Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology

Bige, Ozgur; Demír, Ahmet; Saygılı, Uğur; Göde, Funda; Uslu, Turhan; Koyuncuoğlu, Meral

doi:10.1016/j.ygyno.2011.06.030

Cited by 44 publications

(32 citation statements)

References 16 publications

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“…The pathologist of other sections may not be familiar with diagnostic clues and FS may become difficult. In spite of these disadvantages overall diagnostic accuracy of FS was reported to be reliable in large series ranging from 84.25% to 97.1%, which was 96.5% in our study (1,(3)(4)(5)(6)(7). We think that attendance of the gynecopathologist to gross examination is a very important factor to increase the diagnostic accuracy of FS.…”

Section: Discussionmentioning

confidence: 47%

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Intraoperative frozen section in ovarian neoplasms; a tertiary center experience

Acikalin

Torun²,

Bağır³

et al. 2014

TJPATH

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Objective: Frozen section is an accurate diagnostic tool with some unavoidable pitfalls in gynecologic tumors. We aimed to evaluate the diagnostic value of frozen section, and to detect the factors causing erroneous diagnosis in ovarian tumors. Material and Method:Frozen section and paraffin section reports of 282 patients with ovarian neoplasms diagnosed between July 2006 and January 2013 in our institute were re-analyzed. Results were grouped into benign, borderline (for epithelial tumors) and malignant categories and compared between frozen section and paraffin section diagnosis, statistically. Results:Overall diagnostic accuracy of frozen section was 96.5%. Sensitivity of frozen section for benign, borderline and malignant tumors were 97.5%, 95.8%, and 95.6% and the related specificities were 97.5%, 97.6%, and 100%, respectively. We found the lowest positive predictive value in borderline group (79.3%), all of them with mucinous type epithelium. Second frequent discordant tumor type was immature teratoma. Conclusion:Apart from the limitations of frozen section, pathologists should be aware of the pitfalls of technique and tumor types and tend to sample from the solid areas particularly in mucinous tumors and teratomas to avoid inappropriate surgery. Bulgular:Frozen incelemenin genel tanısal doğruluk oranı %96,5 idi. Benign, borderline ve malign tümörler için frozen incelemenin duyarlığı sırasıyla %97,5, %95,8 ve %95,6 idi. Özgüllük ise aynı sırayla, %97,5, %97,6 ve %100 idi. En düşük pozitif prediktif değer borderline grubunda saptandı (%79,3) ve hataya neden olan tüm olgular müsinöz tip epitelyal tümörler idi. Tanı uyumsuzluğu bulunan ikinci tümör grubu ise immatür teratom idi. Sonuç:Frozen incelemenin kısıtlılıkları yanısıra, patoloğun frozen incelemenin teknik veya tümör tipi ile ilgili tuzaklarını bilmesi, özel-likle müsinöz tümörler ve teratom olgularında solid görünen alanlardan örneklenmesi yetersiz veya gereksiz operasyon yapılmasını önlemek adına yararlı olacaktır.

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Section: Discussionmentioning

confidence: 47%

“…Ovarian cancer is the most common lethal gynecologic cancer and the seventh most common cause of death from cancer in women (4.2% of deaths) worldwide (1,2). Surgical management of ovarian neoplasms differs according to their subtypes.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative frozen section in ovarian neoplasms; a tertiary center experience

Acikalin

Torun²,

Bağır³

et al. 2014

TJPATH

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“…Th erefore, we suppose that pathologist misinterpretation error is associated with pathologists ' experience with gynaecological pathology. Previous studies have also shown that pathologist experience was of crucial importance for the success of frozen section diagnosis in adnexal mass (Brun et al 2008;Bige et al 2011;Stewart et al 2006). Th e other signifi cant source of underdiagnosis, the sampling error, was suggested as one of the most common causes of misdiagnosis in FS of ovarian tumours and the risk of sampling error is related to the size of the tumours (Stewart et al 2006).…”

Section: Discussionmentioning

confidence: 98%

Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis

Başaran

Salman

Çalış³

et al. 2014

Journal of Obstetrics and Gynaecology

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The objective of our study was to evaluate the accuracy of frozen section (FS) in borderline ovarian tumours (BOT) and to define the factors associated with misdiagnosis during FS evaluation. We performed a retrospective review of patients who underwent exploratory laparotomy for an adnexal mass, from January 2007 to July 2012, at a tertiary oncology centre in Turkey. Patients with a diagnosis of BOT either in FS or in permanent pathology were identified. Agreement between FS diagnosis and permanent histology was observed in 37/59 patients (62.7%), which gave a sensitivity and a positive predictive value of 71.2% and 84.1%, respectively. In patients with a diagnosis of BOT by frozen section only (n = 44), the diagnosis was consistent with permanent histopathology in 37/44 patients (84.1%). Frozen section interpreted a malignant tumour as BOT (under-diagnosis) in 6/44 (13.6%) of cases and interpreted a benign lesion as BOT (over-diagnosis) in 1/44 (2.3%) of cases. Slide review of discrepant cases revealed that major pathological causes of under-diagnosis were misinterpretation and sampling errors. Univariate analysis showed that presence of bilateral tumour and positive peritoneal cytology were associated with under-diagnosis. We concluded that, despite significant risk of under-diagnosis, FS analysis is an accurate method for intraoperative diagnosis of BOTs.

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“…Organization of Gynecologic Pathology: Four articles that addressed the rates of discrepancy in initial diagnoses and intraoperative consultation between non-specialist pathologists and gyne-oncology-specialist pathologists were identified [35][36][37][38] . In one hospital, intraoperative consultation (that is, analysis of frozen sections) for gynecologic surgery by gynecologists was provided by surgical pathologists; subspecialized gynecologic pathologists provided that support for gynecologic oncologists.…”

Section: Chemotherapy-related Outcomesmentioning

confidence: 99%

“…The study found that accurate intraoperative diagnosis of borderline ovarian tumours depended mainly on the level of experience of the pathologist 36 . Similarly, Bige et al 37 looked at the accuracy of frozen sections in ovarian cancer with the aim of identifying the role of the gynecologic pathologist based on level of experience. Sensitivity and specificity were higher in the subspecialist group (p value not reported), and more malignant tumours diagnosed by frozen section were found to be discordant with the final diagnosis in the group of non-gynecologic oncology pathologists.…”

Section: Chemotherapy-related Outcomesmentioning

confidence: 99%

The Optimal Organization of Gynecologic Oncology Services: A Systematic Review

Fung-Kee-Fung

Biagi²,

Colgan

et al. 2015

Current Oncology

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Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology

Cited by 44 publications

References 16 publications

Intraoperative frozen section in ovarian neoplasms; a tertiary center experience

Intraoperative frozen section in ovarian neoplasms; a tertiary center experience

Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis

The Optimal Organization of Gynecologic Oncology Services: A Systematic Review

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