Multi-institutional review of the preoperative diagnostic accuracy for pediatric ovarian mature cystic teratomas
Authors
Maria E. Knaus, Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Amanda J. Onwuka, Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Amin Afrazi, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.Follow
Lesley Breech, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.Follow
Kristine S. Corkum, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Follow
Patrick A. Dillon, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Peter F. Ehrlich, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan.
Mary E. Fallat, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky.
Jason D. Fraser, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
Samir K. Gadepalli, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan.
Julia E. Grabowski, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
S Paige Hertweck, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky.
Rashmi Kabre, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Dave R. Lal, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
Matthew P. Landman, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana.
Amy E. Lawrence, Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Charles M. Leys, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Grace Z. Mak, Advocate Aurora Health
Troy A. Markel, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana.
Naila Merchan, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
R Elliott Overman, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan.
Brooks L. Rademacher, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Manish T. Raiji, Advocate Aurora HealthFollow
Beth Rymeski, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Thomas T. Sato, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
Madeline Scannel, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Allegra G. Schikler, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky.
Joseph A. Sujka, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
Tiffany Wright, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky.
Jennifer H. Aldrink, Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.Follow
et al
Recommended Citation
Knaus ME, Onwuka AJ, Afrazi A, et al. Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas. J Pediatr Adolesc Gynecol. 2022;35(4):478-485. doi:10.1016/j.jpag.2022.01.009
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.
