Intraoperative frozen section in ovarian neoplasms; a tertiary center experience.

Arbil Acikalin,Handan Zeren,Goncagul Torun,Fatma Bayram,Ahmet Baris Guzel,Derya Gumurdulu,Umran Gulec,Emine Bagir

doi:10.5146/tjpath.2014.01270

Abstract

Frozen section is an accurate diagnostic tool with some unavoidable pitfalls in gynecologic tumors. We aimed to evaluate the diagnostic value of frozen section, and to detect the factors causing erroneous diagnosis in ovarian tumors. Frozen section and paraffin section reports of 282 patients with ovarian neoplasms diagnosed between July 2006 and January 2013 in our institute were re-analyzed. RESULTS were grouped into benign, borderline (for epithelial tumors) and malignant categories and compared between frozen section and paraffin section diagnosis, statistically. Overall diagnostic accuracy of frozen section was 96.5%. Sensitivity of frozen section for benign, borderline and malignant tumors were 97.5%, 95.8%, and 95.6% and the related specificities were 97.5%, 97.6%, and 100%, respectively. We found the lowest positive predictive value in borderline group (79.3%), all of them with mucinous type epithelium. Second frequent discordant tumor type was immature teratoma. Apart from the limitations of frozen section, pathologists should be aware of the pitfalls of technique and tumor types and tend to sample from the solid areas particularly in mucinous tumors and teratomas to avoid inappropriate surgery.

Highlights

Ovarian cancer is the most common lethal gynecologic cancer and the seventh most common cause of death from cancer in women (4.2% of deaths) worldwide [1, 2]
We found the lowest positive predictive value in borderline group (79.3%), all of them with mucinous type epithelium
Apart from the limitations of frozen section, pathologists should be aware of the pitfalls of technique and tumor types and tend to sample from the solid areas in mucinous tumors and teratomas to avoid inappropriate surgery

Summary

Introduction

Ovarian cancer is the most common lethal gynecologic cancer and the seventh most common cause of death from cancer in women (4.2% of deaths) worldwide [1, 2]. Surgical management of ovarian neoplasms differs according to their subtypes. It is important for the surgeon to determine the category of ovarian neoplasm preoperatively. Preoperative imaging methods such as ultrasonography or serologic evaluations have been used for this aim but they are usually insufficient, especially in early stage cases. In this instance, intraoperative frozen section (FS) has been shown to be a highly sensitive and specific adjunctive method for the surgeon in management of appropriate operation. We analyzed the concordance between FS and paraffin section (PS) and diagnostic accuracy of FS

Results

Discussion

Conclusion