Borderline ovarian tumor frozen section diagnoses with features suspicious of invasive cancer: a retrospective study

Abstract Background A frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma (“at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes. Methods A retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or “at least borderline” frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis. Results A total of 223 women were included, of which 41 women (18.4%) were diagnosed with “at least borderline” at frozen section. Thirteen of forty-one women (31.7%) following “at least borderline” frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an “at least borderline” frozen section diagnosis. Conclusions Overall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an “at least borderline” diagnosis may decrease the risk of surgical over-treatment.

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Analysis of frozen section in correlation with surgical pathology diagnosis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192519 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2312

Author(s):

Ashwini Tangde ◽

Vaidik Shrivastava ◽

Anil Joshi

Keyword(s):

Frozen Section ◽

Final Diagnosis ◽

Surgical Pathology ◽

Histopathological Diagnosis ◽

Pathology Laboratory ◽

Medical College ◽

Incorrect Diagnosis ◽

Frozen Section Diagnosis ◽

Sensitivity Specificity ◽

Suspected Lesion

Background: Frozen section (FS) is a rapid diagnostic procedure performed on tissues obtained intraoperatively. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metastasis, and identifying small structures. But it bears many disadvantages and limitations, the most of which is the danger of incorrect diagnosis. Therefore, it is critical to determine efficiency of frozen section performance periodically. This study was performed to determine accuracy of frozen section by correlating the intra-operative frozen section diagnosis with final diagnosis on permanent sections.Methods: In this retrospective study, authors compared the results of frozen section with their final permanent section diagnosis in Government Medical College and Hospital, Aurangabad, Maharashtra, India during January 2017 to December 2018.Results: Study comprises 83 patients, of which 73 were female and 10 were male. Out of 83 cases, the diagnosis of 76 cases was concordant with conventional histopathology diagnosis while seven were discordant. This gave overall accuracy rate of 91.57% and discordant rate of 8.43%. The overall sensitivity was 85.71% and specificity was 97.92%. The positive predictive and negative predictive value was 96.77% and 90.38% respectively.Conclusions: The accuracy, sensitivity, specificity of frozen section diagnosis in this study are comparable with most international quality control statistics for frozen sections. The results suggest that the correlation of intra-operative frozen section diagnosis with the final histopathological diagnosis on permanent sections forms an integral part of quality assurance activities in the surgical pathology laboratory and specific measures should be taken to reduce the number of discrepancies.

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Frozen Section Diagnosis: Accuracy and Errors; with Emphasis on Reasons for Discordance

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.2932 ◽

2021 ◽

Vol 8 (2) ◽

pp. A33-38

Author(s):

Roopam Kishore Gidwani ◽

Falguni Jay Goswami ◽

Arpan Mehta ◽

Nirali V Shah ◽

Shobhana Ashok Prajapati ◽

...

Keyword(s):

Sampling Error ◽

Frozen Section ◽

False Positive Rate ◽

False Negative ◽

False Negative Rate ◽

Paraffin Section ◽

Cost Effective ◽

Final Diagnosis ◽

Frozen Section Diagnosis ◽

Final Histological Diagnosis

Background: Frozen section is a multistep process involving surgical resection, intraoperative preparation of slides and their microscopic examination. It is important to assess concordant, discordant and deferred diagnosis rates from intra-operative frozen section diagnosis with final diagnosis on paraffin section and to determine the reasons for discordance. An integral part of quality assurance in surgical pathology entails the correlation of intra-operative frozen section diagnosis with final diagnosis on permanent section. Methods: A retrospective analysis of 117 cases of frozen section biopsy was carried out which were reported in the Histopathology department between July 2007 to June 2012. The correlation between the frozen section diagnosis with final histological diagnosis was performed in order to check the accuracy of the technique. The number and type of discrepancies were compared, causes for the discrepancies were analyzed in order to decrease the avoidable errors and improve on the frozen section diagnoses. Results: The overall accuracy of frozen section diagnoses over 5years was 90.60% with false positive rate of 0.85%, false negative rate of 6.84% and 1.71% of deferred diagnosis. Sensitivity was 87.69% and Specificity was 98%. The discrepancies were mainly due to the interpretation error, sampling error and technical artefacts. Conclusions: Gross inspection, sampling by pathologist, frozen section complemented with cytological and histological review and cooperation between consultants can avoid certain limitations and provide rapid, reliable, cost effective information necessary for optimum patient care.

