High rates of oophorectomy for benign ovarian neoplasms in pediatric population

1. In this multicenter retrospective cohort study, pediatric patients with an ovarian neoplasm had high rates of oophorectomy despite low rates of malignancy. Premenarchal status, clinical symptoms on presentation, concerning features on imaging, and having the surgery performed by an adult gynecologist or pediatric surgeon were all associated with increased rate of oophorectomy.

2. Researchers identified various factors associated with a neoplasm being malignant including younger age, larger size, and a solid component or lymphadenopathy on imaging.

Evidence Rating Level: 2 (Good)

Study Rundown: Ovarian masses are relatively rare in the pediatric population, and the majority of masses which are detected are ultimately determined to be benign. Despite the rarity of malignant tumors, up to 50% of pediatric patients with ovarian masses receive oophorectomy (in which the whole ovary is removed), rather than ovarian sparing resections (in which the neoplastic portion is resected). In this retrospective cohort study, researchers assessed for factors associated with malignancy as well as those associated with patients undergoing oophorectomy versus ovarian sparing surgery. Researchers found that despite only 11% of ovarian tumors being malignant, a third of patients underwent oophorectomy. Patients receiving oophorectomy were more likely to be premenarchal, have symptoms such as abdominal bloating and constipation, and exhibit red flags on imaging (e.g. larger lesion size, septations, solid components, extension, and complex features). Additionally, pediatric surgeons and adult gynecologists were more likely than pediatric/adolescent gynecologists to perform oophorectomies. Factors associated with a tumor malignancy included younger patient age, larger size, and a solid component or lymphadenopathy on imaging. These findings suggest a need for additional investigation and the creation of a formalized preoperative risk stratification to determine which patients are appropriate for oophorectomy versus ovarian sparing surgery.

Click here to read the original article, published today in Pediatrics

Relevant Reading: Pediatric Ovarian Tumors – Dilemmas in Diagnosis and Management

In-Depth [retrospective cohort]: Participants included patients ages 2 to 21 years with ovarian neoplasms who were surgically managed between January 1, 2010, and December 31, 2016, at any 1 of 10 institutions of the Midwest Pediatric Surgery Consortium. Primary outcomes included identifying risk factors for malignant ovarian neoplasms based on postoperative pathology reports and clarifying clinical features associated with oophorectomies for benign neoplasms. 819 patients were ultimately included in the study (median age 14.6 years, 63% non-Hispanic white). 725 (89%) of the lesions identified were benign; 94 (11%) were malignant. In patients with benign neoplasms, 33% received oophorectomy or salpingo-oophorectomy, with oophorectomy rates ranging from 15% to 49% across the 10 institutions. Patients who underwent oophorectomy were more likely to be premenarchal (24.6% vs. 18.4% for ovarian sparing, P = .04), have abdominal bloating (P = .03) and constipation (P < .001) on presentation, have preoperative suspicion of malignancy based on imaging (P from .01 to < .001, based on imaging feature), and have their surgery done by an adult gynecologist (OR 4.23, CI: 2.08-8.62) or pediatric surgeon (OR 2.68, CI 1.12 – 6.41) as opposed to a pediatric and adolescent gynecologist. Younger age (13.8 vs. 14.6 years, P = .003), size of mass (14.4 cm vs. 7.6 cm, P < .001), solid components (P < .001), and lymphadenopathy on imaging (p < .001), among other factors, were associated with malignant neoplasms.

Image: PD

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