Can we preoperatively risk stratify ovarian masses for malignancy?

Sarah C. Oltmann, Nilda Garcia, Robert Barber, Rong Huang, Barry Hicks, Anne Fischer

Research output: Contribution to journalArticle

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Abstract

Purpose: 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 151/2-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 (β-HCG), alpha fetoprotein (αFP), and cancer antigen 125 (CA-125) were significantly associated with malignancy (P < .02) and an elevated carcinoembryonic antigen (CEA) was not (P = .1880). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)130-134
Number of pages5
JournalJournal of Pediatric Surgery
Volume45
Issue number1
DOIs
StatePublished - Jan 2010

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Neoplasms
Precocious Puberty
Research Ethics Committees
Odds Ratio
Confidence Intervals
Tumor Biomarkers
Pediatrics
Carcinoembryonic Antigen
alpha-Fetoproteins
Chorionic Gonadotropin
Germ Cells
Age Groups
Antigens
Pain
Incidence

Keywords

  • Gynecology
  • Ovarian malignancy
  • Ovarian mass
  • Pediatric surgery

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Can we preoperatively risk stratify ovarian masses for malignancy? / Oltmann, Sarah C.; Garcia, Nilda; Barber, Robert; Huang, Rong; Hicks, Barry; Fischer, Anne.

In: Journal of Pediatric Surgery, Vol. 45, No. 1, 01.2010, p. 130-134.

Research output: Contribution to journalArticle

Oltmann, Sarah C. ; Garcia, Nilda ; Barber, Robert ; Huang, Rong ; Hicks, Barry ; Fischer, Anne. / Can we preoperatively risk stratify ovarian masses for malignancy?. In: Journal of Pediatric Surgery. 2010 ; Vol. 45, No. 1. pp. 130-134.
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abstract = "Purpose: 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 151/2-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 (β-HCG), alpha fetoprotein (αFP), and cancer antigen 125 (CA-125) were significantly associated with malignancy (P < .02) and an elevated carcinoembryonic antigen (CEA) was not (P = .1880). Conclusion: 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.",
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N2 - Purpose: 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 151/2-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 (β-HCG), alpha fetoprotein (αFP), and cancer antigen 125 (CA-125) were significantly associated with malignancy (P < .02) and an elevated carcinoembryonic antigen (CEA) was not (P = .1880). Conclusion: 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.

AB - Purpose: 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 151/2-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 (β-HCG), alpha fetoprotein (αFP), and cancer antigen 125 (CA-125) were significantly associated with malignancy (P < .02) and an elevated carcinoembryonic antigen (CEA) was not (P = .1880). Conclusion: 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.

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