Contraception-Related Venous Thromboembolism in a Pediatric Institution

Study ObjectiveTo define the thrombotic risk factors of young women presenting to a children's hospital with hormonal contraception-related venous thromboembolism (VTE). We hypothesized that the majority of patients would have additional risk factors for VTE.DesignClinical and laboratory data obtained retrospectively from electronic medical records concerning history of presentation, body mass index (BMI), medical and family history, medication profile, and relevant laboratory studies.SettingNationwide Children's Hospital in Columbus, Ohio, November 2008-May 2012.ParticipantsTwenty-six female patients, age 12-21 years, admitted for hormonal contraception-related VTE.ResultsFifty-seven VTE cases were reviewed, and 26 were identified as contraception-related VTE. 96% of patients had at least 1 additional risk factor for VTE, and 42% of patients had 2 or more additional risk factors. 50% patients had a BMI ≥25 kg/m². 35% of patients had a positive family history of VTE in a first or second-degree relative. 27% of patients were subsequently diagnosed with an inherited thrombophilia, 5 of whom had a positive family history.ConclusionIn a small population of adolescents presenting to a children's hospital with contraception-related VTE, the majority of patients had multiple risk factors for VTE. Obesity was the most common additional risk factor (50%) identified in our study population. More research is needed regarding the impact of obesity on contraception-related VTE in young women, and whether the presence of obesity should influence thrombophilia screening practices prior to prescribing contraception.     

Bleeding disorders in teenagers presenting with menorrhagia

OBJECTIVE: To assess the prevalence of bleeding disorders and establish the clinical variables that are predictive of a bleeding disorder in adolescent women. DESIGN: A retrospective audit of all patients who had coagulation tests following presentation with menorrhagia. SETTING: Inpatient and outpatients of a tertiary adolescent gynaecology service. PATIENTS: Subjects aged 9-19 years with menorrhagia who had coagulation tests performed, and who did not have a known bleeding disorder prior to presentation were included. OUTCOME MEASURES: A bleeding screen was performed to assess prevalence of bleeding disorders in the population. Variables that were investigated as predictive of a bleeding disorder included clinical history, family history, and haematological indices of blood loss. RESULTS: The prevalence of an inherited bleeding disorder was 10.4%. The only statistically significant predictor was a family history of bruising and bleeding. Menstrual history was not predictive. CONCLUSION: Severity of menstrual loss was not predictive of a bleeding disorder, as a significant cause of teenage metrostaxis is due to anovulatory dysfunctional uterine bleeding. The authors recommend that a careful personal and family history of bruising and bleeding be taken in all teenagers who present de novo with menorrhagia. Routine screening in a primary care setting is impractical, but should be mandatory in all patients with a positive family history.     

Inherited thrombophilia and venous thromboembolism

Pulmonary thromboembolism (PTE) is the major cause of maternal death in the UK. Underlying PTE is the problem of deep venous thrombosis (DVT). Inherited thrombophilia will be found in about 50% of women with a personal history of venous thromboembolism (VTE), and screening for thrombophilia should be considered in women with a personal or family history of VTE. There is currently no place for universal screening for thrombophilia in pregnancy. There are particular considerations with regard to the management of thrombophilia in pregnancy. Low-molecular-weight heparins are now the heparin of choice in pregnancy because of a better side-effect profile (substantially reduced risk of heparin-induced osteoporosis and heparin-induced thrombocytopaenia) compared to unfractionated heparin, good safety record for mother and fetus and convenient once-daily dosing for prophylaxis.     

Diagnostic Performance of a Sonographic Volume and Solid Vascular Tissue Score (VSVTS) for Preoperative Risk Assessment of Pediatric and Adolescent Adnexal Masses

