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Nomura N, Sugiyama T, Tajiri T, Fujita H, Hiraiwa S, Toguchi S, Machida T, Itoh H, Kajiwara H, Muramatsu T, Nakamura N. Accuracy of imprint cytology and frozen section histology for intraoperative diagnosis of ovarian epithelial tumors: A comparative study and proposed algorithm. Diagn Cytopathol 2021; 49:682-690. [PMID: 33755339 DOI: 10.1002/dc.24722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Appropriate surgical treatment of epithelial ovarian tumors is reliant on intraoperative diagnosis. A retrospective study to compare the diagnostic accuracies of imprint cytology (IC) with frozen section histology (FSH) in these tumors was performed. METHODS About 78 cases of IC-based and FSH-based diagnoses against the final histopathologic diagnoses in terms of both histologic subtype (serous, mucinous, endometrioid, or clear cell tumor) and behavioral type (benign, borderline, or malignant) were compared. The cytomorphologic features of the tumor cells (nuclear atypia, papillary clusters, adenoma cells, and necrosis) in relation to behavioral types were also evaluated. RESULTS While the diagnostic accuracy of IC and FSH were similar with respect to behavioral type (87% and 88%, respectively), the diagnostic accuracy of IC was superior to that of FSH with respect to histologic subtype (83% and 74%, respectively). Among histopathologically confirmed malignant tumors, the diagnostic accuracy of IC (62/64; 97%) was superior to that of FSH (58/64; 91%). The presence of necrosis and absence of adenoma cells were significantly more prevalent among malignant group than among borderline and benign groups (P < .01, for both). CONCLUSION Since the presence of necrosis and absence of adenoma cells around the carcinoma cells appear useful in distinguishing malignant and borderline tumors, it was proposed to include IC for further intraoperative assessment of any tumors initially diagnosed as a borderline tumor by FSH.
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Affiliation(s)
- Nozomi Nomura
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomoko Sugiyama
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takuma Tajiri
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Hirotaka Fujita
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shinichiro Hiraiwa
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Suguru Toguchi
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomohisa Machida
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Hitoshi Itoh
- Department of Laboratory Medicine, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Toshinari Muramatsu
- Department of Obstetrics and Gynecology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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2
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Alam MS, Tongbram A, Krishnakumar S, Biswas J, Mukherjee B. Sensitivity and specificity of frozen section diagnosis in orbital and adnexal malignancies. Indian J Ophthalmol 2020; 67:1988-1992. [PMID: 31755434 PMCID: PMC6896554 DOI: 10.4103/ijo.ijo_2096_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To analyze the diagnostic accuracy of frozen section in orbital and adnexal malignancies. Methods: A total of 55 cases between January 2006 and December 2011 for which intraoperative frozen section was performed for various orbital and adnexal lesions were included in the study. The frozen section diagnosis was compared with the permanent section diagnosis. Margin clearance was also compared between the two. Data were analysed using SPSS version 14. Odds ratio and cross-tabulation was used to perform the analysis. Results: The mean age at presentation was 51.46 ± 20 years. Eyelid was the most common site of involvement. Out of 55 cases, diagnosis was deferred in four cases (7.27%) on frozen section. Among 51 cases, 44 (86%) cases were concordant, whereas 7 (13%) cases were discordant. The sensitivity and specificity of frozen section compared to permanent section for diagnosis of malignancy was found to be 87.2% and 87.5%, respectively. The sensitivity and specificity of frozen section for diagnoses of basal cell carcinoma was found to be 100%, while it was 83.3% and 100% respectively for sebaceous gland carcinoma and 87.5% and 94.9% respectively for squamous cell carcinoma. Conclusion: Frozen section had high sensitivity and specificity when compared with permanent section for all three parameters studied. It is an important intraoperative tool that is increasingly being used in histopathological examination of ophthalmic lesions. However, it should not be used as a substitute for the permanent section and critical decisions based on it are best avoided.
