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Pediatrics. 2019 Jul;144(1). pii: e20182537. doi: 10.1542/peds.2018-2537. Epub 2019 Jun 4.

Factors Associated With Management of Pediatric Ovarian Neoplasms.

Author information

1
Division of Pediatric Surgery, Department of Surgery and the Research Institute and.
2
Department of Surgery, Mt. Sinai Hospital, New York, New York.
3
Divisions of Pediatric Surgery and.
4
Division of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio.
5
Pediatric and Adolescent Gynecology, Norton Children's Hospital and School of Medicine, University of Louisville, Louisville, Kentucky.
6
Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
7
Division of Pediatric Surgery, Department of Surgery, School of Medicine, Indiana University, Indianapolis, Indiana.
8
Division of Pediatric Surgery, Department of Surgery, School of Medicine, Washington University, St Louis, Missouri.
9
Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
10
Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri.
11
Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
12
Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin; and.
13
Section of Pediatric Surgery, Department of Surgery, the University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
14
Division of Pediatric Surgery, Department of Surgery and the Research Institute and katherine.deans@nationwidechildrens.org.

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.

PMID:
31164439
DOI:
10.1542/peds.2018-2537
[Indexed for MEDLINE]

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