Comparison of Intra Operative Cytology and Frozen Section with Permanent Pathologic Results in Ovarian Masses

Abstract

IntroductionOvarian cancer is the 6th most common form of women's cancer worldwide (1). It accounts for 4% of all female cancers and 31% of cancers of the female genital tract. Ovarian cancer is the 4th most common cause of death from malignancy in women (2). Almost it can be said that, the ovarian cancer has the widest pathologic variety between gynecological cancers and each pathology has a significant effect on the extent of surgery and follow up. The staging of ovarian cancer is totally surgical and determined by intraoperative findings, the extent of the disease and the potential sites of metastatic spread (3). Therefore, it requires accurate intra-operative diagnosis to prevent an extensive surgery in a young patient who desires to preserve her fertility or incurrence of a lengthy surgery to old patient, and also prevention of a second surgery after determination of final pathology. For years, frozen section (FS) has been used to determine intraoperative diagnosis, but due to its limitations, methods such as fine needle aspiration (FNA) of ovarian masses, touch imprint and scraping and squash methods have been developed and underwent review to find a more rapid and more accurate alternative method for FS (4,5). Over diagnosis of FS in malignant tumors is twice its' under diagnosis and under diagnosis of FS in borderline ovarian masses is multifold its over diagnosis (6).In addition to the above mentioned facts, if a suspicious ovarian mass is suddenly discovered during surgery, preparation of FS is not available in many hospitals. So, we decided to investigate the scrape diagnostic method in evaluation of ovarian masses and detect its sensitivity, specificity and accuracy in our center compared to FS and final pathology. Materials and MethodsIn a cross-sectional and descriptive-analytical study performed on women with ovarian masses who have been surgical candidates in Al-Zahra University dependent hospital during the years 2008 to 2011, sensitivity, specificity and accuracy of scrape diagnostic method were evaluated and compared to FS and permanent pathology. In this period, 131 patients with ovarian masses were enrolled into the study. After resection of the ovarian masses in the operating room they were immediately dispatched to pathology ward, fresh and without fixation, and grossly evaluated by pathologists. Gross details of the masses and pathologist's macroscopic diagnosis on the tumors were recorded. Then, mass surface was scrapped after cutting by scalpel and smeared on two glass slides. After one minute fixation in ethanol 96°, slides were stained with rapid Hematoxylin and Eosin (HE) method. While staining cytology slides, FS test was performed on some pieces of Abstract Objectives: Making a decision on the extent of surgery for ovarian tumors depends on the intraoperative diagnosis. The aim of this study was to compare the intraoperative cytology and frozen section (FS) for diagnosis of ovarian masses. Materials and Methods: One hundred and thirty-one patients with ovarian masses who underwent ...