Section Diagnosis Of Ovarian Tumors Research Articles

Accuracy and Reproducibility of Frozen Section Diagnosis in Ovarian Tumors

Intraoperative consultation-frozen section diagnosis (FSD)-determines tumor pathology and guides the optimal surgical management of ovarian neoplasms intraoperatively. To evaluate the diagnostic accuracy of the FSD and analyze the discrepancy between the FSD and final diagnosis. This is a retrospective study of 618 ovarian neoplasm FSDs from 2009 to 2018 at a tertiary health care center. The discrepant cases were reviewed and reevaluated by gynecologic and general surgical pathologists. The outcomes of interest were performing unnecessary procedure, returning for a second surgery, and 30-day postoperative mortality. The sensitivity and the positive predictive value of the FSD were lower in borderline tumors than in benign and malignant epithelial ovarian tumors. Major and minor discrepancies were identified in 5.3% (33 of 618) and 12.3% of (76 of 618) cases, respectively. A root cause analysis of the major discrepant cases showed that sampling error accounted for 43% (14 of 33). The discrepancy distributions of gynecologic and general surgical pathologists were statistically similar in the overall cohort (P = .65). The overall κ for diagnostic agreement among gynecologic pathologists, general surgical pathologists, and final diagnosis was 0.18 (0.10-0.26, P < .001), implying only a slight overall agreement. Of the major discrepant cases, only 3 had a clinical implication. One overdiagnosed patient underwent an unecessary procedure, and 2 underdiagnosed patients were recommended to return for a second surgery. No patient had 30-day postoperative mortality. Frozen section diagnosis remains a definitive diagnostic tool in ovarian neoplasms and plays a crucial role in guiding intraoperative surgical management.

Diagnostic Discordance in Intraoperative Frozen Section Diagnosis of Ovarian Tumors: A Literature Review and Analysis of 871 Cases Treated at a Japanese Cancer Center

This study examined the accuracy and pitfalls associated with frozen section diagnosis of primary ovarian tumors and ovarian metastases based on the 2014 World Health Organization classification (WHO) criteria and proposed improvements from a pathologist's perspective. We microscopically reviewed 871 cases of primary ovarian tumor (N = 802) and ovarian metastasis (N = 69) and compared the results of frozen sections with the final diagnosis. Malignant potential concordance (benign, borderline, or malignant) and specific discordant diagnosis rates were analyzed. Finally, we conducted a unique literature review of specific diagnostic errors in the frozen section diagnosis of primary ovarian tumors. Of 802 primary ovarian tumors, 50 (6.2%) cases showed discordant diagnoses in which mucinous carcinoma (40.5%), low-grade serous carcinoma (LGSC; 31.3%), and mucinous borderline tumor (18.4%) were frequently misinterpreted. Of 69 ovarian metastases, all 4 cases of low-grade appendiceal mucinous neoplasm (LAMN) were misdiagnosed as primary ovarian mucinous tumor. A literature review revealed that mucinous/serous borderline tumor or carcinoma accounted for approximately 70% of 217 reported discordant diagnoses. In the present study, the concordance rate of malignant potential of the tumor was comparable to that previously reported. Even in the 2014 WHO classification, primary ovarian mucinous borderline tumor/carcinoma and LGSC still comprised the majority of discordant cases. Grossing methods that reduce sampling error are required. LAMN was frequently misinterpreted as a benign or borderline ovarian mucinous tumor. To prevent this error, a differential algorithm integrating clinical information and gross findings should be developed.

Role of Frozen Section in Surgical Management of Ovarian Neoplasm.

