Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric and Adolescent Patients

Infographic · Mar 2026 · 1 min read

In brief

Multi-institutional study of 309 pediatric patients identifies optimal tumor marker combinations for preoperative malignancy risk assessment in ovarian masses. Beta-HCG emerged as essential across best-performing panels, with AFP/β-HCG/CA-125/inhibin A achieving 100% negative predictive value to guide ovary-sparing decisions.

β-HCG was present in all best-performing tumor marker combinations for predicting ovarian malignancy in pediatric patients.
The combination α-fetoprotein/β-HCG/CA-125/inhibin A achieved 100% negative predictive value, missing zero malignancies.
Accurate preoperative risk stratification enables ovary-sparing surgery and reduces unnecessary oophorectomy for benign disease.
Among 309 patients aged 6-21 with ovarian masses, only 25 (8%) had malignancy, highlighting importance of avoiding overtreatment.
Multi-marker panels outperform single markers; β-HCG/inhibin A/LDH combination achieved 95.1% accuracy for malignancy prediction.

Written by the GCMD Library team from the infographic.

The infographic uses a teal and coral color scheme with anatomical illustrations of ovaries. The layout flows top to bottom, starting with study parameters in a teal banner, followed by pink boxes highlighting key findings about β-hCG combinations, and coral boxes showing negative predictive value results. A blood vial illustration appears on the left side, and stylized ovary graphics appear on the right.

Anna M Lin, Katherine C Bergus, Josh Bricker, Mary Fallat, S Paige Hertweck, Geri Hewitt, Carley Lutz, Jennifer H Aldrink, Christina Bence, Lesley Breech, Patrick A Dillon, Cynthia Downard, Peter F Ehrlich, Samir Gadepalli, Jason D Fraser, Julia Grabowski, Michael Helmrath, Ronald B Hirschl, Rashmi Kabre, Dave R Lal, Matthew Landman, Charles Leys, Linda Cherney-Stafford, Grace Mak, Troy Markel, Joseph G Pressey, Manish Raiji, Beth Rymeski, Jacqueline Saito, Shawn D St Peter, Lindsey Asti, Katherine Deans, Peter C Minneci; Midwest Pediatric Surgery Consortium

Introduction: Pediatric and adolescent patients with ovarian masses undergo radiographic and serologic workup to determine malignancy risk before surgery. Commonly examined tumor markers for detecting malignancy among these patients are α-fetoprotein, β-human chorionic gonadotropin (β-HCG), cancer antigen-125, inhibin A, and lactate dehydrogenase. This study investigated the diagnostic performance of these tumor markers, individually and in combination, to assess malignancy risk in pediatric and adolescent patients with ovarian masses.

Methods: This was a planned secondary analysis of a multi-institutional interventional study investigating a consensus-based, preoperative risk stratification algorithm in patients aged 6-21 y, undergoing surgery for an ovarian mass between August 2018 and February 2021 at 11 children's hospitals. All included patients underwent preoperative assessment with ≥ 1 tumor marker(s). Individual and all combinations of tumor marker performance were analyzed. A priori clinical consensus was that the optimal combination of tumor markers should minimize the misclassification of patients with malignancy (maximize negative predictive value).

Results: Tumor markers were assessed in 309 out of the 519 patients, and malignancy was found in 25 patients. β-HCG was present among all the best-performing combinations. The most accurate combination was β-HCG/inhibin A/lactate dehydrogenase (accuracy = 0.951). Three combinations did not misclassify any malignant lesions as likely benign (100% negative predictive value), and the most accurate of these three combinations was α-fetoprotein/β-HCG/cancer antigen-125/inhibin A (accuracy = 0.862).

Conclusions: Tumor markers can support preoperative risk stratification for malignancy to determine which patients may benefit from ovary-sparing surgery and minimize those undergoing an unindicated oophorectomy or oophorectomy for benign disease.

The text in the image

Use of Ovarian Tumor Markers in Prediction of Malignancy Risk in Pediatric & Adolescent Patients | Multicenter Prospective Interventional Study | 2018-2021 | 519 patients undergoing ovarian mass surgery | 6-21 years old | 11 participating hospitals | Pre-op evaluation including ≥1 tumor marker | How well do tumor markers assess malignancy risk? | β-hCG was present among all the best-performing combinations | Most accurate combination: β-hCG + inhibin A + LDH (accuracy= 0.951) | Three combinations achieved 100% negative predictive value: | NO malignant tumors were misclassified as benign | Most accurate combination: α-fetoprotein/β-HCG/cancer antigen-125/inhibin A (accuracy = 0.862) | Conclusion: Combining tumor markers improves prediction of malignancy in pediatric ovarian masses. This approach can help guide ovary-sparing surgery and avoid unnecessary oophorectomy. | https://pubmed.ncbi.nlm.nih.gov/41187700 | Lin AM et. al. | Department of Surgery, Nationwide Children's Hospital, United States | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's