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Correlation of Biomarkers and Frozen Section Diagnosis with Paraffin Histopathological Diagnosis in Suspected Ovarian Cancer

International Journal of Molecular and Immuno Oncology ◽

10.25259/ijmio_6_2019 ◽

2019 ◽

Vol 4 ◽

pp. 67-71

Author(s):

Tanushri Mukherjee ◽

Soma Mukherjee ◽

Parikshit Sanyal ◽

Vikram Bharadwaj ◽

S Sampath ◽

...

Keyword(s):

Decision Making ◽

Predictive Value ◽

Frozen Section ◽

False Negative ◽

Paraffin Section ◽

Histopathological Diagnosis ◽

Diagnostic Dilemma ◽

Ovarian Cancers ◽

Frozen Section Diagnosis ◽

Malignant Lesions

Introduction: Ovarian cancers pose diagnostic dilemma and is problematic for decision making for the gynecological oncologist as well as the pathologist. The use of intra-operative frozen section can aid significantly in decision making and assist in choosing the correct operative path once a mass lesion of ovaries is discovered. Materials and Methods: Over a two-year period, 50 cases of Suspected Ovarian cancers were examined by intra- operative frozen section as well as followed up with histopathology in paraffin sections. Results were categorized in two strata—benign and malignant. Results: A comparison between frozen-section diagnosis and findings on paraffin section showed that the sensitivity of frozen section in diagnosis of malignant lesions is 97.14%, with specificity 93.33%, positive predictive value 97.14% and negative predictive value 93.33%. Among 50 cases, one case was reported as false positive and one was reported as false negative. Conclusion: Intra-operative frozen section is a highly sensitive and specific modality for the diagnosis of malignant lesions of the ovary.

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

Analytical Cellular Pathology ◽

10.1155/2000/908426 ◽

2000 ◽

Vol 21 (3-4) ◽

pp. 169-175 ◽

Cited By ~ 18

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.

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Accuracy of Intraoperative Examination in Central Nervous System Lesions: A Study of 133 Cases

Acta Cytologica ◽

10.1159/000495175 ◽

2019 ◽

Vol 63 (3) ◽

pp. 224-232

Author(s):

Ludmila Barbosa de Souza Balsimelli ◽

Jamille Costa de Oliveira ◽

Flora Ávila Adorno ◽

Clarissa Almeida Brites ◽

Giuliano Stefanello Bublitz ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Frozen Section ◽

Final Diagnosis ◽

World Health ◽

Histopathological Diagnosis ◽

Low Grade ◽

Predictive Values ◽

Health Organization ◽

Cns Lesions

Objective: Intraoperative examination is a highly valuable tool for the evaluation of central nervous system (CNS) lesions, helping the neurosurgeon to determine the best surgical management. This study aimed to evaluate the accuracy and to analyze the diagnostic disagreements and pitfalls of the intraoperative examinations through correlation with the final histopathological diagnosis in CNS lesions. Study Design: Retrospective analysis of intraoperative examination of CNS lesions and their final diagnosis obtained during 16 consecutive years. All diagnoses were reviewed and classified according to World Health Organization (WHO) grading for CNS tumors. Squash was performed in 119 cases, while frozen section and both methods were done in 7 cases each. Results: Among the 133 intraoperative examinations considered, 114 (85.7%) presented concordance and 19 (14.3%) diagnostic disagreement when compared with subsequent histopathological examinations. The sensitivity and specificity for the detection of neoplasia in intraoperative examination was 98 and 94%, respectively. The positive and negative predictive values were 99 and 88%, respectively. The accuracy for neoplastic and nonneoplastic disease was 85.7%. Disagreements were more frequent among low-grade (WHO grades I and II) neoplasms and nonmalignant cases. Conclusions: Our results showed good accuracy of the intraoperative assessments for diagnosis of CNS lesions, particularly in high-grade (grades III and IV) lesions and metastatic neoplasms.