Objective:Cancers of the adnexae, including ovarian and fallopian tube, constitute the eighth most common cancers among women worldwide. Surgery remains the cornerstone in the management of ovarian cancer. Intraoperative frozen section diagnosis of ovarian tumors is widely used in making this distinction and to decide the course of surgery. Therefore, the accuracy of this technique is very important. The aim was to determine the overall accuracy, sensitivity, specificity, and predictive values of frozen section for ovarian tumors and to evaluate the role of frozen section in the surgical management of ovarian tumors.Materials and Methods:This was a descriptive longitudinal study conducted in the gynecology department of a tertiary care hospital. During the 1 ½ year period of data collection, frozen section was performed among 60 cases of ovarian neoplasms. The overall accuracy, sensitivity, specificity and predictive values of frozen section for benign, borderline and malignant categories of ovarian tumors were studied.Results:Out of the 60 patients of ovarian tumors, frozen section diagnosis showed that 43 (71.7%) tumors were benign, 11 (18.3%) were malignant and 6 (10%) were of borderline nature. Final histopathological diagnosis showed that 45 (75%) tumors were benign, 11 (18.3%) were malignant and 4 (6.7%) were borderline. Frozen section for benign tumors had 95% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 88% negative predictive value (NPV). Malignant tumors had 90% sensitivity, 97% specificity, 90% PPV and 97% NPV with frozen section. However, frozen section had low sensitivity (75%) and PPV (50%) for borderline tumors. Specificity was 94% and NPV 98% in this group of tumors.Conclusion:Frozen section was found to be an accurate and useful modality in the intraoperative evaluation of patients with ovarian neoplasm. The results can help to decide the type and extent of surgery.

Accuracy of frozen section diagnosis in ovarian masses: experience at a tertiary oncology center

Accurate frozen section diagnosis is necessary for appropriate surgical management. In this study, we planned to determine the accuracy of frozen section diagnosis in our center and to study the factors which may influence the accuracy of frozen section diagnosis of ovarian tumors. In the present study, frozen section diagnosis of adnexal masses in 282 patients was compared with permanent section diagnosis as the gold standard. The overall accuracy of frozen section diagnosis was 95.7%. The sensitivity of frozen section diagnosis for benign, borderline and malignant lesions was 99, 60, and 92%, respectively. The tumor size in discrepant cases was larger than the concordant cases, however no association between mucinous histology and inaccurate diagnosis was found. The sensitivities of gross examination and clinical data in distinguishing benign from non-benign lesions were 93 and 70%, respectively. Frozen section is a reliable method for surgical management of patients with adnexal masses. Gross examination and clinical data are two valuable parts of intraoperative consultation.

Accuracy of frozen section diagnosis in ovarian tumors: Is there a change in the course of time?

A retrospective study of 222 ovarian biopsy results between January 1, 2000 and August 31, 2002 was examined to determine the accuracy of frozen section diagnosis. In addition we reviewed all previous studies that examined the accuracy rates of frozen section diagnosis in ovarian tumors. Histopathologic examination results of frozen section biopsies were concordant with paraffin diagnosis in 92% of all cases. The sensitivity rates for benign, malignant, and borderline ovarian tumors were 98%, 88.7%, and 61%, respectively. There were five (2.2%) false-positive (overdiagnosed), and 13 (5.4%) false-negative (underdiagnosed) patients in frozen section examination. Frozen section examination of mucinous tumors showed higher underdiagnosis rates (20%). Review of previous studies showed no significant variation in accuracy rates of frozen section diagnosis for benign and malignant ovarian tumors, in relation with time. We found low accuracy rates for borderline ovarian tumors which was similar with the previous studies. However, there were consistent and relatively higher sensitivity rates for borderline ovarian tumors in the recent studies. As a result, we conclude that frozen section evaluation in identifying a malignant or benign ovarian tumor is accurate enough for the correct diagnosis. Since accuracy rates for borderline ovarian tumors are low, we should have more improvement in the correct diagnosis.

Accuracy of frozen section diagnosis in ovarian tumors: Is there a change in the course of time?

A retrospective study of 222 ovarian biopsy results between January 1, 2000 and August 31, 2002 was examined to determine the accuracy of frozen section diagnosis. In addition we reviewed all previous studies that examined the accuracy rates of frozen section diagnosis in ovarian tumors. Histopathologic examination results of frozen section biopsies were concordant with paraffin diagnosis in 92% of all cases. The sensitivity rates for benign, malignant, and borderline ovarian tumors were 98%, 88.7%, and 61%, respectively. There were five (2.2%) false-positive (overdiagnosed), and 13 (5.4%) false-negative (underdiagnosed) patients in frozen section examination. Frozen section examination of mucinous tumors showed higher underdiagnosis rates (20%). Review of previous studies showed no significant variation in accuracy rates of frozen section diagnosis for benign and malignant ovarian tumors, in relation with time. We found low accuracy rates for borderline ovarian tumors which was similar with the previous studies. Hovewer, there were consistent and relatively higher sensitivity rates for borderline ovarian tumors in the recent studies. As a result, we conclude that frozen section evaluation in identifying a malignant or benign ovarian tumor is accurate enough for the correct diagnosis. Since accuracy rates for borderline ovarian tumors are low, we should have more improvement in the correct diagnosis.

