Accuracy of Frozen-Section Diagnosis of Ovarian Mucinous Tumors

2012 ◽  
Vol 22 (3) ◽  
pp. 400-406 ◽  
Author(s):  
Tip Pongsuvareeyakul ◽  
Surapan Khunamornpong ◽  
Jongkolnee Settakorn ◽  
Kornkanok Sukpan ◽  
Prapaporn Suprasert ◽  
...  
Keyword(s):  
Tumor Size ◽  
Malignant Tumors ◽  
Independent Predictor ◽  
Frozen Section ◽  
Malignant Potential ◽  
Frozen Sections ◽  
Diagnostic Agreement ◽  
Predictive Values ◽  
Frozen Section Diagnosis ◽  
Low Malignant Potential

ObjectiveThe objective of the study was to evaluate the diagnostic accuracy of intraoperative frozen sections of ovarian mucinous tumors and to identify the features associated with an inaccurate diagnosis.MethodsCases of ovarian mucinous tumors (benign, low malignant potential [LMP] or borderline, primary malignant, and metastatic) diagnosed by frozen section or final histology were recruited. Frozen-section diagnoses were compared with the final histologic diagnoses. Possible variables associated with diagnostic discrepancy were analyzed.ResultsA comparison of the diagnoses was done in 195 cases (102 benign, 61 LMP, 18 primary malignant, and 14 metastatic). Diagnostic agreement was observed in 164 cases (84.1%) and discrepancy in 31 cases (15.9%). The sensitivity of frozen-section diagnosis was low in LMP (67.2%) and malignant tumors (55.6%). The specificity was the lowest in the benign category (78.5%). The positive predictive values of all categories were less than 90% (range, 83.3%–85.7%). Diagnostic discrepancy was associated with tumor size of greater than 13 cm (P = 0.019) and the number of frozen sections of 4 or more (P = 0.035). However, in a multivariate analysis, there was no independent predictor of diagnostic discrepancy. The number of frozen sections 4 or more was strongly associated with tumor size of greater than 13 cm (P = 0.004).ConclusionsThe sensitivity of frozen-section diagnosis of LMP and malignant mucinous tumors was low. The inaccuracy of a frozen-section diagnosis of ovarian mucinous tumors may be related to a tumor size of greater than 13 cm. Increasing the number of intraoperative samples over 3 sections per case may not effectively increase the accuracy of frozen-section diagnosis in mucinous tumors.

scholarly journals Experience with a Dynamic Inexpensive Video-Conferencing System for Frozen Section Telepathology

2000 ◽  
Vol 21 (3-4) ◽  
pp. 169-175 ◽  
Author(s):  
J. P. A. Baak ◽  
P. J. van Diest ◽  
G. A. Meijer
Keyword(s):  
Image Quality ◽  
Frozen Section ◽  
Video Conferencing ◽  
Final Diagnosis ◽  
Complete Agreement ◽  
Frozen Sections ◽  
Predictive Values ◽  
Video Conferencing System ◽  
Frozen Section Diagnosis ◽  
Conferencing System

Aim: To evaluate the feasibility of an inexpensive, generally applicable video‐conferencing system for frozen section telepathology (TP).Methods: A commercially widely available PC‐based dynamic video‐conferencing system (PictureTel LIVE, model PCS 100) has been evaluated, using two, four and six ISDN channels (128–384 kilobits per second (kbs)) bandwidths. 129 frozen sections have been analyzed which were classified by TP as benign, uncertain (the remark probably benign, or probably malignant was allowed), malignant, or not acceptable image quality. The TP results were compared with the original frozen section diagnosis and final paraffin diagnosis.Results: Only 384 kbs (3 ISDN‐2 lines) resulted in acceptable speed and quality of microscope images, and synchronous image/speech transfer. In one of the frozen section cases (0.7%), TP image quality was classified as not acceptable, leaving 128 frozen sections for the analysis. Five of these cases were uncertain by TP, and also deferred by frozen section procedure (FS). One more benign and three malignant FS cases were classified as uncertain by TP. Three additional cases were uncertain by FS, but benign according to TP (in agreement with the final diagnosis). In one case, FS diagnosis was uncertain but TP was malignant (in agreement with the final diagnosis). Thus, test efficiency (i.e., cases with complete agreement) was 120/128 (93.8%, Kappa = 0.88) between FS and TP. Sensitivity was 93.5%, specificity 98.6%, positive and negative predictive values were 97.7% and 96.0%. Between TP and final diagnosis agreement was even higher. More importantly, there was not a single discrepancy as to benign‐malignant. Moreover, there was a clear learning effect: 5 of the 8 FS/TP discrepancies occurred in the first 42 cases (5/42=11.9%), the remaining 3 in the following 86 cases (3/86=3.5%).Discussion: The results are encouraging. However, TP evaluation is time‐consuming (5–15 min for one case instead of 2–4 min although speed went up with more experience) and is more tiring. The system has the following technical drawbacks: no possibility to point at objects or areas of interest in the life image at the other end, resolution (rarely) may become suboptimal (blocky), storage of images evaluated (which is essential for legal reasons) is not easy and no direct control of a remote motorized microscope. Yet, all users were positive about the system both for telepathology and personal contact by video‐conferencing. Conclusion: With a relatively simple videoconferencing system, accurate dynamic telepathology frozen section diagnosis can be obtained without false positive or negative results, although a limited number of uncertain cases will have to be accepted.