Study ObjectiveTo evaluate the diagnostic performance of a Volume and Solid Vascular Tissue Score (VSVTS) for preoperative risk assessment of pediatric and adolescent adnexal masses.DesignA retrospective cohort study comprised of all female individuals who presented with an adnexal mass that was managed surgically between April 2011 and March 2016.SettingThe Hospital for Sick Children (Toronto, Ontario, Canada).ParticipantsFemale individuals 1–18 years of age who presented to a large tertiary pediatric hospital with an adnexal mass that was managed surgically.Main Outcome MeasuresMain outcome measures included diagnostic performance of the VSVTS for malignancy via sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR?), and receiver operating characteristic area-under-the-curve (AUC) analysis.ResultsA total of 179 masses in 169 subjects were included. The malignancy rate was 10.6%. The AUC for the VSTVS was 0.919. A VSTVS cut-off value of 4 achieved a sensitivity of 79% (95% CI 0.54-0.93), specificity of 88% (95% CI 0.82-0.93), PPV of 0.44 (95% CI 0.33-0.56), NPV of 0.97 (95% CI 0.94-0.99), LR+ of 6.77 (95% CI 4.18-10.97), and LR? of 0.24 (95% CI 0.10-0.57).ConclusionsA sonographic scoring system based on the volume and presence of solid vascular tissue improves PPV for preoperative risk stratification of adnexal masses in the pediatric and adolescent population compared to existing ultrasound-only approaches. Further prospective research is needed to determine how best to incorporate components of such scoring systems into clinical management algorithms.     

Second trimester Down syndrome serum screening--results from a pilot study

The results from a pilot prospective study--second trimester Down syndrome [DS] serum screening between 15 and 21 w.g. with two markers (alpha-fetoprotein and free bb-hCG)--were summarised. Sensitivity, false-positive rate [FPR], positive predictive value [PPV] of the screen positive and negative predictive value [NPV] of the screen negative result for the sbgroups II and below 35 years of age were analysed. The uptake for invasive prenatal testing in screen positive patients and the percentage of terminated pregnancies with prenatally diagnosed DS fetuses as well as the ratio "lost unaffected pregnancies/1 DS fetus diagnosed antenatally" were also calculated. High sensitivity of the DS serum screening was achieved--75% and 87.5% in the subgroups below and II the age of 35 respectively with 6.6 and 31.7% FPR. With higher DS age risk the PPV of the screen positive test was higher and the NPV of the screen negative result--lower. The percentage of invasive prenatal testing in screen positive patients was high (average 83.4%) without significant differences in the two age subgroups. Pregnancy was terminated in all cases with antenatally diagnosed DS fetuses. The ratio "lost unaffected pregnancies/1 DS fetus diagnosed antenatally" for serum screening was lower compared to the same ratio when screening by age. The results from our pilot study (serum screening sensitivity and FPR, uptake for invasive testing in screen-positive cases) are comparable to the ones reported in literature. This is an important prerequisite for introduction of mass DS screening for our population.     

Role of human papillomavirus (HPV) testing in the follow-up of patients after treatment for cervical precancerous lesions

OBJECTIVE: To evaluate the role of human papillomavirus (HPV) testing in post-treatment follow-up of patients after therapeutic excision of the cervix due to positive screening tests. STUDY DESIGN: A hospital-based retrospective analysis was performed with prospective collection of patient data of women screened for cervical cancer at a Gynecologic Outpatient Clinic. Patients after therapeutic excision due to positive screening results were identified and followed up with HPV testing and serial cytology. RESULTS: After 61 treatment for cervicalis intraepithelialis neoplasia (CIN), high-risk HPV infection was detected during the post-treatment follow-up at 18 cases (29.5%), 10 of them had persisting cytological atypia (positive predictive value (PPV): 56%), 5 developed CIN (PPV: 28%). When the HPV test was negative (43 patients) in the post-treatment period, neither CIN nor persisting cytological atypia developed (negative predictive value (NPV): 100%) during 1201 patient months (median 26 months). CONCLUSIONS: A negative HPV test eliminates the risk of recurrent disease after treatment for CIN.     

Inherited thrombophilias

Many inherited thrombophilias have been detected and the pathophysiologic insight has increased tremendously during the last decades. Despite, however, the overwhelming observational evidence on the association between inherited thrombophilia and several women's health issues, including VTE, thus far the implications for clinical practice are uncertain. Although there is firm epidemiologic evidence that is helpful in counseling women who have inherited thrombophilia to prevent a first or recurrent VTE, the uncertainty is particularly present for women who have other pregnancy complications, such as recurrent pregnancy loss and pre-eclampsia. For this group, well-designed placebo-controlled trials to assess the harm-benefit ratio are urgently needed.     

