Madenci AL, et al. - For guidance of operative management of pediatric ovarian masses, researchers sought to develop a pre-operative risk assessment tool for childhood and adolescent ovarian malignancy by retrospectively analyzing 188 children (< 18 years old) with ovarian masses who had ovarian surgery at two quaternary care pediatric centers over 4 years. Malignancies were noted in 11% of these cases. No malignancies were noted for simple cysts and small (≤10 cm) marker-negative heterogeneous lesions. Malignancies were noted in 44% percent of the solid lesions, 40% of marker-elevated heterogeneous masses and 5% of the large (>10 cm) marker-negative heterogeneous lesions. Based on these findings, they recommend performing ovarian-sparing resection for simple cysts or tumor marker-negative heterogeneous lesions ≤10 cm. For solid masses or heterogeneous lesions with elevated markers, they recommend performing oophorectomy. They suggest having a careful discussion of ovarian-sparing techniques in cases with large (>10 cm) heterogeneous masses with non-elevated markers. They identified that irrespective of the operative procedure, complete surgical staging is mandatory.