Evaluating the accuracy of frozen section in borderline ovarian tumors.

5564 Background: The objective of this study was to evaluate accuracy of frozen section in borderline ovarian tumors and to determine the tumor characteristics that lead to higher likelihood of inaccurate intraoperative diagnosis (IAIOD). IAIOD is a clinical problem that restricts the diagnostic accuracy of frozen section in borderline ovarian tumors. Methods: This was a retrospective chart review of 622 consecutive cases that were diagnosed with pelvic mass and underwent surgery at busy gynecology services of two institutions, between 2006-2011. Of these cases, 52 were diagnosed as borderline ovarian tumors by frozen section. Experienced pathologists performed frozen section with second opinion from specialized gynecologic pathologists as needed. Terms such as “at least borderline” were also evaluated to help stratify patients. Frozen section and final permanent histology reports were compared. Patient and tumor characteristics that may cause IAIOD such as age of patient, histological subtype, size of tumor, bilaterality, CA-125 levels were studied. Staging was performed when borderline or malignant ovarian tumors were identified by frozen section. Results: Agreement of the frozen section results with final pathology was observed in 37 out of 52 patients with a diagnostic accuracy of 71.15 %. Under diagnosis occurred in 12 out of 52 patients and over diagnosis occurred in 3 out of 52 patients. Age >40 years, size of tumor >5 cm, bilaterality of tumors and CA-125 were not found significant in causing IAIOD when chi-square analysis was performed. Characterization by “at-least” borderline terminology at the time of frozen section did not help identify patients with higher likelihood of IAIOD. Conclusions: In our study, the rate of IAIOD was high, at 23% despite experienced pathologists and using “at-least borderline” terminology. Traditionally described features leading to inaccuracy with frozen sections, such as large tumors with mucinous histology did not increase the risk of IAIOD in this study. Patients with unilateral, small tumors and non-mucinous histology had greatest risk for IAIOD. Given this information, full staging of all borderline ovarian tumors identified at time of frozen section should remain the standard of practice.

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Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors

Journal of Cancer ◽

10.7150/jca.25883 ◽

2018 ◽

Vol 9 (16) ◽

pp. 2817-2824 ◽

Cited By ~ 4

Author(s):

Zhen Huang ◽

Li Li ◽

ChengCheng Li ◽

Samuel Ngaujah ◽

Shu Yao ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Frozen Section ◽

Meta Analysis ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Frozen Section Analysis ◽

Section Analysis

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Analysis of Metastatic Ovarian Tumors from Extragenital Primary Sites

Tumori Journal ◽

10.1177/030089160609200605 ◽

2006 ◽

Vol 92 (6) ◽

pp. 491-495 ◽

Cited By ~ 23

Author(s):

Taner Turan ◽

Burcu Aykan ◽

Sevgi Koc ◽

Nurettin Boran ◽

Gokhan Tulunay ◽

...

Keyword(s):

Tumor Marker ◽

Primary Tumor ◽

Frozen Section ◽

Ovarian Tumors ◽

Ca 125 ◽

Tumor Site ◽

Primary Tumor Site ◽

Adequate Treatment ◽

Presenting Symptoms ◽

Preoperative Serum

Aims and background The aim of this study was to evaluate patients with metastatic ovarian tumors from extragenital primary sites. Methods The medical records of 75 patients were reviewed retrospectively for age at diagnosis, presenting symptoms, preoperative tumor marker levels, preoperative diagnostic workup, operative technique, intraoperative evaluation, frozen-section and pathology results, laterality of metastasis, and primary tumor site. The specific impact of metastasis from colorectal and gastric primary sites on laterality, gross features and dimensions of ovarian mass, volume of ascites and tumor marker levels was investigated. Results Primary sites were stomach (37.3%), colorectal region (28%), lymphoma (12%), breast (6.7%), biliary system (2.7%), appendix (1.3%) and small intestine (1.3%). It was not possible to identify the primary tumor site in 8 (10.7%) patients. Bilateral metastasis was found in 86.4% patients; 42.7% of the metastatic ovarian tumors were Krukenberg tumors; 50.7% of the ovarian masses were solid. Frozen section was confirmed by postoperative pathological results in 98% of the patients. The mean preoperative serum levels of tumor markers were 298.7 U/mL, 178 U/mL and 113.3 U/mL for CA 125, CA 19-9 and CA 15-3, respectively. CA 125 levels were above 35 U/mL in 81.3% of the patients. The presence of ascites was more frequent in ovarian tumors originating from colorectal and gastric primaries. Conclusions Surgery is essential for the diagnosis of the primary tumor and necessary for relief of symptoms. The identification of the primary site is required to plan adequate treatment.