The utility of thrombophilia testing in pregnant women with thrombosis: fact or fiction?

Women who either present with an episode of acute venous thrombosis in pregnancy or who have a history of venous thrombosis who present for prenatal care often undergo testing for inherited thrombophilia. The rationale for screening may include questions about whether screening for inherited thrombophilias can help to alter anticoagulation plans in a pregnancy complicated by venous thrombosis, whether patients with a history of venous thrombosis who present for care in a subsequent pregnancy require anticoagulation and at what intensity, whether knowledge of thrombophilia changes the duration and intensity of anticoagulation outside pregnancy, and whether screening of family members is warranted. Data regarding these issues are reviewed, controversies surrounding thrombophilia testing in this setting are discussed, and clinical recommendations are made.     

The clinical utility of the roll-over test in predicting pregnancy-induced hypertension in a high-risk Andean population

The utility of the roll-over test (ROT) as a prognostic tool for predicting pregnancy-induced hypertension (PIH) was examined in primiparas in Quito, Ecuador. In Study I, 14 of 16 subjects with a +ROT developed PIH (positive predictive value (PPV) = 88%); only 2 of 27 subjects with a -ROT developed PIH (negative predictive value (NPV) = 92.5%). In Study II (n = 66), the PPV and NPV were 71.4% and 78.6%, respectively. Data from these and previous studies indicate that although the ROT is not a perfect predictor, its advantages recommend usage in populations with high PIH-associated maternal and perinatal mortality.     

Thrombophilia and antithrombotic therapy in women with recurrent spontaneous abortions

OBJECTIVE: To investigate the association between thrombophilia and recurrent spontaneous abortions (RSAs) and to evaluate the efficacy of anticoagulant treatment. STUDY DESIGN: All couples with a history of RSAs were studied by immunologic tests and determination of coagulation factors. Low-molecular-weight heparin and low-dose aspirin daily during pregnancy were used in 29 selected cases with acquired and inherited thrombophilia. The control group included 23 women with a history of RSAs and tests positive for thrombophilia who declined to receive medication during pregnancy. RESULTS: All couples with a history of RSAs were studied by immunologic tests and determination of coagulation factors. Low-molecular-weight heparin and low-dose aspirin daily during pregnancy were used in 29 selected cases with acquired and inherited thrombophilia. The control group included 23 women with a history of RSAs and tests positive for thrombophilia who declined to receive medication during pregnancy. CONCLUSION: All couples with RSAs require screening for thrombophilia. Low-molecular-weight heparin and low-dose aspirin daily during pregnancy appear to have a favorable effect on pregnancy outcome in selected women with RSAs and acquired or inherited thrombophilia.     

The effectiveness of the interview for predicting the presence of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), a leading cause of female infertility, occurs in approximately 4% of women of reproductive age. Multifamily studies have established that PCOS has strong inherited traits. Although diagnosis of PCOS in the relatives of affected women can readily be made by clinical and biochemical evaluations, these methods are costly and laborious. The aim of this investigation was to determine whether clinically evident PCOS could be detected by a written questionnaire, which is a significantly less expensive means of detection than direct determination. A questionnaire about the history of possible androgenic symptoms of PCOS was presented to patients and their first-degree female relatives, who were also evaluated by physical and laboratory examinations. The sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) for the detection of PCOS by interview were calculated. The NPV of the proband interview was significantly lower for sisters than for mothers (82% vs. 100%, respectively; p?<?0.05). When the family member completed the written questionnaire directly, the specificity and NPV of self-reporting were equally high (>90%) for both mothers and sisters. Thus direct interviewing of PCOS patients or their mothers and sisters reliably predicts affected status, but patient interview alone will not predict PCOS in almost 50% of the affected sisters.     

