Surgical staging for ovarian sex cord-stromal tumors: What procedural steps are needed?

The recommended surgical procedure for adult ovarian stromal tumors is based on NCCN guidelines but yield of staging steps has not been evaluated. Previous studies have shown poor compliance by surgeons for epithelial and germ cell tumors. This review was undertaken to examine yield of staging components and surgical compliance in ovarian stromal tumors. Comparison with the Children's Oncology Group's (COG) more limited staging for ovarian germ cell tumors was performed.

Retrospective review of compliance with surgical staging and pathologic findings in patients with ovarian sex-cord stromal tumors enrolled in the International OTST and International PPB/DICER1 Registries (Registries).

148 patients, diagnosed from 1985 to 2021, with ovarian sex cord-stromal tumors aged 2 days-60 years at diagnosis with medical records available were identified. Operative and pathology reports were available for 145 patients. Tumor spread was documented in 6 % of peritoneal fluid, 6 % of omentum, 10 % of peritoneal surface, and 3 % of lymph nodes. No samples that appeared normal to the surgeon contained tumor. Seventeen percent had complete staging using NCCN guidelines, whereas 41 % had complete staging using COG guidelines.

Sampling of normal appearing tissue did not show tumor spread. Tumor was found in 3-10% of samples obtained and only from grossly abnormal tissue, confirming continued need for inspection and assessment and documentation of these sites. Future studies focused on determining patterns of spread could inform staging recommendations to capture key elements that predict spread of disease and relapse.