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 6 publications

(5 citation statements)

References 24 publications

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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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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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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“…Kumar et al [27] reported a 98.9% concordance between frozen section and paraffin examinations in determining MI depth, while Aidos et al [2] reported an accuracy of 94.8%. The sensitivity and specificity values reported by different researchers for determining MI depth via IC have been highly variable, ranging from 65% to 98.7% [22,[26][27][28].…”

Section: Endometrial Carcinomamentioning

confidence: 99%

“…Therefore, both the promptness and the accuracy of IC are critically important. In the literature, the sensitivity and specificity of IC have been reported in the ranges of 65-97% and 97-100% [2,3]. Large masses and mucinous and borderline tumors are some of the factors that unfavorably affect the accuracy of IC diagnosis [2].…”

Section: Introductionmentioning

confidence: 99%

“…Still, IC remains a viable option for patients with no hemi-pelvic mapping, as lymph node dissection may be omitted in these patients according to the result of intraoperative pathological evaluation, as stated in the latest NCCN guideline on uterine neoplasms [4]. The accuracy of IC in EC is reported as 68-95% for tumor grade and 72-95% for MI depth [2].…”

Section: Introductionmentioning

confidence: 99%

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The role of intraoperative consultation in the management of ovarian masses and endometrial carcinomas: a 7-year experience

2024

EJGO

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Intraoperative consultation (IC) is often used for surgical planning in gynecological oncology, primarily in ovarian and endometrial cancer surgery. However, there is limited research that compares IC diagnoses and results from definitive analyses. This retrospective study compares IC results and definitive analysis findings in terms of ovarian mass diagnoses and endometrial carcinoma patients consulted for myometrial invasion (MI) depth across 7 years (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). IC was performed in 282 cases to evaluate ovarian masses. The sensitivity of IC was 94% for benign ovarian masses and 90% for malignant ovarian masses. 92 cases were submitted to IC for endometrial carcinoma. Sensitivity was 80% for tumors with <50% MI and 74% for tumors with ≥50% MI. IC is an important method with high sensitivity and specificity for diagnosing ovarian masses and determining MI depth in endometrial carcinomas.

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

Cited by 6 publications

References 24 publications

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

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

The role of intraoperative consultation in the management of ovarian masses and endometrial carcinomas: a 7-year experience

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