The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer

OBJECTIVES: The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting cervical involvement by endometrial cancer. METHODS: A retrospective accuracy study of 135 consecutive women who underwent preoperative MRI and surgery for endometrial cancer at a single gynaecological cancer centre between 1st February 2003 and 30th November 2004. RESULTS: For the detection of any cervical involvement by MRI, the sensitivity was 72%, specificity 93.2%, positive predictive value (PPV) 89.8%, negative predictive value (NPV) 80.2%, positive likelihood ratio (+LR) 10.7 and negative likelihood ratio (-LR) 0.3. When cervical stromal invasion was considered alone, the sensitivity was 84.4%, specificity 87.4%, PPV 67.5%, NPV 94.7%, +LR 6.7 and -LR 0.18. CONCLUSION: We believe that MRI is able to accurately predict cervical involvement in endometrial cancer and allows a decision to be made on the type of hysterectomy to be offered.     

Predictive value of a screen for gestational diabetes mellitus: influence of associated risk factors

BACKGROUND: There is a need for solid evidence of the relative advantages of universal vs. selective screening for gestational diabetes mellitus. Our study of a broad obstetric population determines the positive predictive value of the 50-g oral glucose challenge test for screening in the presence and absence of classical gestational diabetes risk factors. METHODS: A retrospective cohort study was carried out with a total of 2,574 pregnant women. Clinical information was obtained from hospital records and each patient's medical history, and gestational diabetes risk factors were quantified for each pregnant woman. The positive predictive value of a screen was determined with respect to the number of risk factors. RESULTS: Age 30 or over, family history of diabetes, obesity (BMI > or =27) and previous fetal macrosomia were established as the most frequent risk factors. Just over half (54.2%) of our population presented one or more risk factors. Screening covered 75% of the population, and was positive in 15% of the cases. Diagnosis was confirmed in 64 cases, 57 of them at risk, and seven with no risk factors. We obtained an overall positive predictive value of 21.8% (CI 17.3-27.0). This figure increases with the number of risk factors, from 12% for the women with no risk factors, to 40% for those presenting three or more risk factors. CONCLUSIONS: A selective screening program that takes into account the clinical background and characteristics of each pregnant woman allows a high yield of true positives while reducing the possible undesirable effects associated with false positives.     

Annual surveillance by CA125 and transvaginal ultrasound for ovarian cancer in both high-risk and population risk women is ineffective

Objective  To assess the efficacy of annual CA125 and transvaginal ultrasound (TVU) scan as surveillance for ovarian cancer.
Design  Retrospective audit.
Setting  NHS Trust.
Population  Three hundred and forty-one asymptomatic women enrolled for ovarian cancer screening: 179 were in a high-risk group (>10% lifetime risk of developing ovarian cancer), 77 in a moderate risk group (4–10% lifetime risk of developing ovarian cancer) and 71 in a near population risk group (<4% lifetime risk).
Methods  Retrospective audit of case records, laboratory CA125 results, radiology reports, histology records and local cancer registry data.
Main outcome measures  Ovarian cancers occurring in study population. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU, and CA125 as a screening tool for ovarian cancer.
Results  Four ovarian cancers and one endometrial cancer occurred. One ovarian cancer was detected at surveillance, three occurred in women who presented symptomatically between screenings. Thirty women underwent exploratory surgery because of abnormal findings at surveillance. Two women had cancer (PPV = 6.7%); one had ovarian cancer and the other endometrial cancer. Twenty-eight women (93.3%) had no malignancy. Sensitivity, specificity, PPV and NPV for TVU in the whole cohort were 33.3, 85.8, 0.6 and 99.8%, respectively. For high-risk individuals, the figures for TVU were 33.3, 84.5, 1.1 and 99.6, respectively. Combining both modalities for the whole cohort, the sensitivity, specificity, PPV and NPV were 66.7, 82.9, 1.5 and 99.8% and 50.0, 82.8, 1.3 and 99.7%, respectively, for the high-risk group alone.
Conclusions  Ovarian screening by annual TVU and CA125 is inefficient at detecting early-stage ovarian cancers.     

