovarian dermoids

Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchant N, Elliott Overman R, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannell M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Laparoscopy versus laparotomy for pediatric ovarian dermoids. J Pediatr Surg. 2022 Jun;57(6):1008-1012. doi: 10.1016/j.jpedsurg.2022.01.053. Epub 2022 Feb 12. PMID: 35292164.

Abstract
Background: With increased surgeon comfort using laparoscopy, we hypothesized resection of pediatric ovarian dermoids using laparoscopy would yield a shorter length of stay and no increase in morbidity or recurrence compared to laparotomy.
Methods: A retrospective review was performed amongst eleven pediatric hospitals. Patients aged 2 to 21 who underwent resection of an ovarian dermoid from 2010 to 2020 were included. Patient characteristics, operative details, and outcomes by approach were evaluated using Chi-squared and Wilcoxon-Mann tests.
Results: 466 patients were included, with a median age of 14.4 and median follow-up of 4.0 months. 279 patients underwent laparoscopy (60%), 139 laparotomy (30%), and 48 laparoscopy converted to laparotomy (10%). There were no differences in rates of tumor spillage by approach (p = 0.15). 65% underwent ovarian-sparing surgery and 35% underwent oophorectomy. Length of stay was significantly shorter amongst patients who underwent laparoscopy (1 day versus 2 days for laparotomy and converted, p<0.0001). There were no differences in rates of suspected recurrence or reoperation (p = 0.19 and p = 0.57, respectively).
Conclusion: Patients who underwent laparoscopy experienced no differences in the rates of tumor spillage, recurrence, or reoperation and had a shorter length of stay compared to laparotomy. Laparoscopy is an acceptable approach for resection of pediatric ovarian dermoids.
Cite
Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchant N, Elliott Overman R, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannell M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Laparoscopy versus laparotomy for pediatric ovarian dermoids. J Pediatr Surg. 2022 Jun;57(6):1008-1012. doi: 10.1016/j.jpedsurg.2022.01.053. Epub 2022 Feb 12. PMID: 35292164.

Factors Associated With Torsion in Pediatric Patients With Ovarian Masses

Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Aldrink JH, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright TN, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Factors Associated with Torsion in Pediatric Patients with Ovarian Masses. J Surg Res. 2021 Jul;263:110-115. doi: 10.1016/j.jss.2020.12.058. Epub 2021 Feb 26. PMID: 33647800.

Abstract
Background: Management of ovarian torsion has evolved toward ovarian preservation regardless of ovarian appearance during surgery. However, patients with torsion and an ovarian neoplasm undergo a disproportionately high rate of oophorectomy. Our objectives were to identify factors associated with ovarian torsion among females with an ovarian mass and to determine if torsion is associated with malignancy.
Methods: A retrospective review of females aged 2-21 y who underwent an operation for an ovarian cyst or neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariate logistic regression was used to assess factors associated with torsion. Imaging data were assessed for sensitivity, specificity, and predictive value in identifying ovarian torsion.
Results: Of 814 girls with an ovarian neoplasm, 180 (22%) had torsion. In risk-adjusted analyses, patients with a younger age, mass size >5 cm, abdominal pain, and vomiting had an increased likelihood of torsion (P < 0.01 for all). Patients with a mass >5 cm had two times the odds of torsion (odds ratio: 2.1; confidence interval: 1.2, 3.6). Imaging was not reliable at identifying torsion (sensitivity 34%, positive predictive value 49%) or excluding torsion (specificity 72%, negative predictive value 87%). The rates of malignancy were lower in those with an ovarian mass and torsion than those without torsion (10% versus 17%, P = 0.01). Among the 180 girls with torsion and a mass, 48% underwent oophorectomy of which 14% (n = 12) had a malignancy.
Conclusions: In females with an ovarian neoplasm, torsion is not associated with an increased risk of malignancy and ovarian preservation should be considered.
Cite
Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Aldrink JH, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright TN, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Factors Associated with Torsion in Pediatric Patients with Ovarian Masses. J Surg Res. 2021 Jul;263:110-115. doi: 10.1016/j.jss.2020.12.058. Epub 2021 Feb 26. PMID: 33647800.

Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas

Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchan N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannel M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas. J Pediatr Adolesc Gynecol. 2022 Aug;35(4):478-485. doi: 10.1016/j.jpag.2022.01.009. Epub 2022 Feb 4. PMID: 35124214.