Operative staging and conservative surgery in the management of low malignant potential ovarian tumors

1992 ◽  
Vol 2 (3) ◽  
pp. 113-118 ◽  
Author(s):  
W. R. Robinson ◽  
J. P. Curtin ◽  
C. P. Morrow
Keyword(s):  
Ovarian Tumor ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Conservative Surgery ◽  
Malignant Potential ◽  
Factors Affecting ◽  
Surgery Patient ◽  
Intraoperative Management ◽  
Low Malignant Potential ◽  
Histopathologic Findings

The medical records of 45- patients with intraoperative diagnosis of borderline or low malignant potential (LMP) ovarian tumor were reviewed to identify factors affecting intraoperative management. The correlation between gross and histologic staging was examined, as was the complication rate following surgery. Patient age and presence of qualifying pathologic terms on frozen section diagnosis were the only important factors relating to performance of surgical procedure. Surgical complications were closely associated with non-conservative surgery. Thirteen of 14 (92.8%) patients with significant complications had a hysterectomy. These 14 patients had staging procedures at essentially the same rate as the entire population. Thirteen of 45 patients (28.8%) thought to have LMP by frozen section had a different diagnosis on permanent review; 5 were benign and 8 were frankly malignant, confirming the limitations of frozen section in the diagnosis of LMP ovarian tumor. Of 40 with LMP or frankly malignant tumors 5(12.5%) were upstaged based on unsuspected histopathologic findings. These results indicate the need for a standard approach to staging in patients who are suspected to have an LMP ovarian tumor and should encourage the performance of conservative surgery when appropriate.

Accuracy of Frozen Section Diagnosis of the Salivary Gland

1987 ◽  
Vol 96 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Douglas R. Gnepp ◽  
Willa Rae Rader ◽  
Stewart F. Cramer ◽  
Linda L. Cook ◽  
James Sciubba
Keyword(s):  
Salivary Gland ◽  
Malignant Tumor ◽  
Benign Tumor ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Frozen Sections ◽  
Acinic Cell ◽  
Frozen Section Examination ◽  
Permanent Section ◽  
Frozen Section Diagnosis

Three hundred and one salivary gland lesions (162 benign, 72 malignant, and 67 benign non-neoplastic) of 677 cases were evaluated by use of intraoperative frozen sections by 66 pathologists. In seven patients, the diagnosis was deferred for permanent sections. In four cases (1.3%), the diagnosis at permanent section changed from one category of benign tumor to another, and in five cases (1.7%), from one category of malignant tumor to another. In four tumors, a frozen section diagnosis of benign was changed to malignant on permanent sectioning; all four involved acinic cell carcinomas. Only two tumors were incorrectly diagnosed as malignant. We conclude that diagnoses of most salivary gland lesions based on frozen section examination are reliable and accurate. However, the literature does indicate that caution should be exercised when malignant tumors are dealt with.

