Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic Accuracy Value of Intraoperative Frozen Section for Ovarian Neoplasms

  • Original Article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Purpose

Accuracy of intraoperative frozen section diagnosis is extremely important in the evaluation of ovarian tumors so that suitable surgical procedures can be chosen. Therefore, the current study was aimed at measuring the diagnostic accuracy of the intraoperative frozen section to determine the surgical course of tumors.

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 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 intraoperative 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 three 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Materials

The data will be available for editors in case of reasonable requests.

References

  1. Maheshwari A, Gupta S, Kane S, Kulkarni Y, Goyal BK, Tongaonkar HB. Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms: experience at a tertiary oncology center. World J Surg Oncol. 2006;4:12. https://doi.org/10.1186/1477-7819-4-12.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mills AM, Shanes ED. Mucinous ovarian tumors. Surg Pathol Clin. 2019;12(2):565–85. https://doi.org/10.1016/j.path.2019.01.008.

    Article  PubMed  Google Scholar 

  3. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2019;69(1):7–34. https://doi.org/10.3322/caac.21551.

    Article  PubMed  Google Scholar 

  4. Graham L. ACOG releases guidelines on management of adnexal masses. Am Fam Phys. 2008;77(9):1320–3.

    Google Scholar 

  5. Avesi L, Kayani N, Hassan S, Shahid R. Diagnostic accuracy of intraoperative consultation of ovarian neoplasms. Asian J Med Sci. 2014. https://doi.org/10.3126/ajms.v6i1.9782.

    Article  Google Scholar 

  6. Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ. Intraoperative assessment of ovarian tumors: a 5-year review with assessment of discrepant diagnostic cases. Int J Gynecol Pathol Off J Int Soc Gynecol Pathol. 2006;25(3):216–22. https://doi.org/10.1097/01.pgp.0000215295.45738.ed.

    Article  Google Scholar 

  7. Geomini P, Bremer G, Kruitwagen R, Mol BW. Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis. Gynecol Oncol. 2005;96(1):1–9. https://doi.org/10.1016/j.ygyno.2004.09.042.

    Article  PubMed  Google Scholar 

  8. Rotterdam H. Frozen section diagnosis of serous epithelial tumors of the ovary. Am J Diagn Gynecol Obset. 1979;1:89–94.

    Google Scholar 

  9. Cross PA, Naik R, Patel A, Nayar AG, Hemming JD, Williamson SL, et al. Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of gateshead cancer centre experience. BJOG Int J Obstet Gynaecol. 2012;119(2):194–201. https://doi.org/10.1111/j.1471-0528.2011.03129.x.

    Article  CAS  Google Scholar 

  10. Ilvan S, Ramazanoglu R, Ulker Akyildiz E, Calay Z, Bese T, Oruc N. The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol. 2005;97(2):395–9. https://doi.org/10.1016/j.ygyno.2005.01.037.

    Article  PubMed  Google Scholar 

  11. Palakkan S, Augestine T, Valsan MK, Vahab KPA, Nair LK. Role of frozen section in surgical management of ovarian neoplasm. Gynecol Minim Invasive Therapy. 2020;9(1):13–7. https://doi.org/10.4103/gmit.gmit_2_19.

    Article  Google Scholar 

  12. Scully R, Bonfiglio T, Kurman R, Silverberg S, Wilkinson E. World health organization international histological classification of tumours. Histological typing of female genital tract tumours, vol. 19(9). New York: Springer; 1994. p. 4.

    Book  Google Scholar 

  13. Subbian A, Devi UK, Bafna UD. Accuracy rate of frozen section studies in ovarian cancers: a regional cancer institute experience. Indian J Cancer. 2013;50(4):302–5. https://doi.org/10.4103/0019-509x.123599.

    Article  CAS  PubMed  Google Scholar 

  14. Tempfer CB, Polterauer S, Bentz EK, Reinthaller A, Hefler LA. Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynecol Oncol. 2007;107(2):248–52. https://doi.org/10.1016/j.ygyno.2007.06.008.

    Article  PubMed  Google Scholar 

  15. Gol M, Baloglu A, Yigit S, Dogan M, Aydin C, Yensel U. Accuracy of frozen section diagnosis in ovarian tumors: is there a change in the course of time? Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2003;13(5):593–7. https://doi.org/10.1046/j.1525-1438.2003.13389.x.

    Article  CAS  Google Scholar 

  16. Boriboonhirunsarn D, Sermboon A. Accuracy of frozen section in the diagnosis of malignant ovarian tumor. J Obstet Gynaecol Res. 2004;30(5):394–9. https://doi.org/10.1111/j.1447-0756.2004.00218.x.

