Frozen section in borderline ovarian tumors: is it reliable?

Üreyen, Işın; Turan, Taner; Cırık, Derya Akdağ; Taşçı, Tolga; Boran, Nurettin; Bulbul, Dilek; Tulunay, Gökhan

doi:10.1016/j.ejogrb.2014.07.039

Cited by 24 publications

(23 citation statements)

References 18 publications

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“…One study reported mucinous histology to be the only significant factor in IFS underdiagnosis 15. Ureyen et al also addressed the diagnostic difficulty for frozen analysis for borderline ovarian tumors, especially in mucinous and large tumors 10. In our multivariate logistic regression analysis we could not demonstrate any significant histology type accounting for underdiagnosis.…”

Section: Discussionmentioning

confidence: 50%

Intraoperative frozen section analysis of ovarian tumors: a 11-year review of accuracy with clinicopathological correlation in a Hong Kong Regional hospital

Kung¹,

Tsang²,

Yu³

2019

Int J Gynecol Cancer

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ObjectiveIntra-operative frozen section (IFS) can provide an instinct guide for treatment of ovarian tumors intra-operatively, though limitations exist. This study intended to evaluate the diagnostic performance of IFS and possible clinicopathological factors influencing the diagnostic accuracy of IFS.MethodsA retrospective review of IFS of ovarian lesions from 2006 to 2016 was done. The diagnostic performance of benign, borderline, and malignant IFS diagnosis was evaluated. Logistic regression analysis was used to assess the influence of clinicopathological parameters on the likelihood of underdiagnosis.ResultsThere were 1143 consecutive cases during the study period. The overall accuracy was 93.7%. For benign diagnoses, the IFS diagnostic accuracy, sensitivity, and specificity were 97.20%, 100%, and 92.51%, respectively. If borderline and malignant diagnoses were considered as a single group, the IFS diagnostic accuracy was 97.20%, with 92.51% sensitivity and 100% specificity. At univariate regression analysis, intact capsules at time of delivery (ORunadj = 1.9), stage I lesions (ORunadj = 3.76) and ultrasound (USG) score 0 (ORunadj = 2.52) were positively associated with underdiagnosis. Further multivariate analysis showed that only stage I lesions (OR = 3.62) and USG score 0 (OR = 2.32) were positively associated with underdiagnosis. For the cases with underdiagnosed IFS, 54% (34/63) received incomplete primary staging surgery.ConclusionsThe study demonstrated that IFS provided excellent specificity to differentiate borderline or malignant tumors from benign lesions. IFS in early-stage ovarian cancers needs to be interpreted with caution, though IFS is most important for this group of lesions. A reliable IFS diagnosis often requires efficient communication between surgeons and pathologists.

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Section: Discussionmentioning

confidence: 50%

Intraoperative frozen section analysis of ovarian tumors: a 11-year review of accuracy with clinicopathological correlation in a Hong Kong Regional hospital

Kung¹,

Tsang²,

Yu³

2019

Int J Gynecol Cancer

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“…False-negative reports of frozen sections came from: large tumor size, mucinous type, and borderline ovarian pathology. High precaution should be applied in cases with these conditions (Morton et al, 2017;Ayhan et al, 2016;Ureyen et al, 2014;Subbian et al, 2013;Boriboonhirunsarn et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Intra-Operative Frozen Section Diagnosis Accuracy of Ovarian Tumors; Old Fashioned Not Out of Fashion

Muruthapongsatorn

Inploy

Prommas

et al. 2019

Asian Pac J Cancer Prev

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“…The technique was devised a little more than 100 years ago and has advanced in terms of technical expertise and improved microscopic optics. While the role of the frozen section in certain oncologic surgeries like evaluation of margins in squamous cell carcinoma of head and neck and sentinel lymph node evaluation in breast cancer is deemed essential, its role is still a matter of debate in ovarian surgeries [ 1 – 3 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience

et al. 2016

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BackgroundOvarian neoplasms are a heterogeneous group of tumors including surface epithelial, germ cell and sex cord stromal tumors with a subset having low malignant potential (borderline tumors). While the surgical management plan differs in different categories of tumors, preoperative diagnosis is seldom available. In these circumstances, the role of frozen section becomes invaluable. In the current study, we aimed to evaluate the accuracy of the frozen section of ovarian tumors in our setup.MethodsIt was a retrospective study involving 141 cases of ovarian tumors undergoing surgical resection with frozen section evaluation from January 2009 to December 2014. After gross examination, one to five blocks were prepared on the frozen section depending upon the size of the specimen. After frozen section reporting, specimens were processed routinely for final paraffin section evaluation. Results of frozen and paraffin sections were categorized in benign, borderline, and malignant, and accuracy of frozen section was determined.ResultsOut of 141 cases, 107 were diagnosed as benign on final (paraffin) examination, while 6 were borderline and 28 were malignant. Out of 107 benign cases, 45 were non-neoplastic cystic lesions of the ovary including endometriotic, follicular, and corpus luteal cysts. The most common benign neoplastic tumor was mature cystic teratoma (20 cases) followed by mucinous cystadenoma (19 cases), serous cystadenoma (14 cases), sex cord stromal tumors (8 cases), and Brenner tumor (1 case). Among borderline cases, four cases were serous and two of mucinous neoplasms. The most common malignant neoplasm was serous carcinoma (11 cases) followed by mucinous carcinoma (6 cases). The overall accuracy of frozen section diagnosis is above 99 %. The sensitivity and specificity for benign tumors were found to be 100 and 97 %, respectively. The sensitivity and specificity for borderline tumors was 83 and 99 %, respectively, while for malignant tumors, it was 96 and 100 %, respectively.ConclusionsWe found a high sensitivity and specificity of frozen section for the diagnosis of ovarian tumors and to determine its malignant potential. Therefore, it should always be used when the preoperative diagnosis is not definite to govern extent of surgical resection. However, under-diagnosis can occur in tumors of borderline category which can be minimized by increased sampling on the frozen section.

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Frozen section in borderline ovarian tumors: is it reliable?

Cited by 24 publications

References 18 publications

Intraoperative frozen section analysis of ovarian tumors: a 11-year review of accuracy with clinicopathological correlation in a Hong Kong Regional hospital

Intraoperative frozen section analysis of ovarian tumors: a 11-year review of accuracy with clinicopathological correlation in a Hong Kong Regional hospital

The Evaluation of Intra-Operative Frozen Section Diagnosis Accuracy of Ovarian Tumors; Old Fashioned Not Out of Fashion

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience

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