Arin L Madenci1, Bat-Sheva Levine2, Marc R Laufer3, Theonia K Boyd4, Stephen D Voss5, David Zurakowski6, A Lindsay Frazier7, Christopher B Weldon8. 1. 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. 2. Division of Endocrinology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. 3. Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. 4. Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. 5. Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. 6. 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. 7. Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer Center and Harvard Medical School, Boston, MA, USA. 8. 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.
Abstract
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.
BACKGROUND: The appropriate operative approach to pediatricpatients 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.
Authors: Amy E Lawrence; Mary E Fallat; Geri Hewitt; Paige Hertweck; Amanda Onwuka; Amin Afrazi; Christina Bence; Robert C Burns; Kristine S Corkum; Patrick A Dillon; Peter F Ehrlich; Jason D Fraser; Dani O Gonzalez; Julia E Grabowski; Rashmi Kabre; Dave R Lal; Matthew P Landman; Charles M Leys; Grace Z Mak; R Elliott Overman; Brooks L Rademacher; Manish T Raiji; Thomas T Sato; Madeline Scannell; Joseph A Sujka; Tiffany Wright; Peter C Minneci; Katherine J Deans; Jennifer H Aldrink Journal: J Pediatr Surg Date: 2019-10-25 Impact factor: 2.545
Authors: Justyna Łuczak; Maciej Bagłaj; Piotr Dryjański; Alicja Kalcowska; Nastazja Banaszyk-Pucała; Maria Boczar; Krzysztof Dymek; Małgorzata Fryczek; Kaja Giżewska-Kacprzak; Wojciech Górecki; Andrzej Grabowski; Anna Gregor; Maria Jabłońska; Grzegorz Kowalewski; Magdalena Lewandowska; Maria Małowiecka; Anna Ogorzałek; Magdalena Pękalska; Aneta Piotrowska-Gall; Mateusz Porębski; Marek Siewiński; Dariusz Patkowski Journal: Curr Oncol Date: 2022-02-28 Impact factor: 3.677