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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 1/2018

01-01-2018 | Gynecologic Oncology

What is the accuracy of frozen section in the diagnosis of mucinous ovarian tumours? A 9-year review of performance in a Greek tertiary referral centre

Authors: Anastasios Tranoulis, Nikolaos Thomakos, Maria Sotiropoulou, Alexandros Rodolakis

Published in: Archives of Gynecology and Obstetrics | Issue 1/2018

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Abstract

Purpose

This retrospective study aimed to evaluate the diagnostic accuracy of the intra-operative frozen sections (FS) of mucinous ovarian tumours (mOT).

Methods

Between 2007 and 2015, a total of 105 mucinous ovarian samples were collected during laparotomy. The intra-operative FS accuracy was evaluated and potential factors correlated with increased inaccuracy assessed using both univariate and multivariate analysis.

Results

The overall FS accuracy was 82.6%, while diagnostic discrepancy observed in 18/105 cases, including under-diagnosis in 14 and over-diagnosis in four cases. Amongst six cases diagnosed as benign with FS, five were upgraded to low malignant potential and one to malignant in the final formalin fixed, paraffin embedded section (FFPES). Amongst the 37 low malignant potential (LMP) cases, two were finally diagnosed as benign and eight as malignant. Amongst malignant tumours the diagnostic agreement occurred in 21/23 cases, while solely two cases were over-diagnosed. The false FS interpretation resulted in inadequate surgical management in 8/105 (7.6%) cases. Misdiagnosis had a statistically significant association with tumour size greater than 13 cm. The ratio of tumour size per number of frozen sections (TSFSR) less than 8 found to be an independent predictor of inaccuracy [OR 2.46, 95% confidence interval (CI) 1.74–3.46, P < 0.001].

