目的:评估小儿卵巢成熟囊性畸胎瘤(MCT)的术前影像学印象和外科医生诊断准确性设计:回顾性回顾地点:11家儿科医院参与者:2至21岁接受卵巢肿瘤或附件扭转手术治疗并伴有卵巢病变的患者中间:无主要预后措施:术前影像学印象,外科医生诊断,肿瘤标志物,病理结果:我们的队列包括946名女性。最终病理确定422(45%)MCT,405(43%)其他良性病变,和119(12%)恶性肿瘤。MCT的术前成像印象有70%的敏感度,92%的特异性,88%阳性预测值(PPV),和79%的阴性预测值(NPV)。对于术前外科医生的诊断,灵敏度为59%,特异性96%,PPV92%,和净现值74%。一些诊断准确性的措施受到扭转的影响,影像学上病变的大小,成像模式,和外科医生专业。在术前被认为是MCT的352个肿块中,14例为恶性肿瘤(4%)。11例诊断不准确的恶性肿瘤患者进行了肿瘤标志物评估,82%的患者至少有1个肿瘤标志物升高,与MCT的49%相比。
结论:术前影像印象和外科医生诊断的诊断准确性低于小儿卵巢MCT的预期。对于所有卵巢肿瘤,建议进行术前风险评估,包括一组肿瘤标志物和多学科回顾.此过程可以最大程度地减少误诊的风险,并改善手术计划,以最大程度地利用保留卵巢的手术治疗良性病变,并允许对怀疑为恶性的病变进行适当的切除和分期。
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.