    Article  PubMed  Google Scholar 

  17. Tangjitgamol S, Jesadapatrakul S, Manusirivithaya S, Sheanakul C. Accuracy of frozen section in diagnosis of ovarian mass. Int J Gynecol Cancer. 2004;14(2):212–9.

    Article  CAS  Google Scholar 

  18. Suprasert P, Khunamornpong S, Phusong A, Settakorn J, Siriaungkul S. Accuracy of intra-operative frozen sections in the diagnosis of ovarian masses. Asian Pac J Cancer Prev APJCP. 2008;9(4):737–40.

    PubMed  Google Scholar 

  19. Mohammed AB, Ahuja V, Farghaly H. Role of frozen section in the intraoperative management of ovarian masses. Middle East Fertil Soc J. 2014. https://doi.org/10.1016/j.mefs.2014.06.001.

    Article  Google Scholar 

  20. Hashmi AA, Naz S, Edhi MM, Faridi N, Hussain SD, Mumtaz S, et al. Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience. World J Surg Oncol. 2016;14:91. https://doi.org/10.1186/s12957-016-0849-x.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Md Arshad NZ, Ng BK, Md Paiman NA, Abdullah Mahdy Z, Mohd Noor R. Intra-operative frozen sections for ovarian tumors—a tertiary center experience. Asian Pac J Cancer Prev APJCP. 2018;19(1):213–8. https://doi.org/10.22034/APJCP.2018.19.1.213.

    Article  PubMed  Google Scholar 

  22. Moodley M, Bramdev A. Frozen section: its role in gynaecological oncology. J Obstet Gynaecol J Inst Obstet Gynaecol. 2005;25(7):629–34. https://doi.org/10.1080/01443610500278097.

    Article  CAS  Google Scholar 

  23. Acikalin A, Torun G, Bagir E, Bayram F, Zeren H, Gulec U, et al. Intraoperative frozen section in ovarian neoplasms; a tertiary center experience. Turk Patoloji Dergisi. 2014;30(3):184–8. https://doi.org/10.5146/tjpath.2014.01270.

    Article  CAS  PubMed  Google Scholar 

  24. Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol. 2008;27(3):353–65. https://doi.org/10.1097/PGP.0b013e31815c24fe.

    Article  PubMed  Google Scholar 

  25. Gultekin E, Gultekin OE, Cingillioglu B, Sayhan S, Sanci M, Yildirim Y. The value of frozen section evaluation in the management of borderline ovarian tumors. J Cancer Res Ther. 2011;7(4):416–20. https://doi.org/10.4103/0973-1482.92005.

    Article  PubMed  Google Scholar 

  26. Ratnavelu ND, Brown AP, Mallett S, Scholten RJ, Patel A, Founta C, et al. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016;3:Cd010360. https://doi.org/10.1002/14651858.cd010360.pub2.

    Article  PubMed  Google Scholar 

  27. Sukumaran R, Somanathan T, Mathews A, Kattor J, Sambasivan S, Nair RP. Role of frozen section in intraoperative assessment of ovarian masses: a tertiary oncology center experience. Indian J Surg Oncol. 2014;5(2):99–103. https://doi.org/10.1007/s13193-014-0311-x.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bige O, Demir A, Saygili U, Gode F, Uslu T, Koyuncuoglu M. Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology. Gynecol Oncol. 2011;123(1):43–6. https://doi.org/10.1016/j.ygyno.2011.06.030.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the staff of the laboratory of Shahid Beheshti University of Medical Sciences who performed the frozen section and final HPE assessments. This article has been extracted from the thesis written by Mrs. Farinaz Shahmoradi in school of medicine Shahid Beheshti University of medical sciences. (Registeration No: 256M).

Author information

Authors and Affiliations

  1. Obstetrician & Gynecologist, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran

    Farinaz Shahmoradi

  2. Professor of Gyneco-Oncology, Cancer Research Center, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran

    Maliheh Arab

Authors
  1. Farinaz Shahmoradi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maliheh Arab
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MA was the principal investigator of this study. FS contributed to the development of the project and performed the statistical analyses. MA and FS contributed development of the project and gathering the data. MA and FS contributed the writing the manuscript. All authors contributed to the drafting of this paper and approved the final manuscript.

Corresponding author

Correspondence to Maliheh Arab.

Ethics declarations

Conflict of interest

No authors have conflict of interest related with this.

Consent for Publication

All of the participants signed a written informed consent prior to participating in this study.

Ethical Approval

The study was approved by the Ethic Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.MSP.REC.1395.23).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shahmoradi, F., Arab, M. Diagnostic Accuracy Value of Intraoperative Frozen Section for Ovarian Neoplasms. Indian J Gynecol Oncolog 18, 76 (2020). https://doi.org/10.1007/s40944-020-00425-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-020-00425-4

Keywords

Search

Navigation