Intraoperative frozen section in ovarian neoplasms; a tertiary center experience

Acikalin, Arbil; Torun, Goncagül; Bağır, Emine; Bayram, Fatma; Zeren, Handan; Güleç, Ümran Küçükgöz; Güzel, Ahmet Barış; Gümürdülü, Derya

doi:10.5146/tjpath.2014.01270

Cited by 6 publications

(7 citation statements)

References 16 publications

(12 reference statements)

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“…In another retrospective review of 282 cases, sensitivities of the frozen section for benign, borderline, and malignant tumors were 97.5, 95.8, and 95.6 %, and corresponding specificities were 97.5, 97.6, and 100 %, respectively. They found the lowest positive predictive value in borderline group (79.3 %), all of them with mucinous type epithelium as described by other authors [ 9 ]. Another oncology center reported an overall accuracy of 91.85 %.…”

Section: Discussionsupporting

confidence: 59%

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience

et al. 2016

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BackgroundOvarian neoplasms are a heterogeneous group of tumors including surface epithelial, germ cell and sex cord stromal tumors with a subset having low malignant potential (borderline tumors). While the surgical management plan differs in different categories of tumors, preoperative diagnosis is seldom available. In these circumstances, the role of frozen section becomes invaluable. In the current study, we aimed to evaluate the accuracy of the frozen section of ovarian tumors in our setup.MethodsIt was a retrospective study involving 141 cases of ovarian tumors undergoing surgical resection with frozen section evaluation from January 2009 to December 2014. After gross examination, one to five blocks were prepared on the frozen section depending upon the size of the specimen. After frozen section reporting, specimens were processed routinely for final paraffin section evaluation. Results of frozen and paraffin sections were categorized in benign, borderline, and malignant, and accuracy of frozen section was determined.ResultsOut of 141 cases, 107 were diagnosed as benign on final (paraffin) examination, while 6 were borderline and 28 were malignant. Out of 107 benign cases, 45 were non-neoplastic cystic lesions of the ovary including endometriotic, follicular, and corpus luteal cysts. The most common benign neoplastic tumor was mature cystic teratoma (20 cases) followed by mucinous cystadenoma (19 cases), serous cystadenoma (14 cases), sex cord stromal tumors (8 cases), and Brenner tumor (1 case). Among borderline cases, four cases were serous and two of mucinous neoplasms. The most common malignant neoplasm was serous carcinoma (11 cases) followed by mucinous carcinoma (6 cases). The overall accuracy of frozen section diagnosis is above 99 %. The sensitivity and specificity for benign tumors were found to be 100 and 97 %, respectively. The sensitivity and specificity for borderline tumors was 83 and 99 %, respectively, while for malignant tumors, it was 96 and 100 %, respectively.ConclusionsWe found a high sensitivity and specificity of frozen section for the diagnosis of ovarian tumors and to determine its malignant potential. Therefore, it should always be used when the preoperative diagnosis is not definite to govern extent of surgical resection. However, under-diagnosis can occur in tumors of borderline category which can be minimized by increased sampling on the frozen section.

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Section: Discussionsupporting

confidence: 59%

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience

et al. 2016

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“…Given the low accuracy rate for borderline ovarian tumors, care and attention are required to develop this field (10,11,13,14,18). Most studies typically reported a sensitivity of 71-100% for the detection of malignancies by frozen section, and a specificity ranging from 96-100% (11,19,21,23,26,27). In our study, the sensitivity of malignant ovarian tumor detection was 93.3% and the specificity was 100%, reflecting that the frozen section examination was highly sensitive and specific to ovarian malignancy.…”

Section: Discussionsupporting

confidence: 54%

“…In a review of 60 patients of ovarian tumors by(11), frozen section had low sensitivity (75%) and PPV (50%) for borderline tumors. In a further retrospective study of 282 cases, the sensitivity of the frozen section to borderline tumors was 95.8% and the specificity 97.6%(23). For the borderline category, they found the lowest positive predictive value (79.3%), all with epithelium of mucinous type.…”

