Validity of Intraoperative Diagnosis at Laparoscopic Surgery for Ovarian Tumors

Takemoto, Shuji; Ushijima, Kimio; Kawano, Ryosuke; Fukui, Akimasa; Terada, Atsumu; Fujimoto, Takefumi; Imaishi, Hiroto; Kamura, Toshiharu

doi:10.1016/j.jmig.2013.12.002

Cited by 13 publications

(8 citation statements)

References 12 publications

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“…Such a preoperative diagnosis may include several pathological entities: ovarian and nonovarian lesions, nonneoplastic and neoplastic masses, and, among these, benign, borderline, and even invasive neoplasms. Accurate preoperative and/or intraoperative diagnosis may be feasible on many occasions and impossible in others, for the reason that different pathologies may share a variety of similar morphological features [ 16 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Detorakis

Vlachos

Athanasiou

et al. 2016

Minimally Invasive Surgery

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This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3–10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Detorakis

Vlachos

Athanasiou

et al. 2016

Minimally Invasive Surgery

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“…It is universally accepted that the use of an endobag to retrieve the specimen is mandatory to reduce the risk of port-site metastasis [ 26 ]. This procedure may create a distortion of the macroscopic features of a pelvic mass and the consequent inability to perform an accurate macroscopic evaluation [ 27 – 30 ]. Preoperative information, such as sonographic features, plays a major role in allowing the pathologist to distinguish BOTs from negative or cancerous mass at microscopic evaluation.…”

Section: Discussionmentioning

confidence: 99%

Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

Gizzo

Berretta

Gangi

et al. 2014

BioMed Research International

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The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P < 0.05), and overdiagnosis in 11.6% versus 0% (P < 0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.

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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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Validity of Intraoperative Diagnosis at Laparoscopic Surgery for Ovarian Tumors

Cited by 13 publications

References 12 publications

Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

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

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