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

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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Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200503000-00002 ◽

2005 ◽

Vol 15 (2) ◽

pp. 192-202 ◽

Cited By ~ 13

Author(s):

L. R. Medeiros ◽

D. D. Rosa ◽

M. I. Edelweiss ◽

A. T. Stein ◽

M. C. Bozzetti ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ovarian Tumor ◽

Frozen Section ◽

Ovarian Tumors ◽

Frozen Sections ◽

Borderline Tumors ◽

Frozen Section Analysis ◽

Accuracy Rates ◽

Section Result ◽

Section Analysis

A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3–10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94–96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101–605) increased the probability of ovarian cancer to 98% (95% CI, 97–99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45–106) increased the probability of borderline tumors to 79% (95% CI, 71–85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13–26) increased the probability of borderline tumors to 51% (95% CI, 42–60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

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Borderline Ovarian Tumor during Pregnancy: A Case Report

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/160319 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Joao Casanova ◽

Raquel Maciel ◽

Vânia Ferreira ◽

Eugénia Fernandes ◽

Rosa Maria Rodrigues

Keyword(s):

Best Management Practices ◽

Ovarian Tumor ◽

Management Practices ◽

Frozen Section ◽

First Trimester ◽

Ca 125 ◽

Borderline Ovarian Tumor ◽

Term Survival ◽

Liquid Component ◽

The Right

We report a case of a 33 year-old pregnant woman who was diagnosed at the time of the first trimester ultrasound with a multilocular solid arising form the right ovary. An abdominal MRI was performed afterwards and it revealed a pelvic mass, developing from the right ovary, with a liquid component but with a major solid area. CA 125 was within the normal range values. A laparotomy followed by right salpingo-oophorectomy was performed at 14 weeks of gestation and both the frozen section and the definitive histology revealed a borderline mucinous ovarian tumor. Ovarian tumors of low malignant potential comprise 10%–20% of all ovarian malignancies. They carry an excellent prognosis with 95%–99% long-term survival. Whereas in the past, radical surgery (hysterectomy and bilateral salpingo-oophorectomy with peritoneal staging) was standard regardless of the age of the patient, unilateral salpingo-oophorectomy with or without staging has become the recommended management for women who desire childbearing. In the absence of large prospective randomized trials it is difficult to know which are the best management practices and especially to determine the right moment during pregnancy to perform surgery in these patients.

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Value of intraoperative frozen section analysis in re-excision margin evaluation in breast-conserving surgery for cancer: a single institution experience

Indian Journal of Surgery ◽

10.1007/s12262-021-02952-6 ◽

2021 ◽

Author(s):

Jian Guo Shen ◽

Lin Bo Wang ◽

Zi Nong Jiang ◽

Xiao Ming Yuan ◽

Wen He Zhao ◽

...

Keyword(s):

Frozen Section ◽

Breast Conserving Surgery ◽

Single Institution ◽

Intraoperative Frozen Section ◽

Excision Margin ◽

Frozen Section Analysis ◽

Section Analysis

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922 INTRAOPERATIVE FROZEN SECTION ANALYSIS OF POSTEROLATERAL MARGINS IN LAPAROSCOPIC RADICAL PROSTATECTOMY HAS A GOOD PREDICTIVE VALUE TO ALLOW NERVE SPARING WITHOUT COMPROMISING CANCER CONTROL

European Urology Supplements ◽

10.1016/s1569-9056(07)60917-8 ◽

2007 ◽

Vol 6 (2) ◽

pp. 253

Author(s):

M. Marcy ◽

B. Coulibaly ◽

B. Chetaille ◽

O. Simonin ◽

G. Karsenty ◽

...

