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

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.

Accuracy and Reproducibility of Frozen Section Diagnosis in Ovarian Tumors: A 10-Year Experience at a Tertiary Cancer Center

Context.— Intraoperative consultation—frozen section diagnosis (FSD)—determines tumor pathology and guides the optimal surgical management of ovarian neoplasms intraoperatively. Objective.— To evaluate the diagnostic accuracy of the FSD and analyze the discrepancy between the FSD and final diagnosis. Design.— This is a retrospective study of 618 ovarian neoplasm FSDs from 2009 to 2018 at a tertiary health care center. The discrepant cases were reviewed and reevaluated by gynecologic and general surgical pathologists. The outcomes of interest were performing unnecessary procedure, returning for a second surgery, and 30-day postoperative mortality. Results.— The sensitivity and the positive predictive value of the FSD were lower in borderline tumors than in benign and malignant epithelial ovarian tumors. Major and minor discrepancies were identified in 5.3% (33 of 618) and 12.3% of (76 of 618) cases, respectively. A root cause analysis of the major discrepant cases showed that sampling error accounted for 43% (14 of 33). The discrepancy distributions of gynecologic and general surgical pathologists were statistically similar in the overall cohort (P = .65). The overall κ for diagnostic agreement among gynecologic pathologists, general surgical pathologists, and final diagnosis was 0.18 (0.10–0.26, P &lt; .001), implying only a slight overall agreement. Of the major discrepant cases, only 3 had a clinical implication. One overdiagnosed patient underwent unnecessary procedure and 2 underdiagnosed patients were recommended to return for a second surgery. No patient had 30-day postoperative mortality. Conclusions.— Frozen section diagnosis remains a definitive diagnostic tool in ovarian neoplasms and plays a crucial role in guiding intraoperative surgical management.

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

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.