The role of preoperative imaging and tumor markers in predicting malignant ovarian masses in children

  • Guogang YeEmail author
  • Ting Xu
  • Jiangbin Liu
  • Weijue Xu
  • Zhibao Lv
Original Article



To investigate the clinicopathololgic characteristics and the predicting value of preoperative imaging and tumor markers in children with ovarian masses.


Patients admitted in Shanghai children’s hospital with ovary neoplasms between 2010.01 and 2015.12 were retrospectively analyzed. The medical records including age at operation, presentation of symptoms and signs, tumor marker, imaging, pathology, tumor diameter and surgical choice were reviewed. All data were analyzed using SPSS 17.0


A total of 139 patients were included, among which 116 were benign neoplasms and 23 malignant tumors. There was significance difference relation with the tumor diameter, character, torsion and tumor markers, but not the age, position, calculi, and symptoms. The risk factors include tumor diameters ≥ 10 cm, the odds ratio (OR) was 11, 95% confidence interval (CI) was 3–36, solid/complex tumor (OR 6, 95% CI 2, 14) and positive in tumor markers (OR 84, 95% CI 20, 345). Among the patients with benign neoplasms, 77 of them had laparoscopic ovarian cystectomy while 23 patients with malignant tumors had salpingo-oophorectomy and omentum resection.


Preoperative imaging and tumor markers could help identifying the malignant ovarian masses in children. If tumor diameter ≥ 10 cm, solid/complex in imaging and tumor markers abnormal, a radical resection is mandatory; otherwise, an ovarian-sparing surgery is recommended.