Keyword(s):

Radical Prostatectomy ◽

Predictive Value ◽

Frozen Section ◽

Cancer Control ◽

Laparoscopic Radical Prostatectomy ◽

Nerve Sparing ◽

Intraoperative Frozen Section ◽

Frozen Section Analysis ◽

Section Analysis

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Positive neck margin at frozen section analysis is a significant preditor of tumour recurrence and poor survival after pancreatoduodenectomy for pancreatic cancer

Pancreatology ◽

10.1016/j.pan.2020.07.306 ◽

2020 ◽

Vol 20 ◽

pp. S160-S161

Author(s):

G. Guarneri ◽

S. Crippa ◽

G. Belfiori ◽

S. Partelli ◽

M. Pagnanelli ◽

...

Keyword(s):

Pancreatic Cancer ◽

Frozen Section ◽

Tumour Recurrence ◽

Poor Survival ◽

Frozen Section Analysis ◽

Section Analysis

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Bladder-to-bladder metastasis: gallbladder cancer metastasising to the urinary bladder

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7048 ◽

2021 ◽

Author(s):

S Mukherjee ◽

J Abbaraju ◽

G Russell ◽

S Madaan

Keyword(s):

Urinary Bladder ◽

Gallbladder Cancer ◽

Palliative Chemotherapy ◽

Frozen Section ◽

Healthy Woman ◽

Frozen Section Analysis ◽

Bladder Metastasis ◽

Distant Spread ◽

Bladder Mass ◽

Section Analysis

We report a 48-year-old fit and healthy woman who was incidentally diagnosed to have adenocarcinoma of gallbladder after laparoscopic cholecystectomy. Subsequent imaging showed no evidence of regional or distant spread. She was scheduled for elective laparotomy and resection of gallbladder bed, but during laparotomy frozen section analysis of an incidentally discovered peritoneal deposit confirmed metastasis, so the procedure was abandoned. Thereafter, she received cisplatin and gemcitabine chemotherapy. However, surveillance computed tomography incidentally noted a urinary bladder mass which had not been present before. Transurethral resection of the bladder lesion revealed moderately differentiated adenocarcinoma of urinary bladder. The appearance and immunoprofile of the lesion confirmed metastasis from the primary gallbladder cancer, which has not been documented in the literature to the best of our knowledge. Her disease progressed and she is being challenged with gemcitabine and carboplatin as second-line palliative chemotherapy. She is still alive two years after the initial diagnosis.

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Meigs' syndrome with elevated CA 125: case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31802003000500007 ◽

2003 ◽

Vol 121 (5) ◽

pp. 210-212 ◽

Cited By ~ 10

Author(s):

Sabas Carlos Vieira ◽

Leonardo Halley Carvalho Pimentel ◽

José Carlos Castelo Branco Ribeiro ◽

Argemiro Ferreira de Andrade Neto ◽

Jerúsia Oliveira Ibiapina de Santana

Keyword(s):

Case Report ◽

Pleural Effusion ◽

Ovarian Tumor ◽

Frozen Section ◽

Transvaginal Ultrasound ◽

Elevated Serum ◽

Ca 125 ◽

Brazilian Woman ◽

Thoracic Drainage ◽

Benign Ovarian Tumor

CONTEXT: Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovarian tumor. However, patients with Meigs' syndrome can also have elevated serum CA 125 levels. The authors report a case of Meigs' syndrome with elevated CA 125 level. OBJECTIVE: This is a case report of Meigs' syndrome with elevated CA 125 level. CASE REPORT: A 65-year-old Brazilian woman had presented progressive dyspnea, weight loss and decline in general condition over the 7 months preceding admission to our service. In another hospital, the patient had been submitted to thoracic drainage due to pleural effusion. With recurrence of the pleural effusion and increase in abdominal volume due to ascites and a pelvic mass, the patient sought our service. Transvaginal ultrasound showed an extensive adnexal solid mass of 16.4 x 10.8 cm located in the pelvis without exact limits, and the serum CA 125 level was elevated. With a preoperative diagnosis of ovarian carcinoma, the patient was submitted to exploratory laparotomy, which revealed a left ovarian tumor. The frozen section diagnosis was thecoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histology of the specimen confirmed the diagnosis of thecoma. The patient was asymptomatic with a normal serum CA 125 level 20 months after the operation.

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