Abstract
The objective of this study is to determine the diagnostic accuracy of frozen section in detecting epithelial ovarian tumor histological types and its effect on management. A retrospective review was done of all patients who had an intraoperative frozen section for an indeterminate ovarian tumor over a six-year period. The reference standard was final histology. The validity indices for frozen section in diagnosing benign, borderline, and malignant lesions were determined. One hundred thirty-five intraoperative frozen section–diagnosed epithelial ovarian tumors were reviewed. The mean age was 44.9 ± 14.2 years, the median parity was 2, and 57% (77/135) of patients were post-menopausal. The commonest histological subtype was mucinous 48.1% (65/135) on frozen section and 46.7% (63/135) on final histology. The overall concordance rate of frozen section to final histology was 81.5% (ƙ = 0.719, p = 0.0001). The accuracy, sensitivity, specificity, and positive predictive value of frozen section to diagnose benign lesions were 86.7%, 85.7%, 97.2%, and 79.2% respectively. In borderline tumors, the diagnostic test characteristics were 88.1%, 81.2%, 90.3%, and 72.2%. For malignant lesions, these values were 88.1%, 77.8%, 95.1%, and 91.3% respectively. The odds ratios for frozen section being correct were 40.9 (95% CI 14.8–113.5) for benign lesions, 40.3 (95% CI 13.4–121.3) for borderline tumors, and 67.4 (95% CI 20.5–222.0) for malignancy. Over-treatment or under-treatment occurred in 19.3% of patients. Intraoperative frozen section is useful in situations where the nature of the ovarian tumor is uncertain. However, borderline ovarian tumors are more likely to be over-diagnosed. About a fifth of patients received inappropriate treatments based on the frozen section report.
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Dr. Rachel G Chandy for encouragement and logistic support.
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Nyengidiki T Kennedy: Conceptualization, methodology, analysis, data curation, original draft
Ajit Sebastian: Conceptualization, validation, data curation, writing and review, visualization
Dhanya S Thomas: Software, writing and review
Anitha Thomas: Software, writing and review
Mayank Gupta: Software, writing and review
Ramani M Kumar: Methodology, validation, writing and review
Abraham Peedicayil: Conceptualization, methodology, original draft, review and editing, supervision
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Kennedy, N.T., Sebastian, A., Thomas, D.S. et al. Diagnostic Accuracy of Frozen Section and Its Influence on Intraoperative Management of Indeterminate Epithelial Ovarian Tumors. Indian J Surg Oncol 10, 268–273 (2019). https://doi.org/10.1007/s13193-018-00869-3
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DOI: https://doi.org/10.1007/s13193-018-00869-3