Ultrastructure of Cryptorchidism and Seminoma

1981 ◽  
Vol 39 ◽  
pp. 540-541
Author(s):  
Shirley Siew ◽  
Susan C. James
Keyword(s):  
Malignant Tumors ◽  
Frozen Section ◽  
Malignant Potential ◽  
Genetic Influences ◽  
Endocrine Gland ◽  
Medial Aspect ◽  
Left Testis ◽  
Bilateral Orchiectomy

Testicular maldescent is the most common endocrine gland abnormality, as 2.7% of mature neonates are cryptorchid. The significant complications are that there is a disturbance of normal maturation which results in diminished fertility and there is an increase in the malignant potential which is 35 times greater in the undescended than the descended testis. It is considered that genetic influences may be of etiological importance and recurrence has been described in some families. It is of interest, that the case reported here has 2 siblings who have also presented with cryptorchidism and malignant tumors.The propositus is 14 years old. He is well developed (described by some as obese) and shows normal secondary male characteristics except for an immature scrotum. Laparotomy showed both testes to be intraabdominal. A hard nodule (0.5cm) was palpated on the medial aspect of the left testis. Frozen section showed the presence of seminoma and bilateral orchiectomy was performed.

scholarly journals Utility of Intraoperative Frozen Sections during Thyroid Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Russel Kahmke ◽  
Walter T. Lee ◽  
Liana Puscas ◽  
Richard L. Scher ◽  
Michael J. Shealy ◽  
...  
Keyword(s):  
Predictive Value ◽  
Frozen Section ◽  
Case Series ◽  
Follicular Neoplasm ◽  
Frozen Sections ◽  
Fine Needle Aspirate ◽  
Retrospective Case ◽  
Predictive Values ◽  
Fine Needle ◽  
Intraoperative Frozen Section

Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm.Study Design. Retrospective case series.Methods. All patients have a fine needle aspirate biopsy, an intraoperative frozen section, and final pathology performed on a thyroid nodule after initiation of the Bethesda System for Reporting Thyroid Cytopathology in 2009 at a single tertiary referral center. Sensitivity, specificity, positive predictive value, and negative predictive value are calculated in order to determine added benefit of frozen section to original fine needle aspirate data.Results. The sensitivity and specificity of the frozen section were 76.9% and 67.9%, respectively, while for the fine needle aspirate were 53.8% and 74.1%, respectively. The positive and negative predictive values for the fine needle aspirates were 25% and 90.9%, respectively, while for the frozen sections were 27.8% and 94.8%, respectively. There were no changes in the operative course as a consequence of the frozen sections.Conclusion. Our data does not support the clinical usefulness of intraoperative frozen section when the fine needle aspirate yields a Bethesda Criteria diagnosis of follicular neoplasm, suspicious for follicular neoplasm, or suspicious for malignancy at our institution.

scholarly journals Comparison of Different Telepathology Solutions for Primary Frozen Section Diagnostic

2000 ◽  
Vol 21 (3-4) ◽  
pp. 161-167 ◽  
Author(s):  
P. Hufnagl ◽  
G. Bayer ◽  
P. Oberbarnscheidt ◽  
K. Wehrstedt ◽  
H. Guski ◽  
...  
Keyword(s):  
Retrospective Study ◽  
False Positive ◽  
Frozen Section ◽  
False Negative ◽  
Frozen Sections ◽  
Frozen Section Diagnosis

In a retrospective study on a set of 125 cases we compared the following three telepathology solutions for primary frozen section diagnosis: ATM‐TP (connection via ATM), TPS 1.0 (connection via LAN) and TELEMIC (connection via Internet), which represent different concepts of telepathological procedures.A set of 125 routine frozen sections (breast) was selected from the Charité cases of the year 1999. Four experienced pathologists diagnosed retrospectively all of these cases.Using the ATM‐TP and TPS systems and 53 of them with the TELEMIC system. Using the ATM‐TP we recorded no false positive (0%), 4 false negative (3.2%) and 4 deferred (3.2%) cases. Using the TPS we recorded no false positive (0%), 4 false negative (3.2%) and 4 deferred (3.2%) cases. Using the TELEMIC we recorded in 53 cases no false positive (0%), no false negative (0%) and 16 deferred (30.2%) cases.The average time of 2.2 minutes per case using ATM‐TP is also short enough for routine frozen section diagnostic. This is also true for the TPS system with 7.2 minutes per case.

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

2020 ◽  
pp. 106689692096051
Author(s):  
Hiroshi Yoshida ◽  
Hiroki Tanaka ◽  
Takafumi Tsukada ◽  
Naoko Abeto ◽  
Mayumi Kobayashi-Kato ◽  
...  
Keyword(s):  
Literature Review ◽  
Frozen Section ◽  
Malignant Potential ◽  
Ovarian Tumors ◽  
Serous Carcinoma ◽  
Low Grade ◽  
Borderline Tumor ◽  
Mucinous Tumor ◽  
Ovarian Metastases ◽  
Frozen Section Diagnosis

Background 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. Methods 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. Results 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. Conclusion 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.