Abstract
Study objective: To assess the preoperative imaging impression and surgeon diagnostic accuracy for pediatric ovarian mature cystic teratomas (MCTs) DESIGN: Retrospective review SETTING: Eleven pediatric hospitals PARTICIPANTS: Patients ages 2 to 21 who underwent surgical management of an ovarian neoplasm or adnexal torsion with an associated ovarian lesion INTERVENTION: None MAIN OUTCOME MEASURES: Preoperative imaging impression, surgeon diagnosis, tumor markers, and pathology RESULTS: Our cohort included 946 females. Final pathology identified 422 (45%) MCTs, 405 (43%) other benign pathologies, and 119 (12%) malignancies. Preoperative imaging impression for MCTs had a 70% sensitivity, 92% specificity, 88% positive predictive value (PPV), and 79% negative predictive value (NPV). For the preoperative surgeon diagnosis, sensitivity was 59%, specificity 96%, PPV 92%, and NPV 74%. Some measures of diagnostic accuracy were affected by the presence of torsion, size of the lesion on imaging, imaging modality, and surgeon specialty. Of the 352 masses preoperatively thought to be MCTs, 14 were malignancies (4%). Eleven patients with inaccurately diagnosed malignancies had tumor markers evaluated and 82% had at least 1 elevated tumor marker, compared with 49% of those with MCTs.
Conclusions: Diagnostic accuracy for the preoperative imaging impression and surgeon diagnosis is lower than expected for pediatric ovarian MCTs. For all ovarian neoplasms, preoperative risk assessment including a panel of tumor markers and a multidisciplinary review is recommended. This process could minimize the risk of misdiagnosis and improve operative planning to maximize the use of ovarian-sparing surgery for benign lesions and allow for appropriate resection and staging for lesions suspected to be malignant.
Cite
Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchan N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannel M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas. J Pediatr Adolesc Gynecol. 2022 Aug;35(4):478-485. doi: 10.1016/j.jpag.2022.01.009. Epub 2022 Feb 4. PMID: 35124214.

Use and accuracy of intraoperative frozen section analysis for ovarian masses in children and adolescents

Gil LA, Lutz CM, Dillon PA, Downard CD, Ehrlich PF, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Hertweck SP, Hirschl RB, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Raiji MT, Rymeski B, Saito JM, Sato TT, St Peter SD, Stafford LMC, Deans KJ, Minneci PC, Hewitt GD, Aldrink JH; Midwest Pediatric Surgery Consortium. Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents. J Pediatr Adolesc Gynecol. 2023 Apr;36(2):155-159. doi: 10.1016/j.jpag.2022.10.001. Epub 2022 Oct 7. PMID: 36209999.

Abstract
Study objective: Describe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses DESIGN: Prospective cohort study from 2018 to 2021 SETTING: Eleven children's hospitals PARTICIPANTS: Females age 6-21 years undergoing surgical management of an ovarian mass INTERVENTIONS: Obtaining intraoperative FS pathology MAIN OUTCOME MEASURE: Diagnostic accuracy of FS pathology RESULTS: Of 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients, 12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy with or without other procedures. FS results were disparate from final pathology in 7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n = 1), mucinous borderline tumor (n = 2), mucinous carcinoma (n = 1), and immature teratoma (n = 1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology.
Conclusions: FSs are infrequently utilized for pediatric and adolescent ovarian masses and could be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.
Cite
Gil LA, Lutz CM, Dillon PA, Downard CD, Ehrlich PF, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Hertweck SP, Hirschl RB, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Raiji MT, Rymeski B, Saito JM, Sato TT, St Peter SD, Stafford LMC, Deans KJ, Minneci PC, Hewitt GD, Aldrink JH; Midwest Pediatric Surgery Consortium. Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents. J Pediatr Adolesc Gynecol. 2023 Apr;36(2):155-159. doi: 10.1016/j.jpag.2022.10.001. Epub 2022 Oct 7. PMID: 36209999.

Diagnostic Performance of Magnetic Resonance Imaging for Pediatric Ovarian Neoplasms: A Multi-Institutional Review

Bergus KC, Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Markel TA, Merchant N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Diagnostic Performance of Magnetic Resonance Imaging for Pediatric Ovarian Neoplasms: A Multi-Institutional Review. J Pediatr Adolesc Gynecol. 2024 Apr;37(2):192-197. doi: 10.1016/j.jpag.2023.11.006. Epub 2023 Nov 25. PMID: 38008283.

Abstract
Study objective: To assess the diagnostic performance of MRI to predict ovarian malignancy alone and compared with other diagnostic studies.
Methods: A retrospective analysis was conducted of patients aged 2-21 years who underwent ovarian mass resection between 2009 and 2021 at 11 pediatric hospitals. Sociodemographic information, clinical and imaging findings, tumor markers, and operative and pathology details were collected. Diagnostic performance for detecting malignancy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for MRI with other diagnostic modalities.
Results: One thousand and fifty-three patients, with a median age of 14.6 years, underwent resection of an ovarian mass; 10% (110/1053) had malignant disease on pathology, and 13% (136/1053) underwent preoperative MRI. MRI sensitivity, specificity, PPV, and NPV were 60%, 94%, 60%, and 94%. Ultrasound sensitivity, specificity, PPV, and NPV were 31%, 99%, 73%, and 95%. Tumor marker sensitivity, specificity, PPV, and NPV were 90%, 46%, 22%, and 96%. MRI and ultrasound concordance was 88%, with sensitivity, specificity, PPV, and NPV of 33%, 99%, 75%, and 94%. MRI sensitivity in ultrasound-discordant cases was 100%. MRI and tumor marker concordance was 88% with sensitivity, specificity, PPV, and NPV of 100%, 86%, 64%, and 100%. MRI specificity in tumor marker-discordant cases was 100%.
Conclusion: Diagnostic modalities used to assess ovarian neoplasms in pediatric patients typically agree. In cases of disagreement, MRI is more sensitive for malignancy than ultrasound and more specific than tumor markers. Selective use of MRI with preoperative ultrasound and tumor markers may be beneficial when the risk of malignancy is uncertain.
Concise abstract: This retrospective review of 1053 patients aged 2-21 years who underwent ovarian mass resection between 2009 and 2021 at 11 pediatric hospitals found that ultrasound, tumor markers, and MRI tend to agree on benign vs malignant, but in cases of disagreement, MRI is more sensitive for malignancy than ultrasound.
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Bergus KC, Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Markel TA, Merchant N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ; Midwest Pediatric Surgery Consortium. Diagnostic Performance of Magnetic Resonance Imaging for Pediatric Ovarian Neoplasms: A Multi-Institutional Review. J Pediatr Adolesc Gynecol. 2024 Apr;37(2):192-197. doi: 10.1016/j.jpag.2023.11.006. Epub 2023 Nov 25. PMID: 38008283.