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confidence: 88%

Diagnostic Accuracy Value of Intraoperative Frozen Section for Ovarian Neoplasms

Shahmoradi

Arab

2020

Indian J Gynecol Oncolog

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Background Accuracy of intraoperative frozen section diagnosis is extremely important in the evaluation of ovarian tumors so that suitable surgical procedures can be chosen. Methods This retrospective diagnostic accuracy study was conducted in the Department of Obstetrics and Gynecology, Emam Hossein Hospital. The case records of patients with ovarian mass who underwent surgery and intraoperatively frozen section assessments between September 2006 and December 2014 were analyzed. Demographic and clinical data, operative details, frozen section and final histopathology Examination (HPE) were reviewed from the medical records. Results one hundred and ninety three patients with ovarian masses undergoing surgery and frozen section were included. The frozen section diagnoses were benign in 155 (80.31%), borderline in 10 (5.18%), and malignant in 28 (14.51%), whereas the final diagnosis was benign in 154 (79.80%), borderline in 9 (4.66%), and malignant in 30 (15.54%). The overall accuracy of intra-operative frozen section diagnosis was 98.9%. The sensitivity for frozen section diagnosis was 100% for benign, 89% for borderline and 93.3% for malignant category, whereas the specificity was 97%, 99%, and 100%, respectively. There were 3 cases with discordance between the frozen section diagnoses and the final diagnoses, all of which were under diagnosed by frozen section. Conclusion Frozen section was found to be accurate and useful in the intraoperative assessment of patients with ovarian neoplasm. The results may help to determine the type and extent of surgery.

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“…Various studies have compared the diagnostic accuracy of SS and FS with final histopathological diagnosis. [12345678910111213] The benefits of intaoperative diagnosis by cytomorphology over FS have been described. SSs are less time-consuming, inexpensive, and lack freezing artefacts; various heterogeneous areas can be examined in little time and tissue loss can be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…The possible reason for discordance between FS and HPE in mucinous tumors is associated with characteristics of these tumors such as larger sizes and presence of benign, borderline, and malignant components in the same tumor in contrast to serous tumors. [9101112] The sampling thus should be done from solid-looking areas of cystic neoplasms. In addition, metastatic tumors especially mucinous carcinomas maybe challenging in FS if there is inadequate clinical information and communication with the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Scrape Cytology from Ovarian Masss Lesions: A Study of 81 Cases

Gupta

Singh

Bhatt

et al. 2019

J Cytol

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Background: Intraoperative evaluation of an ovarian mass is of crucial importance in its further management, accomplished by frozen section (FS) and scrape smear (SS) examination. Aim: To evaluate utility of SS over FS and to study scrape cytological features of a variety of ovarian neoplasms. Materials and Methods: The study comprised ovarian tumors studied over a period of 1 year (2014–2015) that were submitted for intraoperative assessment. SS and FS were examined and evaluated independently. The results were compared with final pathological diagnosis in each case, and cases with discordant diagnoses were reviewed. All the SSs of ovarian tumors were re-evaluated with Giemsa-stained smears, and cytological features were described. Results: The results of SS and FS were 100% concordant. On histopathology, of 81 cases, 43 were epithelial [(categorized further as serous, mucinous, or malignant mixed Mullerian tumor (MMMT)] along with subcategorization of benign, borderline, and malignant), 16 were germ cell (categorized as teratoma: mature/immature and yolk sac tumor), 11 were sex cord stromal tumors (fibroma, granulosa cell tumor, Sertoli–Leydig cell tumor), 8 cases were hemorrhagic cysts (torsion, endometroid, corpus luteal cyst, etc.), and 3 were metastasis. There were 61 benign, 2 borderline, and 18 malignant cases on FS and scrape. Combining all the values, sensitivity and specificity were 76% and 98.21%, respectively. The diagnostic accuracy in diagnosing malignant lesions was 91%. Conclusion: Adequate knowledge on cytohistological correlation of ovarian scrape cytology may phase out the use of cryostat in intraoperative diagnosis of ovarian neoplasms, and thus be a boon for resource-deprived settings.

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Intraoperative frozen section in ovarian neoplasms; a tertiary center experience

Cited by 6 publications

References 16 publications

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience

Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience

Diagnostic Accuracy Value of Intraoperative Frozen Section for Ovarian Neoplasms

Intraoperative Scrape Cytology from Ovarian Masss Lesions: A Study of 81 Cases

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