Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P<0.05), and overdiagnosis in 11.6% versus 0% (P<0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.

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The value of frozen section evaluation in the management of borderline ovarian tumors

Journal of Cancer Research and Therapeutics ◽

10.4103/0973-1482.92005 ◽

2011 ◽

Vol 7 (4) ◽

pp. 416 ◽

Cited By ~ 10

Author(s):

Emre Gultekin ◽

Basak Cingillioglu ◽

Muzaffer Sanci ◽

OzgeElmastas Gultekin ◽

Sevil Sayhan ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Section Evaluation

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Diagnostic extended usefulness of RMI: comparison of four risk of malignancy index in preoperative differentiation of borderline ovarian tumors and benign ovarian tumors

Journal of Ovarian Research ◽

10.1186/s13048-019-0568-3 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Shuang Zhang ◽

Shan Yu ◽

Wenying Hou ◽

Xiaoying Li ◽

Chunping Ning ◽

...

Keyword(s):

Ovarian Tumor ◽

Menopausal Status ◽

Area Under The Curve ◽

Ovarian Tumors ◽

Borderline Ovarian Tumor ◽

Cancer Antigen 125 ◽

Borderline Ovarian Tumors ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Benign Ovarian Tumors

Abstract Background This study aimed to examine the performance of the four risk of malignancy index (RMI) in discriminating borderline ovarian tumors (BOTs) and benign ovarian masses in daily clinical practice. Methods A total of 162 women with BOTs and 379 women with benign ovarian tumors diagnosed at the Second Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were enrolled in this retrospective study. Also, we classified these patients into serous borderline ovarian tumor (SBOT) and mucinous borderline ovarian tumor (MBOT) subgroup. Preoperative ultrasound findings, cancer antigen 125 (CA125) and menopausal status were reviewed. The area under the curve (AUC) of receiver operator characteristic curves (ROC) and performance indices of RMI I, RMI II, RMI III and RMI IV were calculated and compared for discrimination between benign ovarian tumors and BOTs. Results RMI I had the highest AUC (0.825, 95% CI: 0.790–0.856) among the four RMIs in BOTs group. Similar results were found in SBOT (0.839, 95% CI: 0.804–0.871) and MBOT (0.791, 95% CI: 0.749–0.829) subgroups. RMI I had the highest specificity among the BOTs group (87.6, 95% CI: 83.9–90.7%), SBOT (87.6, 95% CI: 83.9–90.7%) and MBOT group (87.6, 95% CI: 83.9–90.7%). RMI II scored the highest overall in terms of sensitivity among the BOTs group (69.75, 95% CI: 62.1–76.7%), SBOT (74.34, 95% CI: 65.3–82.1%) and MBOT (59.18, 95% CI: 44.2–73.0%) group. Conclusion Compared to other RMIs, RMI I was the best-performed method for differentiation of BOTs from benign ovarian tumors. At the same time, RMI I also performed best in the discrimination SBOT from benign ovarian tumors.

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Frozen section in borderline ovarian tumors: is it reliable?

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2014.07.039 ◽

2014 ◽

Vol 181 ◽

pp. 115-118 ◽

Cited By ~ 8

Author(s):

Isin Ureyen ◽

Taner Turan ◽

Derya Akdag Cirik ◽

Tolga Tasci ◽

Nurettin Boran ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors

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OP03.07: Borderline ovarian tumors and frozen section: role of preoperative He4 and ROMA score to increase frozen section accuracy

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.15129 ◽

2015 ◽

Vol 46 ◽

pp. 61-61

Author(s):

S. Gizzo ◽

M. Noventa ◽

A. Vitagliano ◽

M. Quaranta ◽

R. Venturella ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors

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Diagnostic Dilemma of a Pelvic-Abdominal Mass in a Teenage Girl

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/402 ◽

2021 ◽

Vol 10 (26) ◽

pp. 1957-1960

Author(s):

A.S. Dhillon ◽

Kartika Pandey

Keyword(s):

Frozen Section ◽

Abdominal Mass ◽

Menopausal Status ◽

Germ Cell Tumour ◽

Reproductive Age ◽

Ca 125 ◽

Diagnostic Dilemma ◽

Tumour Spread ◽

Imaging Results ◽

Fertility Sparing

The differential diagnosis of an abdominal mass in young teenage girls include pelvic inflammatory disease, pelvic abdominal Koch’s, endometriosis, pedunculated uterine leiomyomata, colonic mass, and germ cell tumour. There is a strong possibility of benign, borderline, or malignant ovarian carcinoma to be diagnosed in young girls with abdominal mass. Preoperative diagnosis depends on age, menopausal status, serum cancer antigen (CA) level of 125, ultrasound and radiological imaging of the mass. For better diagnosis of benign borderline serous tumours, borderline ovarian tumours (BOTs) and invasive cancers, magnetic resonance imaging (MRI) and positron emission tomography has to be done. However, among patients with benign cysts, BOTs and invasive cancers, CA-125 levels can be same. Likewise, the imaging results are not unique to BOTs. The diagnosis of BOTs can therefore be not established before surgery and intraoperative decisions regarding the extent of surgical management are based on the results of frozen section examination. In BOTs, an effective frozen section diagnosis is of considerable significance. Women of reproductive age always want traditional fertility-sparing surgery. Benign cysts should be distinguished from BOTs. Inadequate surgical staging of BOT may result in misdiagnosis of BOT as a benign tumour, leading to more vigorous treatment and possible tumour spread.1

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EP824 Ambiguous diagnoses of borderline ovarian tumors at frozen section with a definite diagnosis of invasive carcinoma: consequences for counseling and perioperative treatment

10.1136/ijgc-2019-esgo.874 ◽

2019 ◽

Author(s):

K De Decker ◽

KH Jaroch ◽

HG Ter Brugge ◽

J Bart ◽

LFS Kooreman ◽

...

Keyword(s):

Invasive Carcinoma ◽

Frozen Section ◽

Ovarian Tumors ◽

Definite Diagnosis ◽

Perioperative Treatment ◽

Borderline Ovarian Tumors

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Feasibility Study of the Laparoscopic Approach for Borderline Ovarian Tumors

JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY ◽

10.5180/jsgoe.29.402 ◽

2013 ◽

Vol 29 (2) ◽

pp. 402-407

Author(s):

Kazu Ueda ◽

Shin Ohnota ◽

Keiko Kamoshita ◽

Momoko Inoue ◽

Chikage Narui ◽

...

Keyword(s):

Feasibility Study ◽

Laparoscopic Approach ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors

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

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200309000-00004 ◽

2003 ◽

Vol 13 (5) ◽

pp. 593-597 ◽

Cited By ~ 8

Author(s):

M. Gol ◽

A. Baloglu ◽

S. Yigit ◽

M. Dogan ◽

Ç. Aydin ◽

...

Keyword(s):

Frozen Section ◽

Correct Diagnosis ◽

False Negative ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Frozen Section Examination ◽

Benign Ovarian Tumor ◽

Frozen Section Diagnosis ◽

Accuracy Rates ◽

Higher Sensitivity

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.

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