Accuracy of Intraoperative Frozen Section Diagnosis of Ovarian Tumors

Objective. The goal of this work was to evaluate retrospectively, as quality control, the accuracy of frozen section diagnosis in ovarian tumors.Method. We compared 243 frozen section results with the final diagnosis in paraffin sections, from cases studied from January 1994 to April 1999.Results. Results with the two methods were analyzed on two parameters: (a) malignant potential and (b) histological type. As for malignant potential, frozen section diagnosis agreed with the paraffin diagnosis in 94% of all cases (98.5% for malignant tumors, 94% for benign tumors, and 78.6% for borderline tumors). There was one false-positive and 13 false-negative cases. Sensitivity and specificity values for malignant tumors were 93 and 99%; for borderline tumors, 61 and 99%; and for benign tumors, 98 and 93%. With respect to histological type, in 203 cases (84%) the pathologists had no doubt in the diagnosis; in 40 cases (16%) diagnosis was given as “compatible with.” In 35 of these (87.5%) the initial diagnosis was confirmed by paraffin.Conclusion. Frozen section diagnosis seems to be a reliable method for ovarian tumors, with high sensitivity for malignant neoplasms and a low false-positive rate which allow the best choice of treatment. The most frequent problems arise with borderline and granulosa cell tumors.

The value of intraoperative consultation (frozen section) in the diagnosis of ovarian neoplasms

Frozen Section is an important diagnostic tool to determine the nature of ovarian masses. However, like other diagnostic tools, frozen section also has some pitfalls. We aimed to discuss the source and the nature of inaccuracies associated with this procedure. In this retrospective study 360 cases of ovarian masses examined by frozen section were re-evaluated. The sensitivity, specificity and predictive values of frozen section diagnosis of ovarian tumors were calculated. The reasons for the erroneous frozen-section diagnoses were discussed. Overall diagnostic agreement for ovarian lesions was 94.2%. Disagreements were found in nine cases (2.5%). Diagnosis was deferred to permanent sections in 12 cases (3.3%). The sensitivity for malignant tumors was 93.1% and specificity was 99.2%. The sensitivity for benign tumors was 99.2% and specificity was 92.1%. Most problematic cases were mucinous tumors, followed by tumors resembling fibrothecomas, in addition sections without viable tissue fragments or presence of extensive hemorrhage and necrosis also obscured the frozen diagnosis. Another factor was the lack of an effective communication between the surgeon and the pathologist. For an effective usage of this method not only the pathologist but also the surgeons must know the pitfalls of this method and also there must be good communication between the pathologist and the surgeon. Especially deferred cases should be minimized by good communication. In fact it's an intraoperative consultation method that enables the pathologist to gather all the preoperative, intraoperative findings and to be familiar with the further treatment plan of the patient.

The Accuracy of Frozen section Diagnosis of ovarian Tumors

The Accuracy of Frozen section Diagnosis of ovarian Tumors

The accuracy of frozen section diagnosis of ovarian tumors

We compared all frozen section examinations of ovarian tumors during a 6-year period in our institute with the final diagnosis from paraffin sections. In this period, 946 ovarian tumor specimens were removed for histologic assessment; 176 (18.6%) had frozen section examination. Final histological diagnosis was divided into benign (55.1%), borderline malignant (10.3%), and malignant (34.6%). Sensitivity of the frozen section method for malignant or borderline disease was 83.5% and specificity for a benign lesion, 92.8%. Predictive values and 95% confidence intervals were computed: 100% (93–100%) for malignancy, 62% (32–86%) for borderline malignancy, and 92% (85–96%) for a benign disease. Diagnostic problems occurred in large borderline tumors of mucinous cell type. Analysis of the 12 false negative diagnoses revealed that a sampling error was involved in 11 cases. A judgment error was made in the only false positive and in 1 out of 12 false negative frozen section diagnoses. It is concluded that when surgeons and pathologists are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under- and overtreatment of gynecologic patients.