Faculty Collaboration Database

Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas. J Pediatr Adolesc Gynecol 2022 Aug;35(4):478-485

Date

02/07/2022

Pubmed ID

35124214

DOI

10.1016/j.jpag.2022.01.009

Scopus ID

2-s2.0-85127368570 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

STUDY OBJECTIVE: To assess the preoperative imaging impression and surgeon diagnostic accuracy for pediatric ovarian mature cystic teratomas (MCTs) DESIGN: Retrospective review SETTING: Eleven pediatric hospitals PARTICIPANTS: Patients ages 2 to 21 who underwent surgical management of an ovarian neoplasm or adnexal torsion with an associated ovarian lesion INTERVENTION: None MAIN OUTCOME MEASURES: Preoperative imaging impression, surgeon diagnosis, tumor markers, and pathology RESULTS: Our cohort included 946 females. Final pathology identified 422 (45%) MCTs, 405 (43%) other benign pathologies, and 119 (12%) malignancies. Preoperative imaging impression for MCTs had a 70% sensitivity, 92% specificity, 88% positive predictive value (PPV), and 79% negative predictive value (NPV). For the preoperative surgeon diagnosis, sensitivity was 59%, specificity 96%, PPV 92%, and NPV 74%. Some measures of diagnostic accuracy were affected by the presence of torsion, size of the lesion on imaging, imaging modality, and surgeon specialty. Of the 352 masses preoperatively thought to be MCTs, 14 were malignancies (4%). Eleven patients with inaccurately diagnosed malignancies had tumor markers evaluated and 82% had at least 1 elevated tumor marker, compared with 49% of those with MCTs.

CONCLUSIONS: Diagnostic accuracy for the preoperative imaging impression and surgeon diagnosis is lower than expected for pediatric ovarian MCTs. For all ovarian neoplasms, preoperative risk assessment including a panel of tumor markers and a multidisciplinary review is recommended. This process could minimize the risk of misdiagnosis and improve operative planning to maximize the use of ovarian-sparing surgery for benign lesions and allow for appropriate resection and staging for lesions suspected to be malignant.

Author List

Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchan N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannel M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ, Midwest Pediatric Surgery Consortium

Author

Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Biomarkers, Tumor
Child
Child, Preschool
Dermoid Cyst
Female
Humans
Ovarian Neoplasms
Retrospective Studies
Teratoma
Young Adult