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Master of Public Health

Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas

AUTHORS

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 , Merchant 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 , , . Journal of pediatric and adolescent gynecology. 2022 2 3; ().

ABSTRACT

STUDY OBJECTIVE: 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 2-21 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 ≥1 elevated tumor marker, compared to 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 may 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.

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