Factors Influencing the Discordancy Between Intraoperative Frozen Sections and Final Paraffin Pathologies in Ovarian Tumors

Abstract

AimTo retrospectively investigate the pre-operative clinical factors and ultrasonographic features that influence the accuracy of the intraoperative frozen section (IFS) of ovarian tumors.Patients and methodsWomen with ovarian tumors that underwent IFS in one tertiary medical center were recruited from January 2010 to December 2018. Demographic and clinical data of these women were retrieved from medical records in the hospital’s centralized database.ResultsA total of 903 ovarian tumors were enrolled, including 237 (26.2%) benign, 150 (16.6%) borderline tumor, and 516 (57.2%) malignant. The overall accuracy of IFS among all specimens was 89.9%. The sensitivities of IFS in diagnosing borderline tumors (82.0%) and malignant tumors (88.2%) were lower than in diagnosing benign tumors (98.7%, p <0.001, Z-test). The specificity of diagnosing malignant tumors (99.7%) was significantly higher than that of diagnosing benign tumors (94.7%, p <0.001, Z-test). The group with discordant IFS and final paraffin pathology (FPP) had younger age (47.2 ± 14.0 vs. 51.5 ± 11.8 years, p = 0.013, Mann–Whitney U test), and higher percentage of early-stage disease (85.2% vs. 65.1%, p = 0.001, chi-square test) and mucinous (39.3% vs. 3.3%) and endometrioid histologic types (34.4% vs. 20.2%) than the concordant group (all by chi-square test). Menopause (OR 0.34, 95% CI 0.15–0.76, p = 0.009), multicystic tumor in ultrasound (OR 2.14, 95% CI 1.14–4.01, p = 0.018), and ascites existence (OR 0.33, 95% CI 0.14–0.82, p = 0.016) were factors related to the discordant IFS by multivariate analysis.ConclusionsIFS has good accuracy in the diagnosis of ovarian tumors. We recommend more frozen tissue sampling for sonographic multicystic tumors in premenopausal women to improve the accuracy of IFS.

Outcome and prognostic factors of unexpected ovarian carcinomas

“…For most ovarian cancers or those that are suspected to be ovarian cancer in our department, intraoperative frozen pathology is sent. 40 However, we still have some unexpected ovarian cancers. Diagnosing ovarian tumors is often challenging.…”

“…Intraoperative frozen pathology can provide an immediate diagnosis of ovarian tumors and decrease the incidence of unexpected ovarian malignancies. For most ovarian cancers or those that are suspected to be ovarian cancer in our department, intraoperative frozen pathology is sent 40 . However, we still have some unexpected ovarian cancers.…”

Protein Glycosylation as Biomarkers in Gynecologic Cancers

“…The FDA approved the ROMA test in 2011 for predicting the risk of ovarian malignancy in women presenting with pelvic masses. However, the biomarker still has limitations in the UK for pre-operative evaluation of ovarian tumor and for distinguishing the malignant tumor from the benign and borderline tumor [ 66 ].…”

Raman spectroscopic study of benign and malignant ovarian tissues

“…Although the intraoperative frozen section has the advantages of fast, reliable and high diagnostic accuracy, which provides an indispensable basis for clinical treatment, its diagnostic accuracy has some limitations, and there are some missed diagnosis, misdiagnosis and delayed diagnosis. The results are directly related to the sampling of lesions and the quality of sections, and more professional pathologists are needed [25]. On the other hand, Raman technology does not need reagent dyeing, so it is fast, cheap and has the advantages of applicability in vivo.…”