The Accuracy of Intraoperative Frozen Sections in Epithelial Ovarian Tumor

2021 ◽  
Vol 104 (2) ◽  
pp. 214-218
Keyword(s):  
Ovarian Tumor ◽  
Frozen Section ◽  
High Accuracy ◽  
Malignant Neoplasms ◽  
Frozen Sections ◽  
Predictive Values ◽  
Intraoperative Frozen Section ◽  
Epithelial Ovarian Tumor ◽  
Sensitivity Specificity ◽  
Epithelial Neoplasm

Objective: To evaluate the accuracy of the intraoperative frozen section in the diagnosis of epithelial ovarian tumor. Materials and Methods: An observational study of epithelial ovarian tumor reports from patients that underwent surgery with intraoperative consultation at Ramathibodi Hospital, Thailand between 2013 and 2017 was done. The frozen section diagnoses were compared with the final surgical diagnoses and the overall accuracy, sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) were studied. Results: One hundred sixteen ovarian specimen reports were reviewed, comprised of 74 (63.8%) benign, 21 (18.1%) borderline, and 21 (18.1%) malignant neoplasms. Nine cases (7.7%) were discordant diagnoses. The overall accuracy was 92.2%. The sensitivity and specificity for benign, borderline, and malignant neoplasms were 100%, 80.9%, and 76.2%, and 88.1%, 95.8%, and 100%, respectively. The PPV and NPV for benign, borderline, and malignant neoplasms were 93.7%, 80.9%, and 100%, and 100%, 95.8%, and 95.0%, respectively. Conclusion: The intraoperative frozen section has high accuracy in the diagnosis of ovarian epithelial neoplasm. The results can be used in guidance on the extent and type of surgical management. Keywords: Frozen section, Accuracy, Epithelial ovarian tumor

Frozen Section Diagnosis of Pancreatic Lesions

2002 ◽  
Vol 126 (10) ◽  
pp. 1169-1173 ◽  
Author(s):  
Adina M. Cioc ◽  
E. Christopher Ellison ◽  
Daniela M. Proca ◽  
Joel G. Lucas ◽  
Wendy L. Frankel
Keyword(s):  
Frozen Section ◽  
Single Cells ◽  
Benign Lesion ◽  
False Negative ◽  
Resection Margins ◽  
Frozen Sections ◽  
Surgical Biopsy ◽  
Frozen Section Diagnosis ◽  
Metastatic Sites

Abstract Background.—The clinical and radiologic diagnosis of pancreatic cancer and the safety of pancreatic resections have improved. These improvements, together with the indication for resection in some cases of complicated chronic pancreatitis, have reduced the necessity for confirmed preoperative tissue diagnosis. We investigated the clinical use and accuracy of frozen section diagnosis for pancreatic lesions. Design.—We searched archival files for the years 1989–2000 for patients with pancreatic lesions who had received a diagnosis based on frozen section results. We compared the diagnosis of all frozen section slides with that of the permanent sections and reviewed the clinical follow-up notes. We evaluated histologic features useful in differentiating between malignant and benign pancreatic lesions. Results.—A total of 538 patients underwent surgical biopsy and/or resection for suspected pancreatic lesions. Frozen section was requested in 131 cases (284 frozen sections). Ninety cases had frozen section of the pancreatic lesions, 70 cases had frozen section of metastatic sites, and 29 cases had frozen section of surgical margins. Of the 90 cases in which frozen section of the pancreatic lesions was requested, malignancy was diagnosed in 44, a benign lesion was diagnosed in 37, and the diagnosis was atypical and deferred in 9. In total, 3 false-negative frozen sections and 1 false-positive frozen section were identified for respective rates of 1.2% and 0.3%. In all cases in which the frozen section diagnosis was deferred or was inconsistent with the operative impression, and the surgeon acted on his/her impression, the operative diagnoses were subsequently confirmed by additional permanent sections and/or clinical follow-up. The most useful histologic features for the diagnosis of pancreatic adenocarcinoma in frozen sections were variation in nuclear size of at least 4:1, disorganized duct distribution, incomplete duct lumen, and infiltrating single cells. Conclusions.—Frozen sections are useful in conjunction with the impression at surgery for the management of patients with pancreatic lesions. Frozen sections of resection margins were 100% accurate; frozen sections of pancreatic lesions or metastatic sites were accurate in 98.3% of cases. We found an acceptable rate of deferred frozen section (6.6%). The experienced surgeon's impression of malignancy is reliable in cases in which frozen section is deferred or has negative findings.

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