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Reliability of Telepathology for Frozen Section Service

Analytical Cellular Pathology ◽

10.1155/2000/904578 ◽

2000 ◽

Vol 21 (3-4) ◽

pp. 213-222 ◽

Cited By ~ 19

Author(s):

Uwe Wellnitz ◽

Bernd Binder ◽

Peter Fritz ◽

Godehard Friedel ◽

Peter Schwarzmann

Keyword(s):

Diagnostic Accuracy ◽

Technological Development ◽

Frozen Section ◽

False Negative ◽

Daily Practice ◽

Histopathological Diagnosis ◽

Time Saving ◽

Surgical Interventions ◽

Average Accuracy ◽

Frozen Section Diagnosis

One of the most promising applications of telepathology (pathology at a distance by electronic transmission of images in pathology) is frozen section diagnosis, especially because by means of this tool operations requiring an intraoperative histopathological diagnosis are feasible at hospitals without a pathologist on‐site. For the introduction of this diagnostic tool into pathologist's daily practice the evidence of its diagnostic accuracy comparable to that of the conventional frozen section diagnosis is crucial.For this purpose the literature on the diagnostic accuracy of telepathological frozen section diagnosis was reviewed. In a metaanalysis these studies and reports, in which a total of more than 1290 cases had been examined, showed a slightly lower overall diagnostic accuracy (of the telepathological frozen section diagnosis) of about 0.91 than the conventional frozen section diagnosis with an average accuracy of about 0.98 found in an analysis of several studies (on frozen section diagnosis of different organs). This difference is at least predominantly caused by a higher rate of deferred and false negative frozen section diagnoses in the telepathological method, while the specificity of both methods, each more than 0.99 was not significantly different.In conclusion, the introduction of a telepathological frozen section diagnosis for hospitals without an acceptable access to a pathologist is justifiable already at the current state of the technological development especially when considering the advantages (time saving, reduction in costs) compared to the alternative of surgical interventions without access to an intraoperative diagnosis.

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Diagnostic accuracy value of intraoperative frozen section for ovarian neoplasms

10.21203/rs.3.rs-19106/v1 ◽

2020 ◽

Author(s):

Farinaz Shahmoradi ◽

Maliheh Arab

Keyword(s):

Diagnostic Accuracy ◽

Medical Records ◽

Ovarian Neoplasms ◽

Frozen Section ◽

Final Diagnosis ◽

Intraoperative Frozen Section ◽

Frozen Section Diagnosis ◽

Accuracy Study ◽

Extent Of Surgery ◽

Histopathology Examination

Abstract 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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Accuracy of intraoperative frozen section analysis in borderline ovarian tumor and the factors affecting it

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i09.04 ◽

2020 ◽

Vol 7 (09) ◽

pp. 4960-4964

Author(s):

Hacı öztürk ŞAHİN ◽

Alpay YILMAZ ◽

Mehmet BAYRAK ◽

Kemal ÖZERKAN ◽

Hakan OZAN

Keyword(s):

Ovarian Tumor ◽

Frozen Section ◽

Correct Selection ◽

Ca 125 ◽

Borderline Ovarian Tumor ◽

Accuracy Rate ◽

Factors Affecting ◽

Frozen Section Analysis ◽

Section Analysis ◽

Selection Of

Objective: To analyze the accuracy of frozen section (FS) examination of a borderline ovarian tumor (BOT) and the factors affecting it.Methods : We retrospectively evaluated 132 patients who were operated on in our clinic for ovarian mass between 1996 and 2016, who underwent FS examination and who had a BOT as a result of the final pathology. We investigated the Frozen accuracy, overdiagnosis and underdiagnosis rates and the factors affecting the accuracy of the diagnosis.Results : The mean age of the sample group was 44.6 ± 15.2 years. 50.8% of our patients were serous, 34.8% were mucinous and 14.4% were sero-mucinous in histology. Our Frozen Section accuracy rate was 75%, and underdiagnosis and overdiagnosis rates were 20.5% and 4.5%, respectively.The factors affecting the accuracy of the frozen section were histological type (p = 0.003), presence of solid component (p = 0.002) and preoperative CA 125 value (p = 0.001).Conclusion : Frozen examination has a low accuracy rate that affects the correct selection of surgical treatment for BOTs. FS should be performed by experienced gyneco-pathologists and it is necessary to consider carefully the factors that may cause misdiagnosis of the pathology.

