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 which patients may or
may not benefit from an ovarian-sparing approach. This proposed strategy
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.
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