Pre and Intraoperative Diagnosis of Ovarian Tumours: How Accurate Are We?

Abstract

In the assessment of malignant potential of ovarian tumours, frozen section has been found to be accurate in 97.1% (168 of 173) of cases. The positive predictive value of frozen section in the diagnosis of a malignant lesion was 100% (34 of 34). Errors were mainly made in the diagnosis of borderline tumours with a predictive value of 87.5% (7 of 8). The negative predictive value was 98.4% (127 of 129). Frozen section however, was less accurate in the diagnosis of specific histological type with an accuracy rate of 91.9% (159 of 173). Macroscopic features were found to be useful in the intraoperative prediction of malignant potential. Completely cystic tumours were benign in 96.4% (108 of 167) of cases. Solid/cystic tumors were malignant in 69% (27 of 38) of cases. Completely solid tumours were malignant in 56% (9 of 16) of cases. Frozen section in completely cystic tumours only marginally improved the clinical macroscopic diagnosis of malignancy. The sensitivity and specificity of ultrasound scan in the diagnosis of malignant/borderline tumours were 82% and 86% respectively. The false negative rate of 7% makes laparoscopic excision of unsuspected malignant ovarian cyst a significant possibility. The predictive value of ultrasound scan in the diagnosis of malignant ovarian tumour was 62% (26 of 42). In the preoperative assessment of malignant potential of ovarian tumours, this study shows that ultrasound scan has a high false positive and a significant false negative rate. Careful intraoperative assessment of gross features and the use of frozen section especially in those with solid/cystic and solid tumours will help achieve a high accuracy rate in the assessment of ovarian tumours.

Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis

“…All 18 included studies were retrospective cohort studies [11,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] (Table 1). All studies but two included consecutive patients undergoing frozen section diagnosis [11,39].…”

“…Six of the sixteen consecutive studies reported that, in some patients, the diagnosis was deferred at frozen section diagnosis [27,29,33,[37][38][39] ( Table 2). The percentage of patients in which the diagnosis was deferred varied between 1% and 6%, whereas in one study, the diagnosis was even deferred in 20% of the patients (39).…”

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

“…Several studies have demonstrated that frozen section accurately distinguishes invasive from benign ovarian tumors [12][13][14][15][16][17], whereas this method is less accurate for large or borderline (low-malignantpotential) ovarian tumors [16].…”

Intraoperative Consultation in Ovarian Pathology

“…Although frozen section has a high accuracy in diagnosing malignant potential, it Akrivos /Thomakos /Sotiropoulou / Rodolakis /Antsaklis Gynecol Obstet Invest 2010; 70:193-199 196 is less accurate in diagnosing a specific histologic type with an accuracy rate of approximately 90% [14] . Lowgrade mucinous tumors and borderline tumors can be very confusing for the pathologist [47] .…”

“…Concerning ovarian masses, intraoperative consultation stage I ovarian carcinoma have elevated tumor markers [12,13] . Furthermore, in one study by Lim et al [14] , 31% of unsuspected ovarian malignancies had a benign appearance on preoperative evaluation. Consequently, one can clearly understand the importance of intraoperative consultation when we have to deal with ovarian masses.…”