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Frozen Section Diagnosis of Ovarian Epithelial Tumors: Diagnostic Pearls and Pitfalls

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0289-ra ◽

2019 ◽

Vol 143 (1) ◽

pp. 47-64 ◽

Cited By ~ 4

Author(s):

Natalia Buza

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Benign Tumors ◽

Ovarian Carcinomas ◽

Intraoperative Frozen Section ◽

Epithelial Tumors ◽

Ovarian Epithelial Tumors ◽

Wide Range ◽

Frozen Section Diagnosis ◽

Section Evaluation

Context.— Epithelial tumors of the ovary are one of the most frequently encountered gynecologic specimens in the frozen section laboratory. The preoperative diagnostic workup of an ovarian mass is typically limited to imaging studies and serum markers, both of which suffer from low sensitivity and specificity. Therefore, intraoperative frozen section evaluation is crucial for determining the required extent of surgery, that is, cystectomy for benign tumors, oophorectomy or limited surgical staging for borderline tumors in younger patients to preserve fertility, or extensive staging procedure for ovarian carcinomas. Ovarian epithelial tumors may exhibit a wide range of morphologic patterns, which often overlap with each other and can mimic a variety of other ovarian nonepithelial neoplasms as well. A combination of careful gross examination, appropriate sampling and interpretation of morphologic findings, and familiarity with the clinical context is the key to the accurate frozen section diagnosis and successful intraoperative consultation. Objective.— To review the salient frozen section diagnostic features of ovarian epithelial tumors, with special emphasis on useful clinicopathologic and morphologic clues and potential diagnostic pitfalls. Data Sources.— Review of the literature and personal experience of the author. Conclusions.— Frozen section evaluation of ovarian tumors continues to pose a significant diagnostic challenge for practicing pathologists. This review article presents detailed discussions of the most common clinical scenarios and diagnostic problems encountered during intraoperative frozen section evaluation of mucinous, serous, endometrioid, and clear cell ovarian tumors.

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Accuracy of Frozen Section with Histopathological Report in an Institute

Journal of Nepal Medical Association ◽

10.31729/jnma.3545 ◽

2018 ◽

Vol 56 (210) ◽

pp. 572-577

Author(s):

Purbesh Adhikari ◽

Paricha Upadhyaya ◽

Smriti Karki ◽

Chandra Shekhar Agrawal ◽

Shyam Thapa Chhetri ◽

...

Keyword(s):

Predictive Value ◽

Sampling Error ◽

Frozen Section ◽

Cross Sectional Study ◽

Histopathological Diagnosis ◽

Cross Sectional ◽

Tissue Samples ◽

Organ Systems ◽

Discordance Rate ◽

Frozen Section Diagnosis

Introduction: Frozen section helps in rapid intra-operative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. Frozen section is also performed for evaluation of surgical margins and detection of lymph node metastasis. In addition it is applied for detection of unknown pathological processes.The objective of this study was to assess the accuracy of frozen section diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report.Methods: This was a cross sectional study of 41 frozen section samples done in the department of pathology of BP Koirala Institute of Health Sciences from September 2014 to August 2015. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study.Results: The overall accuracy of frozen section diagnosis was 97%. The sensitivity was 94%, specificity was 87%, positive predictive value was 90% and negative predictive value was 93%. The concordance rate was 90.2% and the discordance rate was 9.8%.Conclusions: The results of frozen section varied in different organ systems and the common cause of discrepancy in our study were the gross sampling error and the interpretational error.

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