Abstract
Purpose
Accuracy of intraoperative frozen section diagnosis is extremely important in the evaluation of ovarian tumors so that suitable surgical procedures can be chosen. Therefore, the current study was aimed at measuring the diagnostic accuracy of the intraoperative frozen section to determine the surgical course of tumors.
Methods
This retrospective diagnostic accuracy study was conducted in the Department of Obstetrics and Gynecology, Emam Hossein Hospital. The case records of patients with ovarian mass who underwent surgery and intraoperatively frozen section assessments between September 2006 and December 2014 were analyzed. Demographic and clinical data, operative details, frozen section, and final histopathology examination were reviewed from the medical records.
Results
One hundred and ninety-three patients with ovarian masses undergoing surgery and frozen section were included. The frozen section diagnoses were benign in 155 (80.31%), borderline in 10 (5.18%), and malignant in 28 (14.51%), whereas the final diagnosis was benign in 154 (79.80%), borderline in 9 (4.66%), and malignant in 30 (15.54%). The overall accuracy of intraoperative frozen section diagnosis was 98.9%. The sensitivity for frozen section diagnosis was 100% for benign, 89% for borderline, and 93.3% for malignant category, whereas the specificity was 97%, 99%, and 100%, respectively. There were three cases with discordance between the frozen section diagnoses and the final diagnoses, all of which were under-diagnosed by frozen section.
Conclusion
Frozen section was found to be accurate and useful in the intraoperative assessment of patients with ovarian neoplasm. The results may help to determine the type and extent of surgery.
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Availability of Data and Materials
The data will be available for editors in case of reasonable requests.
References
Maheshwari A, Gupta S, Kane S, Kulkarni Y, Goyal BK, Tongaonkar HB. Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms: experience at a tertiary oncology center. World J Surg Oncol. 2006;4:12. https://doi.org/10.1186/1477-7819-4-12.
Mills AM, Shanes ED. Mucinous ovarian tumors. Surg Pathol Clin. 2019;12(2):565–85. https://doi.org/10.1016/j.path.2019.01.008.
Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.
Graham L. ACOG releases guidelines on management of adnexal masses. Am Fam Phys. 2008;77(9):1320–3.
Avesi L, Kayani N, Hassan S, Shahid R. Diagnostic accuracy of intraoperative consultation of ovarian neoplasms. Asian J Med Sci. 2014. https://doi.org/10.3126/ajms.v6i1.9782.
Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ. Intraoperative assessment of ovarian tumors: a 5-year review with assessment of discrepant diagnostic cases. Int J Gynecol Pathol Off J Int Soc Gynecol Pathol. 2006;25(3):216–22. https://doi.org/10.1097/01.pgp.0000215295.45738.ed.
Geomini P, Bremer G, Kruitwagen R, Mol BW. Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis. Gynecol Oncol. 2005;96(1):1–9. https://doi.org/10.1016/j.ygyno.2004.09.042.
Rotterdam H. Frozen section diagnosis of serous epithelial tumors of the ovary. Am J Diagn Gynecol Obset. 1979;1:89–94.
Cross PA, Naik R, Patel A, Nayar AG, Hemming JD, Williamson SL, et al. Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of gateshead cancer centre experience. BJOG Int J Obstet Gynaecol. 2012;119(2):194–201. https://doi.org/10.1111/j.1471-0528.2011.03129.x.
Ilvan S, Ramazanoglu R, Ulker Akyildiz E, Calay Z, Bese T, Oruc N. The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol. 2005;97(2):395–9. https://doi.org/10.1016/j.ygyno.2005.01.037.
Palakkan S, Augestine T, Valsan MK, Vahab KPA, Nair LK. Role of frozen section in surgical management of ovarian neoplasm. Gynecol Minim Invasive Therapy. 2020;9(1):13–7. https://doi.org/10.4103/gmit.gmit_2_19.
Scully R, Bonfiglio T, Kurman R, Silverberg S, Wilkinson E. World health organization international histological classification of tumours. Histological typing of female genital tract tumours, vol. 19(9). New York: Springer; 1994. p. 4.
Subbian A, Devi UK, Bafna UD. Accuracy rate of frozen section studies in ovarian cancers: a regional cancer institute experience. Indian J Cancer. 2013;50(4):302–5. https://doi.org/10.4103/0019-509x.123599.
Tempfer CB, Polterauer S, Bentz EK, Reinthaller A, Hefler LA. Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynecol Oncol. 2007;107(2):248–52. https://doi.org/10.1016/j.ygyno.2007.06.008.
