The Accuracy of a Frozen Section Diagnosis of Borderline Ovarian Malignancy

Menzin, Andrew; Rubin, Stephen C.; Noumoff, Joel S.; LiVolsi, Virginia A.

doi:10.1006/gyno.1995.0004

Cited by 78 publications

(46 citation statements)

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“…We were particularly interested in evaluating the contribution of cytology to the accurate diagnosis of borderline epithelial tumors because we and other investigators have documented the limitations of frozen section diagnosis in these cases. [5][6][7][8][9][10] Mucinous neoplasms are particularly problematic because they are often large and frequently show heterogeneous histological appearances, including a spectrum of benign, borderline, and malignant elements within a single tumor. Thus, the limited sample examined in the intraoperative situation may not be representative of the highest-grade component.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Nevertheless, there are problem areas in frozen section diagnosis, including the accurate recognition of borderline epithelial tumors and the distinction of some primary ovarian neoplasms from malignancies metastatic to the ovaries. [5][6][7][8][9][10][11][12][13] The identification of rare ovarian neoplasms and uncommon nonneoplastic conditions may also prove difficult because most individual pathologists will encounter such lesions infrequently.…”

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confidence: 99%

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Value of cytology in the intraoperative assessment of ovarian tumors

Stewart

Brennan

Koay

et al. 2010

Cancer Cytopathology

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BACKGROUND:Intraoperative pathological assessment is frequently requested in patients with suspected ovarian neoplasia so that optimal surgical management can be performed. In this study the accuracy of intraoperative cytology has been assessed and the results compared with frozen section diagnosis.METHODS:The study comprised 402 ovarian tumors that were submitted for intraoperative assessment in which both cytology preparations, usually scrape smears, and conventional frozen sections were examined. Each technique was evaluated independently, although the diagnosis transmitted to the surgeon was based upon the combination of the clinical, macroscopic, histological, and cytological information. The results were compared with the final pathological diagnosis in each case and cases with discordant diagnoses were reviewed.RESULTS:There were 226 benign lesions, 35 borderline epithelial neoplasms, and 141 malignant tumors according to the final pathological diagnosis. All benign lesions were accurately categorized using both frozen section and cytology. Thirty (86%) of the borderline tumors and 137 (97%) of the malignant tumors were accurately identified on frozen section, whereas the corresponding results for cytology were 23 (66%) and 131 (93%), respectively. There were no false‐positive diagnoses with either technique and the overall accuracy was 97.8%. Cytological evaluation provided better morphologic detail, permitted wider tumor sampling, and directed appropriate ancillary investigations in some cases.CONCLUSIONS:Overall, frozen section was more accurate than smear preparations in this series. However, cytology has a complementary role in the intraoperative assessment of ovarian neoplasia and provides a more specific diagnosis in some cases. Cancer (Cancer Cytopathol) 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Value of cytology in the intraoperative assessment of ovarian tumors

Stewart

Brennan

Koay

et al. 2010

Cancer Cytopathology

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“…However, frozen section diagnosis of BTO is less reliable than frozen section diagnosis of benign or malignant ovarian tumors. [5][6][7][8][9][10][11][12][13][14] Thus, some investigators have sought to find significant factors related to misdiagnosis. Houck et al 8 found that mucinous histology was the only significant predictor for under-diagnosis by frozen section.…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary

Kim

Park

et al. 2009

J Gynecol Oncol

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Objective:We have assessed the accuracy of frozen section diagnosis and the outcomes of misdiagnosis in borderline tumors of the ovary (BTO) according to frozen section. Methods: All pathology reports with BTO in both frozen and permanent section analyses between 1994 and 2008 at Seoul St. Mary's Hospital were reviewed. Frozen section diagnosis and permanent section histology reports were compared. Logistic regression models were conducted to evaluate the correlation of patient and tumor characteristics with diagnostic accuracy. The clinical outcomes of misdiagnosis were evaluated. Results: Agreement between frozen section diagnosis and permanent histology was observed in 63 of 101 patients (62.4%). Among the 76 patients with frozen section proven BTO, under-diagnosis and over-diagnosis occurred in 8 of 76 (10.5%) and 5 of 76 patients (6.6%), respectively. Mean diameter of under-diagnosed tumor was larger than matched BTO (21.0±11.4 vs. 13.7±7.1; p=0.021). Tumor size 20 cm was determined as the optimal cut-off for under-diagnosis (50% sensitivity, 87.3% specificity). Among 8 under-diagnosed patients, no patient relapsed. Among 5 over-diagnosed patients, 2 patients ＜ 35 years of age had fertility-preserving surgery. Conclusion: Although frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian tumors, over-diagnosis and under-diagnosis are relatively frequent in frozen proven BTO. Surgical decision-making for BTO based on frozen section diagnosis should be done carefully, especially in large tumors.

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“…The results of our study demonstrate that the low sensitivity of frozen section examination is mainly due to the underdiagnosis of mucinous BOTs as benign tumors (Figures 1 and 2). The inaccuracy of frozen section examinations in diagnosing mucinous BOTs was previously reported by other authors [13][14][15][16]. The limitations of frozen section in diagnosing mucinous BOTs may be due to the fact that, in this neoplasm, invasive mucinous ovarian cancer can often be observed in areas adjacent to benign and borderline histology, suggesting a continuum to malignant progression which is not observed in the other epithelial ovarian lesions [17].…”

Section: Discussionmentioning

confidence: 78%

“…Overdiagnosis and underdiagnosis occurred in 6.6% and 30.6% of the cases, respectively. We performed a literature research and identified five previous studies exclusively examining the frozen section diagnosis of BOTs (12)(13)(14)(15)(16). Data of these studies and the present investigation were pooled; 516 cases were identified.…”

Section: Discussionmentioning

confidence: 99%