Conclusions

The accuracy rate of FS in our study was 82.6%. Frozen section had low accuracy amongst LMP tumours adversely influencing the adequate surgical management. This discordance seems to reflect adverse predictors such as the LMP heterogeneity, maximal tumour diameter and low TSFSR.
Literature
1.
Shimada M, Kigawa J, Ohishi Y et al (2009) Clinicopathological characteristics of mucinous adenocarcinoma of the ovary. Gynecol Oncol 113:331–334CrossRefPubMed
2.
Seidman JD, Kurman RJ, Ronnett BM (2003) Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol 27:985–993CrossRefPubMed
3.
Ledermann JA, Luvero D, Shafer A, O’Connor D, Mangili G, Friedlander M, Pfisterer J, Mirza MR, Kim JW, Alexandre J, Oza A, Brown J (2014) Gynecologic Cancer InterGroup (GCIG) consensus review for mucinous ovarian carcinoma. Int J Gynecol Cancer 24(9 Suppl 3):S14–S19CrossRefPubMed
4.
Cross PA, Naik R, Patel A, Nayar AG, Hemming JD, Williamson SL, Henry JA, Edmondson RJ, Godfrey KA, Galaal K, Kucukmetin A, Lopes AD (2012) Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 119(2):194–201CrossRefPubMed
5.
Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ (2006) Intraoperative assessment of ovarian tumors: a 5-year review with assessment of discrepant diagnostic cases. Int J Gynecol Pathol 25(3):216–222PubMed
6.
Cuello M, Galleguillos G, Zárate C, Córdova M, Brañes J, Chuaqui R, Wild R (1999) Frozen-section biopsy in ovarian neoplasm diagnosis: diagnostic correlation according to diameter and weight in tumors of epithelial origin. Rev Med Chil 127(10):1199–1205CrossRefPubMed
7.
Ilvan S, Ramazanoglu R, Ulker Akyildiz E, Calay Z, Bese T, Oruc N (2005) The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol 97(2):395–399CrossRefPubMed
8.
Bige O, Demir A, Saygili U, Gode F, Uslu T, Koyuncuoglu M (2011) Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology. Gynecol Oncol 123(1):43–46CrossRefPubMed
9.
Rose PG, Rubin RB, Nelson BE, Hunter RE, Reale FR (1994) Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors. Am J Obstet Gynecol 171(3):823–826CrossRefPubMed
10.
Wasinghon P, Suthippintawong C, Tuipae S (2008) The accuracy of intraoperative frozen sections in the diagnosis of ovarian tumors. J Med Assoc Thail 91(12):1791–1795
11.
Usutubun A, Altinok G, Kucukali T (1998) The value of intraoperative consultation (frozen section) in the diagnosis of ovarian neoplasms. Acta Obstet Gynecol Scand 77:1013–1016CrossRef
12.
Yeo EL, Yu KM, Poddar NC, Hui PK, Tang LC (1998) The accuracy of intraoperative frozen section in the diagnosis of ovarian tumors. J Obstet Gynaecol Res 24(3):189–195CrossRefPubMed
13.
Spann CO, Kennedy JE, Musoke E (1994) Intraoperative consultation of ovarian neoplasms. J Natl Med Assoc 86(2):141–144PubMedPubMedCentral
14.
Obiakor I, Maiman M, Mittal K, Awobuluyi M, DiMaio T, Demopoulos R (1991) The accuracy of frozen section in the diagnosis of ovarian neoplasms. Gynecol Oncol 43(1):61–63CrossRefPubMed
15.
Whang KG, Chen TC, Wang TY, Yang YC, Su TH (1998) Accuracy of frozen section diagnosis in gynecology. Gynecol Oncol 70:105–110CrossRef
16.
Rakhshan A, Zham H, Kazempour M (2009) Accuracy of frozen section diagnosis in ovarian masses: experience at a tertiary oncology center. Arch Gynecol Obstet 280(2):223–228CrossRefPubMed
17.
Açikalin A, Torun G, Bağir E, Bayram F, Zeren H, Güleç U, Güzel AB, Gümürdülü D (2014) Intraoperative frozen section in ovarian neoplasms. A tertiary center experience. Turk Patoloji Derg 30(3):184–188PubMed
18.
Brun JL, Cortez A, Rouzier R, Callard P, Bazot M, Uzan S, Daraï E (2008) Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors. Am J Obstet Gynecol 199(3):244.e1-7CrossRefPubMed
19.
Houck K, Nikrui N, Duska L, Chang Y, Fuller AF, Bell D, Goodman A (2000) Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol 95(6 Pt 1):839–843PubMed
20.
Pongsuvareeyakul T, Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Siriaunkgul S (2012) Accuracy of frozen-section diagnosis of ovarian mucinous tumors. Int J Gynecol Cancer 22(3):400–406CrossRefPubMed
21.
Storms AA, Sukumvanich P, Monaco SE, Beriwal S, Krivak TC, Olawaiye AB, Kanbour-Shakir A (2012) Mucinous tumors of the ovary: diagnostic challenges at frozen section and clinical implications. Gynecol Oncol 125(1):75–79CrossRefPubMed
22.
Twaalfhoven FC, Peters AA, Trimbos JB, Hermans J, Fleuren GJ (1991) The accuracy of frozen section diagnosis of ovarian tumors. Gen Oncol 41(3):189–192CrossRef
23.
Cho YH, Kim DY, Kim JH et al (2006) Is complete surgical staging necessary in patients with stage I mucinous epithelial ovarian tumours? Gynecol Oncol 103:878–882CrossRefPubMed
24.
Schmeler KM, Tao X, Frumovitz M et al (2010) Prevalence of lymph node metastasis in primary mucinous carcinoma of the ovary. Obstet Gynecol 116:269–273CrossRefPubMedPubMedCentral
25.
Alexandre J, Ray-Coquard I, Selle F et al (2010) Mucinous advanced epithelial ovarian carcinoma clinical presentation and sensitivity to platinum-paclitaxel-based chemotherapy, the GINECO experience. Ann Oncol 21:2377–2381CrossRefPubMed
26.
Lee KR, Young RH (2003) The distinction between primary and metastatic mucinous carcinomas of the ovary: gross and histologic findings in 50 cases. Am J Surg Pathol 27:281–292CrossRefPubMed
27.
Vergote I, De Brabanter J, Fyles A et al (2001) Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357:176–182CrossRefPubMed
28.
Seidman JD, Vang R, Ronnett BM, Yemelyanova A, Cosin JA (2015) Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. Gynecol Oncol 136(2):336–340CrossRefPubMed
29.
Sherman ME, Berman J, Birrer MJ, Cho KR, Ellenson LH, Gorstein F, Seidman JD (2004) Current challenges and opportunities for research on borderline ovarian tumors. Hum Pathol 35(8):961–970CrossRefPubMed
30.
Baker P, Oliva E (2008) A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 27(3):353–365CrossRefPubMed
31.
Mukhopadhyay D, Rajab R, Nobbenhuis M, Dilley J, Heath O, Wang J, Ind TE, Barton DP (2016) Outcome of appendicectomies at surgery of mucinous ovarian neoplasms: report from a UK center and review of literature. Int J Gynecol Cancer 26(6):1020–1026CrossRefPubMed
32.
Cheng A, Li M, Kanis MJ, Xu Y, Zhang Q, Cui B, Jiang J, Zhang Y, Yang X, Kong B (2017) Is it necessary to perform routine appendectomy for mucinous ovarian neoplasms? A retrospective study and meta-analysis. Gynecol Oncol 144(1):215–222CrossRefPubMed
33.
Moore L, Gajjar K, Jimenez- Linan M, Crawford R (2016) Prevalence of appendiceal lesions in appendicectomies performed during surgery for mucinous ovarian tumors: a retrospective study. Int J Gynecol Cancer 26(8):1386–1389CrossRefPubMed
Metadata
Title
What is the accuracy of frozen section in the diagnosis of mucinous ovarian tumours? A 9-year review of performance in a Greek tertiary referral centre
Authors
Anastasios Tranoulis
Nikolaos Thomakos
Maria Sotiropoulou
Alexandros Rodolakis
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 1/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-017-4582-7

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