MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology

Abstract

The aim was to compare the accuracy of magnetic resonance imaging (MRI) and intraoperative consultation (IC) for the diagnosis of adnexal masses, with reference to final histology. MRI was performed in 136 women with sonographically indeterminate adnexal masses. IC included macroscopic and frozen-section examination. Macroscopic examination and MRI determined size, nature, and presence of vegetations or solid portions within masses. All masses were characterized as benign or malignant according to previously published MR imaging and histopathologic criteria. Sensitivities, specificities, and predictive values for the diagnosis of malignancy of MRI and IC were assessed. Histology revealed 168 adnexal masses (99 benign, 23 borderline and 46 invasive). Frozen sections were examined in 151 cases. Among the 151 adnexal masses studied by both MRI and IC, respective sensitivities, specificities, positive and predictive values of both methods for the diagnosis of malignancy were 89.7% and 84.5%, 91.4% and 100%, 86.7% and 100%, and 93.4% and 91.3%. Sensitivities of MR imaging and frozen section for the diagnosis of serous versus mucinous borderline tumors were 33.3% and 93.3%, and 62.5% and 12.5%, respectively. MRI is less accurate than IC for characterizing adnexal masses. However, MRI may increase the relevance of IC for borderline mucinous tumors.

Impact of serum tumor marker determination on the management of women with borderline ovarian tumors: Multivariate analysis of a French multicentre study

“…Diagnosis of adnexal masses is mainly based on imaging techniques and preoperative serum tumor marker assays (16)(17)(18)(19)(20)(21). Serum tumor markers have been evaluated in only small series of women with BOT, and their contribution to treatment and follow-up is unclear (22)(23)(24).…”

Magnetic resonance evaluation of adnexal masses

“…Transvaginal ultrasonography (TVUS) should be the first imaging approach for adnexal lesions (2), which allows specific diagnosis in the majority of cases (3). However, magnetic resonance imaging (MRI) is superior in the characterization of adnexal masses (4) and should be used to further characterize indeterminate adnexal mass identified by US (5). Previous imaging studies have reported accuracies in the characterization of malignancy of adnexal masses ranging from 60 to 95% for US (4,6,7) and from 83 to 94% for MRI (3, 4, 7Á13); the lower figure of 83% is from a relatively early pioneer study using older equipment (3).…”

Added Value of Perfusion in Gynaecological Imaging

“…And so, correct preoperative diagnosis and complete staging may give them the chance to do conservative surgeries [14,17,18]. Moreover, preoperative MRI suggesting borderline pathology was shown to help pathologists when intraoperative histology is required [14,19].…”