Amy E Lawrence1, Mary E Fallat2, Geri Hewitt3, Paige Hertweck4, Amanda Onwuka5, Amin Afrazi6, Christina Bence7, Robert C Burns8, Kristine S Corkum9, Patrick A Dillon10, Peter F Ehrlich11, Jason D Fraser12, Dani O Gonzalez1, Julia E Grabowski9, Rashmi Kabre9, Dave R Lal7, Matthew P Landman8, Charles M Leys6, Grace Z Mak13, R Elliott Overman11, Brooks L Rademacher6, Manish T Raiji13, Thomas T Sato7, Madeline Scannell10, Joseph A Sujka1, Tiffany Wright2, Peter C Minneci1, Katherine J Deans1, Jennifer H Aldrink14. 1. Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. 2. Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY. 3. Department of Surgery, Division of Pediatric and Adolescent Gynecology, The Ohio State University, Nationwide Children's Hospital, Columbus, OH. 4. Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY; Department of Obstetrics and Gynecology, Louisville University School of Medicine, Louisville, KY. 5. Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH. 6. Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 7. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 8. Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. 9. Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. 10. Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 11. Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI. 12. Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO. 13. Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL. 14. Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. Electronic address: Jennifer.Aldrink@nationwidechildrens.org.
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.
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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