Risk of malignancy index in the preoperative evaluation of patients with adnexal masses

OBJECTIVE: The aim of this study was to evaluate the use of a Risk of Malignancy Index (RMI) in primary evaluation of patients with adnexal masses. METHODS: The RMI is based on menopausal status, ultrasonographic findings, and serum CA 125 level. A cutoff level of 200 was chosen as the threshold for referral for centralized primary surgery. This setup was evaluated by sensitivity, specificity, and positive predictive (PPV) and negative predictive (NPV) values with respect to the ability to distinguish malignant from benign pelvic masses.RESULTS: The sensitivity was 70.6%, specificity 89.3%, PPV 66.1%, and NPV 91.1% for the total material. For the patients undergoing surgery the sensitivity was 70.6%, specificity 87.7%, PPV 66.1%, and NPV 89.8%. If stage I disease is considered "benign" disease, the sensitivity is 95.5%, specificity 87.9%, PPV 57.8%, and NPV 99.1%. CONCLUSIONS: RMI is a simple, easily applicable method in the primary evaluation of patients with adnexal masses. It is usable as a method for selective referral of relevant patients for centralized primary surgery. The method has significant limitations in borderline ovarian tumors, stage I invasive cancers, and nonepithelial tumors. Other methods should be evaluated to increase diagnostic accuracy in these cases.     

Transvaginal Sonography Post–Office Hysteroscopy as a Screening Tool for Tubal Patency: A Reliable and Feasible Technique in an Outpatient Setting

ObjectiveTo determine feasibility and accuracy of post-hysteroscopic transvaginal ultrasonography (TVUS) measurement of pelvic fluid accumulation as a screening method for tubal patency (TP).MethodsWe conducted a retrospective cohort study of 85 patients who underwent uterine cavity assessment by office hysteroscopy at our university-affiliated fertility centre from November 2019 to October 2020. During the study period, two-dimensional (2D) TVUS was performed pre- and post-hysteroscopy to evaluate TP. Patient records were reviewed for demographics, diagnosis, and prior/subsequent TP testing. Predictive values for TP were calculated.ResultsPelvic fluid accumulation post-hysteroscopy was found in 65.9% of patients (56). Accumulation of fluid was seen with the use of as little as 10–50 mL of saline. Using more fluid did not increase the likelihood of demonstrating TP (P = 0.17). A trend towards more false-negative results for TP was observed when less fluid was used (7.7% with 10–50 mL vs. 3.8% with 60–190 mL and 1.3% with 200–760 mL; P = 0.10). The positive predictive value (PPV) of TVUS post-hysteroscopy in comparison to known patency/occlusion was 100%; negative predictive value (NPV) was 33%; sensitivity was 82.8%; and specificity was 100%. Similar values were seen in a second analysis that included patients with highly suspected patent or occluded tubes (n = 60); presumed predictive values were: PPV 100%, NPV 42%, sensitivity 78.8%, and specificity 100%. The use of more fluid did not increase pain (P = 0.75). This finding remains after accounting for confounders (e.g., pre-medication, endometrial biopsy).ConclusionTVUS pre- and post-hysteroscopy is feasible in an outpatient setting, and can serve as a reliable screening tool for TP. When hysteroscopy is performed and TP is not known, TVUS can be added for screening, potentially omitting the need for more invasive examinations. With limited non-urgent ambulatory services, it is of upmost importance to maximize information from a single procedure.     

Quantitative fetal fibronectin and cervical length in symptomatic women: results from a prospective blinded cohort study*

Objectives: Our objectives were to determine whether quantitative fetal fibronectin (fFN) and cervical length (CL) screening can be used alone or in combination as prognostic tests to identify symptomatic women at the highest or lowest risk for spontaneous preterm birth (sPTB).

Methods: A prospective, blinded cohort study of women presenting with a singleton gestation to our triage unit between 22-33w6d with preterm labor symptoms was performed. Women with ruptured membranes, moderate/severe bleeding, and dilation >2?cm were excluded. The primary outcome was sPTB <37 weeks. We evaluated test characteristics of quantitative fFN and CL assessment, both separately and in combination, considering traditionally reported cut-points (fFN ≥50 and CL <25), as well as cut-points above and below these measures. We found interactions between fFN >50 and CL <25 and sPTB by parity and obstetric history (p?Results: Five hundred eighty women were enrolled and 537 women were available for analysis. Overall sPTB rate was 11.1%. Among nulliparous women, increasing levels of fFN were associated with increasing risk of sPTB, with PPV going from 26.5% at ≥20?ng/mL to 44.4% at ≥200?ng/mL. A cut-point of 20?ng/mL had higher sensitivity (69.2%) and higher NPV (96.8%) and therefore identified a “low-risk” group. fFN was not informative for multiparous women regardless of prior obstetrical history or quantitative level chosen. For all women, a shorter CL was associated with an increased sPTB risk. Among nulliparas and multiparas without a prior sPTB, a CL <20?mm optimized test characteristics (PPV 25 and 20%, NPV 95.5, and 92.7%, respectively). For multiparas with a prior sPTB, CL <25?mm was more useful. Using fFN and CL in combination for nulliparas did not improve test characteristics over using the individual fFN (p?=?.74) and CL (p?=?.31) components separately.

