Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review

Renaud, Elizabeth; Sømme, Stig; Islam, Saleem; Cameron, Danielle B.; Gates, Robert L.; Williams, Regan F.; Jancelewicz, Tim; Oyetunji, Tolulope A.; Grabowski, Julia; Diefenbach, Karen A.; Baird, Robert; Arnold, Meghan A.; Lal, Dave R.; Shelton, Julia; Guner, Yigit S.; Gosain, Ankush; Kawaguchi, Akemi L.; Ricca, Robert L.; Goldin, Adam B.; Dasgupta, Roshni

doi:10.1016/j.jpedsurg.2018.08.058

Cited by 67 publications

(65 citation statements)

References 69 publications

(177 reference statements)

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“…CA 125 N 35 U/mL CA 19-9 N 37 U/mL AFP N 10 ng/mL Quantitative beta-hCG N 2.3 mIU/mL LDH N 170 U/L CEA N 3 ng/mL Inhibin A N 80 pg/mL Inhibin B N 44 pg/mL for age 2-5 years; N 27 pg/mL for age 5-8; N 67 pg/mL for age [8][9][10][11]; N 120 pg/mL for age 11-14; and N 136 pg/mL for age 14-21. The rate of testing for tumor markers in this high-risk cohort varied considerably ( Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…Recently, efforts are being made to promote ovary-sparing surgery in the appropriate setting [5][6][7]. However, one of the challenges facing surgeons is how best to preoperatively risk stratify the patient who presents with an ovarian neoplasm [3,4,[8][9][10]. Elements of the patient's history, physical exam, imaging, and laboratory testing may be used to determine the best operative approach for patients with ovarian masses that are concerning for malignancy.…”

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confidence: 99%

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Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms

Lawrence

Fallat

Hewitt

et al. 2020

Journal of Pediatric Surgery

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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.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms

Lawrence

Fallat

Hewitt

et al. 2020

Journal of Pediatric Surgery

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“…[12,15,16] We think that the negative tumor markers should encourage ovarian sparing surgery as the likelihood of malignancy is significantly low. [17] Although malignanant potential of heterogenous lesions is hard to define, pure cystic lesions should always be managed conservatively as cystadenomas are the most neoplastic conditions in such cases. [13] Although not adequate, the ovarian sparing rate is higher in ovarian torsions than ovarian tumors and it was not possible if the patient had a torsed tumor.…”

Section: Discussionmentioning

confidence: 99%

Çocuklarda Over Tümörlerinin Ve Adneks Torsiyonlarının Sağaltımı; Nasıl Kurtarabiliriz?

Yağız¹,

Karaman²,

Erdoğan³

2019

Journal of Contemporary Medicine

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Background/Aims: Although rare, torsion and malignancy of the uterine adnexa, are a common concern of differential diagnosis while dealing with abdominal pain in girlsMethods:Forty-seven patients  who were operated for adnexal torsion or ovarian tumor between March 2004 and December 2010 are enrolled in the study. Results:Twenty one patients had torsion of the uterine adnexa, 18 had ovarian tumors and 8 had an ovarian tumor with torsion. The rate of radical surgery was 47% in torsion which was elevated to 72% in tumor and 100% in tumors with torsion. In ovarian torsion, the rate of radical surgery and adnexal sparing were not different between early versus late presenting cases. Conclusions: Despite encouraging data in the literature favor ovarian sparing, radical surgery still seems to remain high in girls with adnexal torsion and tumors. Ovarian sparing seems possible in tumors but further studies are needed to determine the best management strategy. 

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“…From a surgical perspective, patients presenting with an ovarian mass undergo a pre-operative assessment with imaging (typically USS and MRI) and serum tumor marker estimation [19,20]. There has been a gradual move by pediatric surgeons to adopt fertility preserving approaches where possible [19][20][21], i.e. electing to perform an ovarian cystectomy rather than oophorectomy where pre-operative imaging and tumor markers suggest a likely non-malignant diagnosis.…”

Section: Surgical Staging and Ovarian Preservationmentioning

confidence: 99%

Recurrent ovarian immature teratoma in a 12-year-old girl: Implications for management

Frazer

Hook

Addley

et al. 2019

Gynecologic Oncology

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Immature teratomas (IT) are rare and recurrences uncommon. A 12-year-old female with grade 3 (high-grade) ovarian IT underwent surgical resection but experienced early recurrences; the first was treated with surgery but the second was metastatic and managed with chemotherapy, resulting in growing-teratoma-syndrome and need for further surgery. She now remains well in uneventful clinical follow-up. We believe chemotherapy could be reserved for very carefully selected recurrent IT cases, which may alter the natural history of disease.

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Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review

Abstract: Level 1-4 (mainly 3-4).

Cited by 67 publications

References 69 publications

Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms

Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms

Çocuklarda Over Tümörlerinin Ve Adneks Torsiyonlarının Sağaltımı; Nasıl Kurtarabiliriz?

Recurrent ovarian immature teratoma in a 12-year-old girl: Implications for management

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