Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors

Abstract

Objective: First, to evaluate the sensitivity and positive predictive value (PPV) of intra-operative frozen section (FS) diagnosis in borderline ovarian tumors (BOTs), and to explore the factors affecting the diagnostic accuracy. Second, to assess the clinical outcomes of misdiagnosed BOT patients.Methods: We performed a retrospective study of all patients diagnosed as BOT through FS or paraffin section (PS) at Qilu Hospital between January 2005 and December 2015. Clinical and pathologic data were extracted. Univariate analysis was performed using standard two-sided statistical tests. We also performed a meta-analysis to further validate the findings.Results: In our retrospective study, 155 patients were included. Agreement between FS and PS diagnosis was observed in 127/155 (81.9%) patients, yielding a sensitivity of 92.7% and a PPV of 87.6%. Under-diagnosis and over-diagnosis occurred in 22 cases (14.2%) and 6 cases (3.9%), respectively. In our univariate analysis of our retrospective study, tumor size (p=0.048) and surgery approach (p=0.024) were significantly associated with misdiagnosis.The pooled analysis of 13 studies including 1,577 patients indicated that the accuracy (69.2%), sensitivity (82.5%), and PPV (81.1%) were low; also under-diagnosis (20.2%) and over-diagnosis (10.5%) were frequent. The meta-analysis results showed that mucinous histology (p < 0.0001, OR=2.03 [1.47-2.81]) and unilateral tumors (p=0.001, OR=2.39 [1.41-4.06]) were associated with the misdiagnosis of BOT. In our retrospective study, there was no statistical significance of clinical outcome such as extent of surgery (p=0.838), recurrence (p=0.586), fertility (p=0.560), death (p=0.362) between misdiagnosed and accurately diagnosed BOT patients.Conclusions: FS analysis of BOTs has low accuracy, sensitivity, and PPV. Under-diagnosis and over-diagnosis are frequent. Meta-analysis results verify that mucinous histology and unilateral tumors are associated with misdiagnosis of FS. Nevertheless, misdiagnosed patients have a good clinical outcome despite the high frequency of misdiagnosis through FS.

Feasibility of Single-Port Access (SPA) Laparoscopy for Large Ovarian Tumor Suspected to Be Borderline Ovarian Tumor

“…The sensitivity and PPV of FS analysis for BOT were 66.6% and 69.2%, respectively. These values are relatively lower than has been previously reported (sensitivity between 75 and 93% and PPV between 88 and 95%) (24,25). Underdiagnosis was identified in 30 patients (16.8%) in the present study, which was relatively higher than that reported in previous studies (24).…”

“…These values are relatively lower than has been previously reported (sensitivity between 75 and 93% and PPV between 88 and 95%) (24,25). Underdiagnosis was identified in 30 patients (16.8%) in the present study, which was relatively higher than that reported in previous studies (24). Such discrepancies in misdiagnosis could be explained by the relatively large tumor size and the fact that the most common histological subtype of the tumor in the present study was a mucinous tumor, which often contains benign, borderline, and malignant components together (24,26,27).…”

“…Underdiagnosis was identified in 30 patients (16.8%) in the present study, which was relatively higher than that reported in previous studies (24). Such discrepancies in misdiagnosis could be explained by the relatively large tumor size and the fact that the most common histological subtype of the tumor in the present study was a mucinous tumor, which often contains benign, borderline, and malignant components together (24,26,27). However, the rates of misdiagnosis in the FS analysis did not differ between the SPA Group and the Laparotomy Group in the present study.…”

“…Similar findings have also been reported in previous studies. According to a meta-analysis that evaluated the misdiagnosis rates of FS analysis in BOT, the surgical approach (laparoscopy vs. laparotomy) was not associated with the accuracy of FS analysis (OR = 1.34, CI 0.57-3.11, p = 0.50) (24).…”

Clinical Features and Management of Women with Borderline Ovarian Tumors in a Single Center in Brazil

“…3,4 Besides, frozen-section readings will never achieve 100% of accuracy; however, despite the possibility of underdiagnosis and overdiagnosis, they may provide guidance in most cases. 2,5,6 A careful inspection of the abdominal and pelvic cavities should be performed for adequate staging and complete removal of the disease. Surgical staging generally includes cytologic washings, resection of the tumor, infracolic omentectomy and peritoneal biopsies.…”