Conclusions: This study identifies the importance of stratifying by parity and obstetrical history when using screening modalities for risk assessment in symptomatic women. For nulliparous women, either quantitative fFN or cervical length assessment can be utilized, depending on resources available, but a lower cut-point of 20?ng/mL should be used for quantitative fFN. For multiparous women, fFN is not useful and cervical length assessment should be the main screening tool utilized when there is clinical uncertainty. Regardless of parity, the PPV of fFN and CL is low and therefore the greatest clinical utility remains in its NPV.     

检测阴道液hCG水平诊断胎膜早破的价值

目的 :探讨阴道液 h CG的测定能否用于胎膜早破的临床诊断。方法 :对 73例晚期孕胎膜早破的孕妇和 5 7例正常晚期孕妇 ,采集阴道液进行 h CG定性和定量检测。结果 :阴道液 h CG定性检测诊断胎膜早破的敏感性为 90 .4 % ,特异性为 93.0 % ,阳性预测值为 94 .3% ,阴性预测值为 88.3%。阴道液 h CG定量检测 (h CG>4 0 IU/ L为界限值 )诊断胎膜早破的敏感性为 97.3% ,特异性为 94 .7% ,阳性预测值为 95 .9% ,阴性预测值为 96 .4 %。结论 :阴道液 h CG检测是胎膜早破的标志物而且简单、快速、可靠     

Ovarian cancer screening in women with a family history of breast or ovarian cancer

OBJECTIVE: To evaluate positive predictive values of CA 125 or transvaginal ultrasonography screening for ovarian cancer according to family history of breast or ovarian cancer. METHODS: In the screening arm of a randomized controlled trial of screening compared with usual care, 28,460 women with family history data received baseline and annual CA 125 and transvaginal ultrasonography examinations. We analyzed CA 125 and transvaginal ultrasonography results from the first four rounds of screening. We classified women as average (n=22,687), moderate (n=2,572), or high (n=2,163) risk based on family history, or high risk due to a personal history of breast cancer (n=1,038). Cancers were identified by active follow-up of women with abnormal screening results and annual questionnaires. We calculated positive predictive values for screening combinations. RESULTS: Similar proportions (4.8-5.0%) of women in each group had abnormal screening results. Higher-risk women were more likely than lower-risk women to undergo biopsy after a positive screen. Screening identified 43 invasive ovarian cancers. The positive predictive values for abnormal screening results were 0.7% in average-risk, 1.3% in moderate-risk, and 1.6% in high-risk groups; one ovarian cancer occurred among the breast cancer survivors. The positive predictive values for postbaseline abnormal screening results were also higher in the higher-risk groups. The positive predictive values did not significantly differ across risk groups. CONCLUSION: Probabilities of abnormal annual CA 125 and transvaginal ultrasonography screens were similar across groups based on family history of breast or ovarian cancer. However, ovarian cancer was more likely to be diagnosed after an abnormal screening result among women at higher family history-based risk than among women at lower risk. LEVEL OF EVIDENCE: I.     

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

Study ObjectiveTo assess the preoperative imaging impression and surgeon diagnostic accuracy for pediatric ovarian mature cystic teratomas (MCTs)DesignRetrospective reviewSettingEleven pediatric hospitalsParticipantsPatients ages 2 to 21 who underwent surgical management of an ovarian neoplasm or adnexal torsion with an associated ovarian lesionInterventionNoneMain Outcome MeasuresPreoperative imaging impression, surgeon diagnosis, tumor markers, and pathologyResultsOur 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.ConclusionsDiagnostic 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.