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Affiliation(s)
- Md Shahid Alam
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Andrea Tongbram
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Subramanian Krishnakumar
- Department of Ocular Pathology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Ocular Pathology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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3
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Park JY, Lee SH, Kim KR, Kim YT, Nam JH. Accuracy of frozen section diagnosis and factors associated with final pathological diagnosis upgrade of mucinous ovarian tumors. J Gynecol Oncol 2020; 30:e95. [PMID: 31576689 PMCID: PMC6779608 DOI: 10.3802/jgo.2019.30.e95] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/21/2019] [Accepted: 05/12/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To determine the accuracy of frozen section diagnosis and factors associated with final pathological diagnosis upgrade in patients with mucinous ovarian tumors. Methods This study included 1,032 patients with mucinous ovarian tumors who underwent frozen section diagnosis during surgery. Sensitivity, specificity, and diagnostic accuracy of frozen section diagnosis was calculated. Univariate and multivariate regression analyses were performed to determine factors associated with diagnosis upgrade in the final pathology report. Results The sensitivity and specificity of frozen section diagnosis were 99.1% (95% confidence interval [CI]=98%–99.6%) and 82.2% (95% CI=77.9%–85.7%), respectively, for benign mucinous tumors; 74.6% (95% CI=69.1%–79.4%) and 96.7% (95% CI=95.2%–97.8%), respectively, for mucinous borderline ovarian tumors; and 72.5% (95% CI=62.9%–80.3%) and 98.8% (95% CI=97.9%–99.3%), respectively, for invasive mucinous carcinomas. The multivariate analysis revealed that mixed tumor histology (odds ratio [OR]=2.8; 95% CI=1.3–6.3; p=0.012), tumor size >12 cm (OR=2.5; 95% CI=1.5–4.3; p=0.001), multilocular tumor (OR=2.9; 95% CI=1.4–6.0; p=0.006), and presence of a solid component in the tumor (OR=3.1; 95% CI=1.8–5.1; p<0.001) were independent risk factors for final pathological diagnosis upgrade. Conclusions Mixed tumor histology, tumor size >12 cm, multilocular tumor, and presence of a solid component in the tumor were independent risk factors for final pathological diagnosis upgrade based on frozen section diagnosis.
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Affiliation(s)
- Jeong Yeol Park
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyu Rae Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Tak Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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4
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Colombo N, Sessa C, Bois AD, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Int J Gynecol Cancer 2019; 29:ijgc-2019-000308. [PMID: 31048403 DOI: 10.1136/ijgc-2019-000308] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
The development of guidelines is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on April 12-14, 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonié, Bordeaux, France
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France
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5
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Matsuo K, Machida H, Mandelbaum RS, Grubbs BH, Roman LD, Sood AK, Gershenson DM. Mucinous borderline ovarian tumor versus invasive well-differentiated mucinous ovarian cancer: Difference in characteristics and outcomes. Gynecol Oncol 2019; 153:230-237. [PMID: 30797590 DOI: 10.1016/j.ygyno.2019.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Mucinous borderline ovarian tumor (mucinous-BOT) and invasive well-differentiated mucinous ovarian cancer (mucinous-OC) are often histopathologically misclassified. The objective of this study was to examine differences in clinico-pathological characteristics and outcomes of these two entities. METHODS This is a retrospective population-based study examining the Surveillance, Epidemiology, and End Results Program from 1988 to 2000. Stage I mucinous-BOTs and stage I well-differentiated mucinous-OC were compared for patient demographics, tumor characteristics, and outcomes. Propensity score matching and multivariable analysis were used to assess cause-specific survival (CSS). RESULTS A total of 2130 mucinous-BOT and 581 mucinous-OC cases were examined for analysis. On multivariable analysis, women with mucinous-OC were more likely to be older, Eastern U.S. residents, and have undergone hysterectomy or lymphadenectomy compared to those with mucinous-BOT, and the number of women diagnosed with mucinous-OC decreased over time (all, P < 0.05). Mucinous-OCs were more likely to be stage T1c and have a smaller tumor size as compared to mucinous-BOT (both, adjusted-P < 0.05). After propensity score matching, women with mucinous-OC had significantly poorer CSS compared to those with mucinous-BOT on multivariable analysis (10-year rates: 92.7% versus 97.5%, adjusted-hazard ratio [HR] 2.03, P = 0.007). Similar results were observed among subgroups for reproductive age, stage T1a disease, large tumor, and unstaged cases (all, P < 0.05). CONCLUSION Stage I mucinous-BOT and stage I invasive well-differentiated mucinous-OC have distinct differences in clinical characteristics and patient survival. The inability to conduct centralized pathology review in our study limits our conclusions given the recognized issue of misclassification of mucinous-BOT and mucinous-OC, but further highlights the importance of making the proper histopathological diagnosis for invasive cancer when the ovarian tumor is of mucinous histology.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Brendan H Grubbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anil K Sood
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David M Gershenson