Factors Associated With Management of Pediatric Ovarian Neoplasms.

Lawrence AE, Gonzalez DO, Fallat ME, Aldrink JH, Hewitt GD, Hertweck SP, Onwuka A, Bence C, Burns RC, Dillon PA, Ehrlich PF, Fraser JD, Grabowski JE, Hirschl RB, Kabre R, Kohler JE, Lal DR, Landman MP, Leys CM, Mak GZ, Sato TT, Scannell M, Sujka JA, Minneci PC, Deans KJ. Factors Associated With Management of Pediatric Ovarian Neoplasms. Pediatrics. 2019 Jul;144(1):e20182537. doi: 10.1542/peds.2018-2537. Epub 2019 Jun 4. PMID: 31164439.

Abstract
Background: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions.
Methods: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy.
Results: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001).
Conclusions: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.
Cite
Lawrence AE, Gonzalez DO, Fallat ME, Aldrink JH, Hewitt GD, Hertweck SP, Onwuka A, Bence C, Burns RC, Dillon PA, Ehrlich PF, Fraser JD, Grabowski JE, Hirschl RB, Kabre R, Kohler JE, Lal DR, Landman MP, Leys CM, Mak GZ, Sato TT, Scannell M, Sujka JA, Minneci PC, Deans KJ. Factors Associated With Management of Pediatric Ovarian Neoplasms. Pediatrics. 2019 Jul;144(1):e20182537. doi: 10.1542/peds.2018-2537. Epub 2019 Jun 4. PMID: 31164439.

Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients

Minneci PC, Bergus KC, Lutz C, Aldrink J, Bence C, Breech L, Dillon PA, Downard C, Ehrlich PF, Fallat M, Fraser JD, Grabowski J, Helmrath M, Hertweck P, Hewitt G, Hirschl RB, Kabre R, Lal DR, Landman M, Leys C, Mak G, Markel T, Pressey J, Raiji M, Rymeski B, Saito J, Sato TT, St Peter SD, Cooper J, Deans K; Midwest Pediatric Surgery Consortium. Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients. JAMA. 2023 Oct 3;330(13):1247-1254. doi: 10.1001/jama.2023.17183. PMID: 37787794; PMCID: PMC10548301.

Abstract
Importance: Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health.
Objective: To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies.
Design, setting, and participants: Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up.
Intervention: Implementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons.
Main outcomes and measures: Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution.
Results: A total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%.
Conclusions and relevance: Unnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.
Cite
Minneci PC, Bergus KC, Lutz C, Aldrink J, Bence C, Breech L, Dillon PA, Downard C, Ehrlich PF, Fallat M, Fraser JD, Grabowski J, Helmrath M, Hertweck P, Hewitt G, Hirschl RB, Kabre R, Lal DR, Landman M, Leys C, Mak G, Markel T, Pressey J, Raiji M, Rymeski B, Saito J, Sato TT, St Peter SD, Cooper J, Deans K; Midwest Pediatric Surgery Consortium. Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients. JAMA. 2023 Oct 3;330(13):1247-1254. doi: 10.1001/jama.2023.17183. PMID: 37787794; PMCID: PMC10548301.

Reply to Letter to the Editor

Knaus ME, Onwuka AJ, Deans KJ, Minneci PC; Midwest Pediatric Surgery Consortium. Reply to Letter to the Editor by Priyadarsini A, et al. J Pediatr Surg. 2022 Nov;57(11):750. doi: 10.1016/j.jpedsurg.2022.06.016. Epub 2022 Jul 8. PMID: 35906109.

Abstract
No abstract available.
Cite
Knaus ME, Onwuka AJ, Deans KJ, Minneci PC; Midwest Pediatric Surgery Consortium. Reply to Letter to the Editor by Priyadarsini A, et al. J Pediatr Surg. 2022 Nov;57(11):750. doi: 10.1016/j.jpedsurg.2022.06.016. Epub 2022 Jul 8. PMID: 35906109.