Frozen Section in the Management of Ovarian and Uterine Tumors: The Past 5 Years in a Tertiary Centre

Aidos, Joana; Veríssimo, Renata; Almeida, Joana Palmira; Carvalho, Teresa; Martins, Nuno Nogueira; Martins, Francisco Nogueira

doi:10.1055/s-0038-1668526

Cited by 9 publications

(12 citation statements)

References 24 publications

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“…The mean age of the women for whom frozen section analysis was sent in this study was 49.2 years. This was similar to the observations noted in the study done by Aidos et al, in which the mean age noted was 51 years [ 4 ]. However, in the study done by Stephan et al, the mean age of women included in the study was 60.1 years [ 1 ].…”

Section: Discussionsupporting

confidence: 92%

“…However, in the study done by Stephan et al, the mean age of women included in the study was 60.1 years [ 1 ]. According to this study, the frozen section's sensitivity is 94.11%, which was almost similar to the study done by Aidos et al, where the sensitivity was 96.9% [ 4 ]. However, the sensitivity of the frozen section in the studies done by Wang et al and Stephan et al was 84.2% and 90%, respectively [ 2 , 1 ].…”

Section: Discussionsupporting

confidence: 89%

“…The most common malignancy seen in the female genital tract worldwide is endometrial carcinoma [ 1 , 4 , 5 ]. In our study as well, the most commonly reported cancer sent for frozen section analysis was endometrial carcinoma (14.4% overall) (Figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

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Exploring the Diagnostic Challenges of Uterine Lesions in Frozen Section: A Comprehensive Study at a Tertiary Care Center

B.,

2024

Cureus

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Introduction Uterine masses are commonly submitted for frozen section, to guide the surgeon, regarding the type and extent of the procedure during surgery. Despite the technical difficulties in processing, sectioning, and staining of frozen section samples, it remains a fairly reliable intraoperative tool. Aim This study aims to analyze the diverse spectrum of uterine masses sent for frozen sections for two years. In addition, it aims to analyze the histomorphology of the uterine masses sent for the frozen section and correlate it with that of the routine histopathological findings, thereby justifying the diagnostic value of the frozen section with this study. Furthermore, the study aims to classify the lesions into benign and malignant, quantify their frequency, and list the most common lesions seen in the uterine mass specimens sent for frozen section analysis. Methodology This retrospective descriptive study includes data from January 2021 to December 2022, retrieved from the archives of the Department of Pathology at Saveetha Medical College. This study includes a total of 76 cases, including all the uterine masses sent for frozen section analysis during the study period. Results Of the total of 76 cases received, 17 (22.4%) were malignant and 59 (77.6%) were benign. Of the malignant cases reported, the most common was endometrial carcinoma, and the least common entities encountered were carcinosarcoma and leiomyosarcoma. Of the benign cases, benign endometrial polyp was the most common endometrial lesion and leiomyoma with and without degeneration was the most common myometrial lesion encountered. Of the 50 cases of leiomyoma encountered, 16 had extensive degenerative changes. The most common degeneration seen in the fibroid was hyaline degeneration, and the least common was xanthogranulomatous degeneration. Conclusions The intraoperative frozen section analysis is a very important diagnostic tool, but we need to be aware of its limitations. The accuracy, sensitivity, and specificity rates were found to be high. Thus, frozen section diagnoses can be very valuable in the clinical management of uterine tumors. Careful gross examination, sampling from representative areas, and good communication between the pathologist and surgeon may help in avoiding its limitations.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

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Exploring the Diagnostic Challenges of Uterine Lesions in Frozen Section: A Comprehensive Study at a Tertiary Care Center

B.,

2024

Cureus

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“…Moreover, the frozen section analysis has a variable role to play in different scenarios. In the case of ovarian and endometrial tumors, it has a high sensitivity and specificity [ 22 ]: whereas, in the case of excluding uterine sarcoma it isn't reliable. This is because for uterine sarcomas, multiple areas need to be sampled in order to establish a diagnosis wherein a frozen section is restricted to a limited tissue sample, making the chances of obtaining a false-negative result highly likely [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

et al. 2021

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Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

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“…Aidos et al . performed a study on 286 patients and demonstrated that the sensitivity of the frozen section examination was 96.25% in diagnosing endometrial cancer and in determining the depth of myometrial invasion ( 12 ). A meta-analysis reports that the frozen section examination was the gold standard in endometrial cancer, especially in determining the depth of myometrial invasion ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of TVUS, MRI, and Frozen Section Methods in Preoperative Detection of Myometrial Invasion in Patients with Endometrial Cancer

Kural

Yılmaz

Melekoğlu

et al. 2021

ACC

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SUMMARY We aimed to evaluate the depth of myometrial invasion preoperatively with transvaginal ultrasound, magnetic resonance imaging, and frozen section examination techniques in patients diagnosed with endometrial cancer. Our study included 65 patients. Transvaginal ultrasound and magnetic resonance imaging were performed in study patients in the preoperative period. Frozen section examination was performed in all hysterectomy samples obtained from all study patients. Data were analyzed with SPSS Statistics 22.0 program. The sensitivity of transvaginal ultrasound in determining the depth of myometrial invasion was 88.64%, specificity 90.48%, positive predictive value 95.12%, and negative predictive value 79.17%. For magnetic resonance imaging, the sensitivity was 63.64%, specificity 95.24%, positive predictive value 96.55%, and negative predictive value 55.56%. In addition to the frozen section examination, which is the gold standard in determining the myometrial invasion depth, transvaginal ultrasound and magnetic resonance imaging have become commonly used methods for this purpose in recent years. Ultrasound examination performed by an experienced specialist is superior to magnetic resonance imaging as it is fast, inexpensive, and associated with higher sensitivity.

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Frozen Section in the Management of Ovarian and Uterine Tumors: The Past 5 Years in a Tertiary Centre

Cited by 9 publications

References 24 publications

Exploring the Diagnostic Challenges of Uterine Lesions in Frozen Section: A Comprehensive Study at a Tertiary Care Center

Exploring the Diagnostic Challenges of Uterine Lesions in Frozen Section: A Comprehensive Study at a Tertiary Care Center

Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

Comparison of TVUS, MRI, and Frozen Section Methods in Preoperative Detection of Myometrial Invasion in Patients with Endometrial Cancer

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