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Huang Z, Li L, Li C, Ngaujah S, Yao S, Chu R, Xie L, Yang X, Zhang X, Liu P, Jiang J, Zhang Y, Cui B, Song K, Kong B. Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors. J Cancer 2018; 9:2817-2824. [PMID: 30123350 PMCID: PMC6096369 DOI: 10.7150/jca.25883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/09/2018] [Indexed: 12/22/2022] Open
Abstract
Objective: First, to evaluate the sensitivity and positive predictive value (PPV) of intra-operative frozen section (FS) diagnosis in borderline ovarian tumors (BOTs), and to explore the factors affecting the diagnostic accuracy. Second, to assess the clinical outcomes of misdiagnosed BOT patients. Methods: We performed a retrospective study of all patients diagnosed as BOT through FS or paraffin section (PS) at Qilu Hospital between January 2005 and December 2015. Clinical and pathologic data were extracted. Univariate analysis was performed using standard two-sided statistical tests. We also performed a meta-analysis to further validate the findings. Results: In our retrospective study, 155 patients were included. Agreement between FS and PS diagnosis was observed in 127/155 (81.9%) patients, yielding a sensitivity of 92.7% and a PPV of 87.6%. Under-diagnosis and over-diagnosis occurred in 22 cases (14.2%) and 6 cases (3.9%), respectively. In our univariate analysis of our retrospective study, tumor size (p=0.048) and surgery approach (p=0.024) were significantly associated with misdiagnosis. The pooled analysis of 13 studies including 1,577 patients indicated that the accuracy (69.2%), sensitivity (82.5%), and PPV (81.1%) were low; also under-diagnosis (20.2%) and over-diagnosis (10.5%) were frequent. The meta-analysis results showed that mucinous histology (p < 0.0001, OR=2.03 [1.47-2.81]) and unilateral tumors (p=0.001, OR=2.39 [1.41-4.06]) were associated with the misdiagnosis of BOT. In our retrospective study, there was no statistical significance of clinical outcome such as extent of surgery (p=0.838), recurrence (p=0.586), fertility (p=0.560), death (p=0.362) between misdiagnosed and accurately diagnosed BOT patients. Conclusions: FS analysis of BOTs has low accuracy, sensitivity, and PPV. Under-diagnosis and over-diagnosis are frequent. Meta-analysis results verify that mucinous histology and unilateral tumors are associated with misdiagnosis of FS. Nevertheless, misdiagnosed patients have a good clinical outcome despite the high frequency of misdiagnosis through FS.
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Affiliation(s)
- Zhen Huang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,School of Medicine, Shandong University, Ji'nan city, Shandong province, China.,Ganzhou maternity & child health hospital, Jiangxi province, China
| | - Li Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - ChengCheng Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,School of Medicine, Shandong University, Ji'nan city, Shandong province, China
| | - Samuel Ngaujah
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,School of Medicine, Shandong University, Ji'nan city, Shandong province, China
| | - Shu Yao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,School of Medicine, Shandong University, Ji'nan city, Shandong province, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,School of Medicine, Shandong University, Ji'nan city, Shandong province, China
| | - Lin Xie
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,School of Medicine, Shandong University, Ji'nan city, Shandong province, China
| | - XingSheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - Xiangning Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - Baoxia Cui
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China
| | - Kun Song
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,Gynecology oncology key laboratory, Qilu Hospital, Shandong University, Ji'nan city, Shandong province, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.,Gynecology oncology key laboratory, Qilu Hospital, Shandong University, Ji'nan city, Shandong province, China
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7
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Accuracy of Intraoperative Frozen Section Diagnosis of Borderline Ovarian Tumors by Hospital Type. J Minim Invasive Gynecol 2018; 26:87-93. [PMID: 29680231 DOI: 10.1016/j.jmig.2018.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital-academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists-and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor. DESIGN Retrospective study (Canadian Task Force classification II-1). SETTING Tertiary care, academic, and community hospitals. PATIENTS Women with an intraoperative frozen section diagnosis of borderline ovarian tumor at 1 of 3 types of hospital from April 1998 through June 2016. INTERVENTIONS Comparison of final pathology with intraoperative frozen section diagnosis. MEASUREMENTS AND MAIN RESULTS Two hundred twelve women met the inclusion criteria. The frozen section diagnosis of borderline ovarian tumor correlated with the final pathologic diagnosis in 192 of 212 cases (90.6%), and the rate of correlation did not differ among the 3 hospital types (p = .82). Seven tumors (3.3%) were downgraded to benign on final pathologic analysis and 13 (6.1%) upgraded to invasive carcinoma. The 3 hospital types did not differ with respect to the proportion of tumors upgraded to invasive carcinoma (p = .62). Mucinous (odds ratio, 7.1; 95% confidence interval, 2.1-23.7; p = .002) and endometrioid borderline ovarian tumors (odds ratio, 32.4; 95% confidence interval, 1.8-595.5; p = .02) were more likely than serous ovarian tumors to be upgraded to carcinoma. Only 88 patients (41.5%) underwent lymphadenectomy, and only 1 (1.1%) had invasive carcinoma in a lymph node. CONCLUSIONS A frozen section diagnosis of borderline ovarian tumor correlates with the final pathologic diagnosis in a variety of hospital types.
