Accuracy of Intraoperative Frozen Section Diagnosis of Ovarian Tumors

doi:10.1006/gyno.2001.6133

Gynecologic Oncology

Volume 81, Issue 2, May 2001, Pages 230-232

https://doi.org/10.1006/gyno.2001.6133 Get rights and content

Abstract

Objective. The goal of this work was to evaluate retrospectively, as quality control, the accuracy of frozen section diagnosis in ovarian tumors.

Method. We compared 243 frozen section results with the final diagnosis in paraffin sections, from cases studied from January 1994 to April 1999.

Results. Results with the two methods were analyzed on two parameters: (a) malignant potential and (b) histological type. As for malignant potential, frozen section diagnosis agreed with the paraffin diagnosis in 94% of all cases (98.5% for malignant tumors, 94% for benign tumors, and 78.6% for borderline tumors). There was one false-positive and 13 false-negative cases. Sensitivity and specificity values for malignant tumors were 93 and 99%; for borderline tumors, 61 and 99%; and for benign tumors, 98 and 93%. With respect to histological type, in 203 cases (84%) the pathologists had no doubt in the diagnosis; in 40 cases (16%) diagnosis was given as “compatible with.” In 35 of these (87.5%) the initial diagnosis was confirmed by paraffin.

Conclusion. Frozen section diagnosis seems to be a reliable method for ovarian tumors, with high sensitivity for malignant neoplasms and a low false-positive rate which allow the best choice of treatment. The most frequent problems arise with borderline and granulosa cell tumors.

References (16)

RE Fechner
Frozen section (intraoperative consultation)
Hum Pathol
(1988)
PG Rose et al.
Accuracy of frozen section (intraoperative consultation) diagnosis of ovarian tumors
Am J Obstet Gynecol
(1994)
I Obiakor et al.
The accuracy of frozen section in the diagnosis of ovarian neoplasms
Gynecol Oncol
(1991)
S Souka et al.
The combined use of cytological imprint and frozen section in the intraoperative diagnosis of ovarian tumors
Int J Gynecol Obstet
(1990)
F CM Twaalfhoven et al.
The accuracy of frozen section diagnosis of ovarian tumors
Gynecol Oncol
(1991)
KG Wang et al.
Accuracy of frozen section diagnosis in gynecology
Gynecol Oncol
(1998)
AW Menzin et al.
The accuracy of a frozen section diagnosis of borderline ovarian malignancy
Gynecol Oncol
(1995)

There are more references available in the full text version of this article.

Cited by (94)

Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents
2023, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
In the adult population, because approximately 75% of patients with ovarian cancer are diagnosed with stage III-IV disease, FS pathology is primarily utilized to guide decision-making with regard to staging and debulking, whereas for the minority that present with early-stage disease, National Comprehensive Cancer Network guidelines recommend intraoperative FS for women who are candidates for fertility-sparing surgery.15-17 However, previous studies reported varying results in terms of accuracy, with sensitivities ranging from 65% to 97% and specificities ranging from 97% to 100%.18-22 The sensitivity and specificity of our study cohort were relatively low in comparison (44.4% and 94.4%, respectively).
Describe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses
Prospective cohort study from 2018 to 2021
Eleven children's hospitals
Females age 6-21 years undergoing surgical management of an ovarian mass
Obtaining intraoperative FS pathology
Diagnostic accuracy of FS pathology
Of 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients, 12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy with or without other procedures. FS results were disparate from final pathology in 7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n = 1), mucinous borderline tumor (n = 2), mucinous carcinoma (n = 1), and immature teratoma (n = 1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology.
FSs are infrequently utilized for pediatric and adolescent ovarian masses and could be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.
Surgical management of ovarian tumors without the support of intraoperative pathology readings in Bhaktapur Cancer Hospital
2020, Gynecologic Oncology Reports
Citation Excerpt :
Pinto et al. looked at the accuracy of IOFS depending on the type of ovarian mass. For malignant, borderline, and ovarian masses, the accuracy rates were 98.5%, 76.9% and 94%, respectively (Pinto et al., 2001). Despite the utility of IOFS for surgical guidance, IOFS equipment is expensive and many hospitals in low- and middle-income countries do not have the financial means to obtain cryostat machines.
Intraoperative frozen section plays an important role in surgical management of ovarian masses. Many hospitals in low- and middle-income countries lack this intraoperative pathologic guidance. In this retrospective analysis, we assessed the management of 62 patients who underwent surgical treatment for ovarian masses at Bhaktapur Cancer Hospital in Nepal in light of the final histopathology results. Final histopathology found that 64.5% of the ovarian masses were malignant, 1.0% were borderline, and 30.6% were benign. 55 of the 62 total cases were considered “clinically suspicious” and 52 of the 62 cases underwent hysterectomy and staging procedures in addition to oophorectomy. There was no significant difference in the surgical management or in the postoperative complications when comparing benign, borderline, and malignant masses. Without the support of intraoperative frozen section, benign and malignant masses were treated the same way. The majority of benign cases were overtreated and were exposed to additional risks of postoperative complications. Several malignant cases were undertreated and required additional surgery to appropriately treat and stage malignant ovarian masses. Improved pathology support in Bhaktapur Cancer Hospital would result in better patient outcomes, fewer complications, and avoidance of additional staging surgeries.
Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review
2019, Journal of Pediatric Surgery
Citation Excerpt :
Grade B, consistent level 2 and 3 studies Eight studies addressed the role of frozen section in the intraoperative diagnosis of ovarian malignancy [28–35]. Most of these studies were of level 3 or 4 evidence and focused primarily on adult patients and on epithelial tumors.
The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy.
The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review.
Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence.
Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature.
Systematic review of level 1–4 studies.
Level 1–4 (mainly 3–4).
Accuracy of Intraoperative Frozen Section Diagnosis of Borderline Ovarian Tumors by Hospital Type
2019, Journal of Minimally Invasive Gynecology
To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital—academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists—and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor.
Retrospective study (Canadian Task Force classification II-1).
Tertiary care, academic, and community hospitals.
Women with an intraoperative frozen section diagnosis of borderline ovarian tumor at 1 of 3 types of hospital from April 1998 through June 2016.
Comparison of final pathology with intraoperative frozen section diagnosis.
Two hundred twelve women met the inclusion criteria. The frozen section diagnosis of borderline ovarian tumor correlated with the final pathologic diagnosis in 192 of 212 cases (90.6%), and the rate of correlation did not differ among the 3 hospital types (p = .82). Seven tumors (3.3%) were downgraded to benign on final pathologic analysis and 13 (6.1%) upgraded to invasive carcinoma. The 3 hospital types did not differ with respect to the proportion of tumors upgraded to invasive carcinoma (p = .62). Mucinous (odds ratio, 7.1; 95% confidence interval, 2.1–23.7; p = .002) and endometrioid borderline ovarian tumors (odds ratio, 32.4; 95% confidence interval, 1.8–595.5; p = .02) were more likely than serous ovarian tumors to be upgraded to carcinoma. Only 88 patients (41.5%) underwent lymphadenectomy, and only 1 (1.1%) had invasive carcinoma in a lymph node.
A frozen section diagnosis of borderline ovarian tumor correlates with the final pathologic diagnosis in a variety of hospital types.
The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor
2016, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
Thus, intraoperative frozen section examination plays a critical role [10]. Although the sensitivity of frozen section analysis approach about 90% for ovarian benign and malignant tumors, the sensitivities for detection of BOT (all histologies) and mucinous BOT decrease to about 50–85% and 29–48%, respectively [11–20]. The most commonly used clinical tools for evaluation of adnexal masses are imaging modalities and tumor markers [21,22].
To evaluate the utility of tumor markers and complete blood count to increase the diagnostic accuracy to detect malignant cases that are intraoperatively reported as mucinous borderline ovarian tumors (BOT).
Patients who underwent laparotomy at our gynecologic oncology clinic between 2007 and 2015 for evaluation of an adnexal mass with an intraoperative frozen section report of mucinous BOT were retrospectively analyzed. Patients were grouped according to the final pathological diagnoses (malignant, borderline and benign), and were compared in terms of tumor marker levels and complete blood count parameters. Significant parameters were evaluated together with frozen section results, and were assessed for diagnostic accuracy.
A total of 63 patients were included in the study. Of these, 41 patients had borderline, 11 patients had benign, and 11 patients had malignant mucinous ovarian tumors. Patient age, menopausal status, hemoglobin, platelet and lymphocyte counts were similar among the groups (p > 0.05). On the other hand, white blood cell, neutrophil counts and neutrophil/lymphocyte ratio (NLR) were significantly higher in malignant cases (p < 0.05). Similarly, CA125 and CA19-9 were significantly higher in malignant group (p < 0.05). When evaluated with the frozen section results, CA19-9 and NLR had the highest sensitivity to detect mucinous cancers (81 and 78 percent, respectively).
In patients who have an intraoperative frozen section diagnosis of borderline mucinous ovarian tumors, CA19-9, NLR and CA125 were significant predictors of malignancy. In light of larger future studies, we believe that integrating these parameters into routine clinical practice may decrease the rate of under diagnosis.
Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: A Tertiary Cancer Center Experience
2023, Indian Journal of Gynecologic Oncology

View all citing articles on Scopus

¹: To whom correspondence should be addressed at Rua Sampaio Vidal, 438, 13066-700, Campinas, SP, Brazil. Fax: +55-19-3289-3897 or +55-19-3242-9800. E-mail: [email protected].

View full text

Regular ArticleAccuracy of Intraoperative Frozen Section Diagnosis of Ovarian Tumors

Abstract

Hum Pathol

Am J Obstet Gynecol

Gynecol Oncol

Int J Gynecol Obstet

Gynecol Oncol

Gynecol Oncol

Gynecol Oncol

Regular Article
Accuracy of Intraoperative Frozen Section Diagnosis of Ovarian Tumors