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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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Borderline Ovarian Tumors: Fifteen Years’ Experience at a Scottish Tertiary Cancer Center

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001364 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1683-1691 ◽

Cited By ~ 6

Author(s):

James May ◽

Karolina Skorupskaite ◽

Mario Congiu ◽

Nidal Ghaoui ◽

Graeme A. Walker ◽

...

Keyword(s):

Malignant Transformation ◽

Surgical Management ◽

Early Stage ◽

Ovarian Tumors ◽

Ca 125 ◽

Ovarian Malignancy ◽

Borderline Ovarian Tumors ◽

Gynecology And Obstetrics ◽

Preoperative Serum

ObjectivesSince the recognition of borderline ovarian tumors (BOTs) in the 1970s, the management of this subset of epithelial ovarian tumors has presented a challenge to clinicians. The majority present at an early stage, but their diagnosis is often only made following surgery, hence the heterogeneity of surgical management. Borderline ovarian tumors are morphologically diverse, and their behavior is subsequently also heterogeneous. We aimed to assess recurrence rates and the rate of malignant transformation in patients diagnosed with BOT. Secondary objectives included a review of current management and assessment of tumor markers, stage, cyst dimensions, and the presence of micropapillary features as prognostic indicators of recurrence.MethodsThis retrospective cohort study included all patients treated with BOT between 2000 and 2015 in the southeast region of Scotland. Clinical, surgicopathological, and follow-up data were collated. Data were analyzed with reference to recurrence and malignant transformation.ResultsTwo hundred seventy-five patients underwent treatment for BOT in the study period. Surgical management was highly variable. A diagnosis of recurrent/persistent BOT or ovarian malignancy following initial treatment of BOT was rare, with only 12 (4%) of 275 cases. There were 7 cases (3%) of ovarian malignancy. Advanced International Federation of Gynecology and Obstetrics stage was the most prominent prognostic factor. Elevated preoperative serum CA-125 and the presence of micropapillary features correlated with advanced stage at presentation. With a lack of clear guidance, follow-up was highly variable with a median of 43 months (0–136 months).ConclusionsTo our knowledge, this study is the largest BOT cohort in the United Kingdom. Recurrent disease is rare in optimally staged, completely resected, early-stage BOT, without high-risk features. Caution is needed in women electing not to undergo completion staging after diagnosis and in those opting for a fertility-preserving approach. Thorough informed consent and clear plans for surveillance and follow-up are needed with consideration of delayed completion surgery as appropriate.

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An Evaluation of Frozen Section and Lymph Node Dissection Results for Mucinous Ovarian Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001150 ◽

2018 ◽

Vol 28 (1) ◽

pp. 92-98 ◽

Cited By ~ 4

Author(s):

Marisa R. Moroney ◽

Miriam D. Post ◽

Amber A. Berning ◽

Jeanelle Sheeder ◽

Bradley R. Corr

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Tumor Size ◽

Frozen Section ◽

Ovarian Tumors ◽

Node Dissection ◽

Cross Sectional ◽

Mucinous Histology ◽

Final Pathology ◽

Mucinous Ovarian Tumors

ObjectivesIntraoperative frozen section has greater than 90% accuracy for ovarian tumors; however, mucinous histology has been shown to be associated with increased frozen section inaccuracy. Recent data demonstrate that primary ovarian mucinous carcinomas have no lymph node involvement, even when extraovarian disease is present, and therefore may not require lymph node dissection. Our primary objective is to evaluate the accuracy of identifying mucinous histology on frozen section.Methods/MaterialsA cross-sectional review of mucinous ovarian tumors in surgical patients at one institution from 2006 to 2016 was performed. Cases reporting a mucinous ovarian tumor on frozen section or final pathology were identified. Frozen section results were compared with final diagnosis to calculate concordance rates. Analyses with χ2 and t tests were performed to identify variables associated with pathology discordance.ResultsA total of 126 mucinous ovarian tumors were identified. Of these, 106 were reported as mucinous on frozen section and 103 (97.2%) were concordant on final pathology. Discordant cases included 2 serous and 1 clear cell tumor. Among the 103 mucinous tumors, classification as malignant, borderline, or benign was concordant in 74 (71.8%) of 103 cases, whereas 22 (21.4%) of 103 were discordant and 7 (6.8%) were deferred to final pathology. Lymph node dissection was performed in 33 cases; the only case with lymph node metastasis was a gastrointestinal mucinous adenocarcinoma. Discordance between frozen section and final pathology was associated with larger tumor size and diagnosis other than benign: discordant cases had a mean tumor size of 21.7 cm compared with 14.4 cm for concordant cases (P < 0.001), and 93.5% of discordant cases were borderline or malignant, compared with 30.5% of concordant cases (P < 0.001).ConclusionsIntraoperative identification of mucinous histology by frozen section is reliable with a concordance rate to final pathology of 97.2%. No lymph node metastases were present in any malignant or borderline primary ovarian cases.

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