Factors associated with management of pediatric ovarian neoplasms

Amy E. Lawrence, Dani O. Gonzalez, Mary E. Fallat, Jennifer H. Aldrink, Geri D. Hewitt, S. Paige Hertweck, Amanda Onwuka, Christina Bence, Robert C. Burns, Patrick A. Dillon, Peter F. Ehrlich, Jason D. Fraser, Julia E. Grabowski, Ronald B. Hirschl, Rashmi Kabre, Jonathan E. Kohler, Dave R. Lal, Matthew P. Landman, Charles M. Leys, Grace Z. MakThomas T. Sato, Madeline Scannell, Joseph A. Sujka, Peter C. Minneci, Katherine J. Deans*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

Original languageEnglish (US)
Article numbere20182537
JournalPediatrics
Volume144
Issue number1
DOIs
StatePublished - Jan 1 2019

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Ovarian Neoplasms
Ovariectomy
Pediatrics
Neoplasms
Ovarian Diseases
Ovary
Logistic Models
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lawrence, A. E., Gonzalez, D. O., Fallat, M. E., Aldrink, J. H., Hewitt, G. D., Hertweck, S. P., ... Deans, K. J. (2019). Factors associated with management of pediatric ovarian neoplasms. Pediatrics, 144(1), [e20182537]. https://doi.org/10.1542/peds.2018-2537
Lawrence, Amy E. ; Gonzalez, Dani O. ; Fallat, Mary E. ; Aldrink, Jennifer H. ; Hewitt, Geri D. ; Hertweck, S. Paige ; Onwuka, Amanda ; Bence, Christina ; Burns, Robert C. ; Dillon, Patrick A. ; Ehrlich, Peter F. ; Fraser, Jason D. ; Grabowski, Julia E. ; Hirschl, Ronald B. ; Kabre, Rashmi ; Kohler, Jonathan E. ; Lal, Dave R. ; Landman, Matthew P. ; Leys, Charles M. ; Mak, Grace Z. ; Sato, Thomas T. ; Scannell, Madeline ; Sujka, Joseph A. ; Minneci, Peter C. ; Deans, Katherine J. / Factors associated with management of pediatric ovarian neoplasms. In: Pediatrics. 2019 ; Vol. 144, No. 1.
@article{261baa3ff62e42d690b3895876888028,
title = "Factors associated with management of pediatric ovarian neoplasms",
abstract = "BACKGROUND: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11{\%}. The overall oophorectomy rate for benign disease was 33{\%} (range: 15{\%}-49{\%}) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45{\%}; pediatric surgeon, 32{\%}; pediatric gynecologist, 18{\%}), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.",
author = "Lawrence, {Amy E.} and Gonzalez, {Dani O.} and Fallat, {Mary E.} and Aldrink, {Jennifer H.} and Hewitt, {Geri D.} and Hertweck, {S. Paige} and Amanda Onwuka and Christina Bence and Burns, {Robert C.} and Dillon, {Patrick A.} and Ehrlich, {Peter F.} and Fraser, {Jason D.} and Grabowski, {Julia E.} and Hirschl, {Ronald B.} and Rashmi Kabre and Kohler, {Jonathan E.} and Lal, {Dave R.} and Landman, {Matthew P.} and Leys, {Charles M.} and Mak, {Grace Z.} and Sato, {Thomas T.} and Madeline Scannell and Sujka, {Joseph A.} and Minneci, {Peter C.} and Deans, {Katherine J.}",
year = "2019",
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Lawrence, AE, Gonzalez, DO, Fallat, ME, Aldrink, JH, Hewitt, GD, Hertweck, SP, Onwuka, A, Bence, C, Burns, RC, Dillon, PA, Ehrlich, PF, Fraser, JD, Grabowski, JE, Hirschl, RB, Kabre, R, Kohler, JE, Lal, DR, Landman, MP, Leys, CM, Mak, GZ, Sato, TT, Scannell, M, Sujka, JA, Minneci, PC & Deans, KJ 2019, 'Factors associated with management of pediatric ovarian neoplasms', Pediatrics, vol. 144, no. 1, e20182537. https://doi.org/10.1542/peds.2018-2537

Factors associated with management of pediatric ovarian neoplasms. / Lawrence, Amy E.; Gonzalez, Dani O.; Fallat, Mary E.; Aldrink, Jennifer H.; Hewitt, Geri D.; Hertweck, S. Paige; Onwuka, Amanda; Bence, Christina; Burns, Robert C.; Dillon, Patrick A.; Ehrlich, Peter F.; Fraser, Jason D.; Grabowski, Julia E.; Hirschl, Ronald B.; Kabre, Rashmi; Kohler, Jonathan E.; Lal, Dave R.; Landman, Matthew P.; Leys, Charles M.; Mak, Grace Z.; Sato, Thomas T.; Scannell, Madeline; Sujka, Joseph A.; Minneci, Peter C.; Deans, Katherine J.

In: Pediatrics, Vol. 144, No. 1, e20182537, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with management of pediatric ovarian neoplasms

AU - Lawrence, Amy E.

AU - Gonzalez, Dani O.

AU - Fallat, Mary E.

AU - Aldrink, Jennifer H.

AU - Hewitt, Geri D.

AU - Hertweck, S. Paige

AU - Onwuka, Amanda

AU - Bence, Christina

AU - Burns, Robert C.

AU - Dillon, Patrick A.

AU - Ehrlich, Peter F.

AU - Fraser, Jason D.

AU - Grabowski, Julia E.

AU - Hirschl, Ronald B.

AU - Kabre, Rashmi

AU - Kohler, Jonathan E.

AU - Lal, Dave R.

AU - Landman, Matthew P.

AU - Leys, Charles M.

AU - Mak, Grace Z.

AU - Sato, Thomas T.

AU - Scannell, Madeline

AU - Sujka, Joseph A.

AU - Minneci, Peter C.

AU - Deans, Katherine J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

AB - BACKGROUND: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

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DO - 10.1542/peds.2018-2537

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Lawrence AE, Gonzalez DO, Fallat ME, Aldrink JH, Hewitt GD, Hertweck SP et al. Factors associated with management of pediatric ovarian neoplasms. Pediatrics. 2019 Jan 1;144(1). e20182537. https://doi.org/10.1542/peds.2018-2537