Ovarian mass Ovarian malignancy Children Preoperation 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Human rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Piura B, Dgani R, Zalel Y, Nemet D, Yanai-Inbar I, Cohen Y, Glezerman M (1995) Malignant germ cell tumors of the ovary: a study of 20 cases. J Surg Oncol 59(3):155–161CrossRefGoogle Scholar
  2. 2.
    Lindfors O (1971) Primary ovarian neoplasms in infants and children. A study of 81 cases diagnosed in Finland and Sweden. Ann Chirurgiae Gynaecol Fenniae Suppl 177:1–66Google Scholar
  3. 3.
    Al Jama FE, Al Ghamdi AA, Gasim T, Al Dakhiel SA, Rahman J, Rahman MS (2011) Ovarian tumors in children and adolescents—a clinical study of 52 patients in a university hospital. J Pediatr Adolesc Gynecol 24(1):25–28CrossRefGoogle Scholar
  4. 4.
    von Allmen D (2005) Malignant lesions of the ovary in childhood. Semin Pediatr Surg 14(2):100–105CrossRefGoogle Scholar
  5. 5.
    Al-Badawi IA, AlOmar O, Albadawi N, Abu-Zaid A (2016) Single-port laparoscopic surgery for benign salpingo-ovarian pathology: a single-center experience from Saudi Arabia. Ann Saudi Med 36(1):64–69CrossRefGoogle Scholar
  6. 6.
    Loux T, Falk GA, Gaffley M, Ortega S, Ramos C, Malvezzi L, Knight CG, Burnweit C (2015) Single-incision single-instrument adnexal surgery in pediatric patients. Minimally Invasive Surg 2015:246950CrossRefGoogle Scholar
  7. 7.
    Yousef Y, Pucci V, Emil S (2016) The relationship between intraoperative rupture and recurrence of pediatric ovarian neoplasms: preliminary observations. J Pediatr Adolesc Gynecol 29(2):111–116CrossRefGoogle Scholar
  8. 8.
    Montanari G, Di Donato N, Del Forno S, Benfenati A, Bertoldo V, Vincenzi C, Casadio P, Seracchioli R (2013) Laparoscopic management of early stage ovarian cancer: is it feasible, safe, and adequate? A retrospective study. Eur J Gynaecol Oncol 34(5):415–418PubMedGoogle Scholar
  9. 9.
    Zhang M, Jiang W, Li G, Xu C (2014) Ovarian masses in children and adolescents—an analysis of 521 clinical cases. J Pediatr Adolesc Gynecol 27(3):e73–e77CrossRefGoogle Scholar
  10. 10.
    Oltmann SC, Garcia N, Barber R, Huang R, Hicks B, Fischer A (2010) Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg 45(1):130–134CrossRefGoogle Scholar
  11. 11.
    Papic JC, Finnell SM, Slaven JE, Billmire DF, Rescorla FJ, Leys CM (2014) Predictors of ovarian malignancy in children: overcoming clinical barriers of ovarian preservation. J Pediatric Surg 49(1):144–147 (discussion 147–148)CrossRefGoogle Scholar
  12. 12.
    Akturk E, Dede M, Yenen MC, Kocyigit YK, Ergun A (2015) Comparison of nine morphological scoring systems to detect ovarian malignancy. Eur J Gynaecol Oncol 36(3):304–308PubMedGoogle Scholar
  13. 13.
    Abudukadeer A, Azam S, Zunong B, Mutailipu AZ, Huijun B, Qun L (2016) Accuracy of intra-operative frozen section and its role in the diagnostic evaluation of ovarian tumors. Eur J Gynaecol Oncol 37(2):216–220PubMedGoogle Scholar
  14. 14.
    Spinelli C, Pucci V, Strambi S, Piccolo RL, Martin A, Messineo A (2015) Treatment of ovarian lesions in children and adolescents: a retrospective study of 130 cases. Pediatr Hematol Oncol 32(3):199–206CrossRefGoogle Scholar
  15. 15.
    Stankovic ZB, Sedlecky K, Savic D, Lukac BJ, Mazibrada I, Perovic S (2017) Ovarian preservation from tumors and torsions in girls: prospective diagnostic study. J Pediatr Adolesc Gynecol 30(3):405–412CrossRefGoogle Scholar
  16. 16.
    Bakacak M, Serin S, Ercan O, Kostu B, Bostanci MS, Bakacak Z, Kiran H, Kiran G (2016) Utility of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to distinguish malignant from benign ovarian masses. J Turk German Gynecol Assoc 17(1):21–25CrossRefGoogle Scholar
  17. 17.
    Hermans AJ, Kluivers KB, Siebers AG, Wijnen MH, Bulten J, Massuger LF, Coppus SF (2016) The value of fine needle aspiration cytology diagnosis in ovarian masses in children and adolescents. Hum Reprod 31(6):1236–1240CrossRefGoogle Scholar
  18. 18.
    Amies Oelschlager AM, Gow KW, Morse CB, Lara-Torre E (2016) Management of large ovarian neoplasms in pediatric and adolescent females. J Pediatr Adolesc Gynecol 29(2):88–94CrossRefGoogle Scholar
  19. 19.
    Oue T, Uehara S, Sasaki T, Nose S, Saka R, Yamanaka H, Ueno T, Tazuke Y, Okuyama H (2015) Treatment and ovarian preservation in children with ovarian tumors. J Pediatr Surg 50(12):2116–2118CrossRefGoogle Scholar
  20. 20.
    Hermans AJ, Kluivers KB, Wijnen MH, Bulten J, Massuger LF, Coppus SF (2015) Diagnosis and treatment of adnexal masses in children and adolescents. Obstet Gynecol 125(3):611–615CrossRefGoogle Scholar
  21. 21.
    Billmire D, Vinocur C, Rescorla F, Cushing B, London W, Schlatter M, Davis M, Giller R, Lauer S, Olson T et al (2004) Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study. J Pediatric Surg 39(3):424–429 (discussion 424–429)CrossRefGoogle Scholar
  22. 22.
    Vaysse C, Delsol M, Carfagna L, Bouali O, Combelles S, Lemasson F, Le Mandat A, Castex MP, Pasquet M, Moscovici J et al (2010) Ovarian germ cell tumors in children. Management, survival and ovarian prognosis. A report of 75 cases. J Pediatric Surg 45(7):1484–1490CrossRefGoogle Scholar
  23. 23.
    Gonzalez DO, Minneci PC, Deans KJ (2017) Management of benign ovarian lesions in girls: a trend toward fewer oophorectomies. Curr Opin Obstet Gynecol 29(5):289–294CrossRefGoogle Scholar
  24. 24.
    Epelman M, Chikwava KR, Chauvin N, Servaes S (2011) Imaging of pediatric ovarian neoplasms. Pediatr Radiol 41(9):1085–1099CrossRefGoogle Scholar
  25. 25.
    Spinelli C, Pucci V, Buti I, Liserre J, Messineo A, Bianco F, Ugolini C (2012) The role of tumor markers in the surgical approach of ovarian masses in pediatric age: a 10-year study and a literature review. Ann Surg Oncol 19(6):1766–1773CrossRefGoogle Scholar
  26. 26.
    McDonald JM, Doran S, DeSimone CP, Ueland FR, DePriest PD, Ware RA, Saunders BA, Pavlik EJ, Goodrich S, Kryscio RJ et al (2010) Predicting risk of malignancy in adnexal masses. Obstet Gynecol 115(4):687–694CrossRefGoogle Scholar
  27. 27.
    McCarthy JD, Erickson KM, Smith YR, Quint EH (2010) Premenarchal ovarian torsion and elevated CA-125. J Pediatr Adolesc Gynecol 23(1):e47–50CrossRefGoogle Scholar
  28. 28.
    Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, Frazier AL, Billmire DF, Rescorla FJ, Weil BR et al (2019) Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 54(9):1921–1925CrossRefGoogle Scholar
  29. 29.
    Goldberg HR, Kives S, Allen L, Navarro OM, Lam CZ (2019) Preoperative risk stratification of adnexal masses in the pediatric and adolescent population: evaluating the decision tree system. J Pediatric Adolesc Gynecol. CrossRefGoogle Scholar
  30. 30.
    Lawrence AE, Minneci PC, Deans KJ (2019) Ovary-sparing surgery for benign pediatric ovarian masses. Curr Opin Pediatr 31(3):386–390CrossRefGoogle Scholar
  31. 31.
    Mokhles P, Ahmadi A, Rahehagh R, Soofizadeh N, Ghaderi E (2019) Compatibility of the frozen section method in histopathological specimens for female pelvic masses with results for pathology and tumor markers. Med J Islam Republ Iran 33:42Google Scholar
  32. 32.
    Bhardwaj S, Ahluwalia C, Yadav AK, Zaheer S, Kolte S, Arora R (2019) Comparative diagnostic accuracy of frozen sections and scrape cytology in ovarian neoplasms. J Mid-life Health 10(2):89–92Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Guogang Ye
    • 1
    Email author
  • Ting Xu
    • 1
  • Jiangbin Liu
    • 1
  • Weijue Xu
    • 1
  • Zhibao Lv
    • 1
  1. 1.Department of General Surgery, Shanghai Children’s HospitalShanghai Jiao Tong UniversityShanghaiChina

Personalised recommendations