Gol M, Baloglu A, Yigit S, Dogan M, Aydin C, Yensel U. Accuracy of frozen section diagnosis in ovarian tumors: is there a change in the course of time? Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2003;13(5):593–7. https://doi.org/10.1046/j.1525-1438.2003.13389.x.
Boriboonhirunsarn D, Sermboon A. Accuracy of frozen section in the diagnosis of malignant ovarian tumor. J Obstet Gynaecol Res. 2004;30(5):394–9. https://doi.org/10.1111/j.1447-0756.2004.00218.x.
Tangjitgamol S, Jesadapatrakul S, Manusirivithaya S, Sheanakul C. Accuracy of frozen section in diagnosis of ovarian mass. Int J Gynecol Cancer. 2004;14(2):212–9.
Suprasert P, Khunamornpong S, Phusong A, Settakorn J, Siriaungkul S. Accuracy of intra-operative frozen sections in the diagnosis of ovarian masses. Asian Pac J Cancer Prev APJCP. 2008;9(4):737–40.
Mohammed AB, Ahuja V, Farghaly H. Role of frozen section in the intraoperative management of ovarian masses. Middle East Fertil Soc J. 2014. https://doi.org/10.1016/j.mefs.2014.06.001.
Hashmi AA, Naz S, Edhi MM, Faridi N, Hussain SD, Mumtaz S, et al. Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience. World J Surg Oncol. 2016;14:91. https://doi.org/10.1186/s12957-016-0849-x.
Md Arshad NZ, Ng BK, Md Paiman NA, Abdullah Mahdy Z, Mohd Noor R. Intra-operative frozen sections for ovarian tumors—a tertiary center experience. Asian Pac J Cancer Prev APJCP. 2018;19(1):213–8. https://doi.org/10.22034/APJCP.2018.19.1.213.
Moodley M, Bramdev A. Frozen section: its role in gynaecological oncology. J Obstet Gynaecol J Inst Obstet Gynaecol. 2005;25(7):629–34. https://doi.org/10.1080/01443610500278097.
Acikalin A, Torun G, Bagir E, Bayram F, Zeren H, Gulec U, et al. Intraoperative frozen section in ovarian neoplasms; a tertiary center experience. Turk Patoloji Dergisi. 2014;30(3):184–8. https://doi.org/10.5146/tjpath.2014.01270.
Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol. 2008;27(3):353–65. https://doi.org/10.1097/PGP.0b013e31815c24fe.
Gultekin E, Gultekin OE, Cingillioglu B, Sayhan S, Sanci M, Yildirim Y. The value of frozen section evaluation in the management of borderline ovarian tumors. J Cancer Res Ther. 2011;7(4):416–20. https://doi.org/10.4103/0973-1482.92005.
Ratnavelu ND, Brown AP, Mallett S, Scholten RJ, Patel A, Founta C, et al. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016;3:Cd010360. https://doi.org/10.1002/14651858.cd010360.pub2.
Sukumaran R, Somanathan T, Mathews A, Kattor J, Sambasivan S, Nair RP. Role of frozen section in intraoperative assessment of ovarian masses: a tertiary oncology center experience. Indian J Surg Oncol. 2014;5(2):99–103. https://doi.org/10.1007/s13193-014-0311-x.
Bige O, Demir A, Saygili U, Gode F, Uslu T, Koyuncuoglu M. Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology. Gynecol Oncol. 2011;123(1):43–6. https://doi.org/10.1016/j.ygyno.2011.06.030.
Acknowledgements
We would like to thank the staff of the laboratory of Shahid Beheshti University of Medical Sciences who performed the frozen section and final HPE assessments. This article has been extracted from the thesis written by Mrs. Farinaz Shahmoradi in school of medicine Shahid Beheshti University of medical sciences. (Registeration No: 256M).
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MA was the principal investigator of this study. FS contributed to the development of the project and performed the statistical analyses. MA and FS contributed development of the project and gathering the data. MA and FS contributed the writing the manuscript. All authors contributed to the drafting of this paper and approved the final manuscript.
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All of the participants signed a written informed consent prior to participating in this study.
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The study was approved by the Ethic Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.MSP.REC.1395.23).
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Shahmoradi, F., Arab, M. Diagnostic Accuracy Value of Intraoperative Frozen Section for Ovarian Neoplasms. Indian J Gynecol Oncolog 18, 76 (2020). https://doi.org/10.1007/s40944-020-00425-4
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DOI: https://doi.org/10.1007/s40944-020-00425-4