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8
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Bohara S, Jain S, Khurana N, Shangpliang DM, Agarwal S, Gandhi G. Intraoperative Cytology of Ovarian Neoplasms with an Attempt to Grade Epithelial Tumors. J Cytol 2018; 35:1-7. [PMID: 29403162 PMCID: PMC5795721 DOI: 10.4103/joc.joc_183_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Intraoperative cytology (IOC) is a simple and quick technique with excellent preservation of cellular details. In the present study, we have evaluated the role of IOC by various methods of smear preparation and compared it with frozen section diagnosis. A scoring system was followed for epithelial tumors for characterization and grading on the basis of cellularity, pattern, nuclear, cytoplasmic features, and background details. Materials and Methods The study was conducted during a time span of 2 years in total 48 cases of ovarian tumors. Fine-needle aspiration cytology, touch/imprint, scrape, and crush techniques were used. The smears so prepared were processed for toluidine blue and Giemsa and Papanicolaou staining. Cases were cytomorphologically categorized into four groups: Indeterminate; unequivocally benign; borderline tumor with equivocal morphology; and unequivocally malignant (graded into well, moderately, and poorly differentiated). Results In our study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.88, 96, 96, 88.88, and 92.31%, respectively, were recorded. This was comparable to frozen section diagnosis with a sensitivity, specificity, PPV, NPV, and accuracy of 85.18, 96.15, 95.83, 86.21, and 90.56%, respectively. In epithelial tumors, cytological grading correlated with histopathological grading in 85.29% cases of epithelial tumors. Conclusion IOC gives comparable results to frozen section and can be used for intraoperative assessment of ovarian tumors. Grading of epithelial tumors on IOC can be performed and may become an important step in intraoperative decision-making for better management and outcome of the patient.
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Affiliation(s)
- Sangita Bohara
- Department of Pathology and Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology and Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology and Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Darilin M Shangpliang
- Department of Pathology and Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Swapnil Agarwal
- Department of Pathology and Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Gauri Gandhi
- Department of Pathology and Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
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9
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Bozdag H, Guzin K, Gocmen A, Kabaca S, Usta A, Akdeniz Duran E. The diagnostic value of frozen section for borderline ovarian tumours. J OBSTET GYNAECOL 2016; 36:626-30. [DOI: 10.3109/01443615.2015.1133574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Halenur Bozdag
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Kadir Guzin
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Ahmet Gocmen
- Department of Obstetrics and Gynecology, Faculty of Medicine, İstanbul Medeniyet University, Istanbul, Turkey and
| | - Sedef Kabaca
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Akın Usta
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Esra Akdeniz Duran
- Department of Statistics, Faculty of Sciences, İstanbul Medeniyet University, Istanbul, Turkey
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10
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Seckin KD, Karslı MF, Yucel B, Bestel M, Yıldırım D, Canaz E, Akbayır O. The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol 2015; 196:60-3. [PMID: 26683535 DOI: 10.1016/j.ejogrb.2015.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the utility of tumor markers and complete blood count to increase the diagnostic accuracy to detect malignant cases that are intraoperatively reported as mucinous borderline ovarian tumors (BOT). STUDY DESIGN Patients who underwent laparotomy at our gynecologic oncology clinic between 2007 and 2015 for evaluation of an adnexal mass with an intraoperative frozen section report of mucinous BOT were retrospectively analyzed. Patients were grouped according to the final pathological diagnoses (malignant, borderline and benign), and were compared in terms of tumor marker levels and complete blood count parameters. Significant parameters were evaluated together with frozen section results, and were assessed for diagnostic accuracy. RESULTS A total of 63 patients were included in the study. Of these, 41 patients had borderline, 11 patients had benign, and 11 patients had malignant mucinous ovarian tumors. Patient age, menopausal status, hemoglobin, platelet and lymphocyte counts were similar among the groups (p>0.05). On the other hand, white blood cell, neutrophil counts and neutrophil/lymphocyte ratio (NLR) were significantly higher in malignant cases (p<0.05). Similarly, CA125 and CA19-9 were significantly higher in malignant group (p<0.05). When evaluated with the frozen section results, CA19-9 and NLR had the highest sensitivity to detect mucinous cancers (81 and 78 percent, respectively). CONCLUSIONS In patients who have an intraoperative frozen section diagnosis of borderline mucinous ovarian tumors, CA19-9, NLR and CA125 were significant predictors of malignancy. In light of larger future studies, we believe that integrating these parameters into routine clinical practice may decrease the rate of under diagnosis.
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Affiliation(s)
- Kerem Doga Seckin
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Fatih Karslı
- Obstetrics and Gynecology Department, Sami Ulus Women and Children Health Training and Research Hospital, Ankara, Turkey
| | - Burak Yucel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Melih Bestel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Dogukan Yıldırım
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Emel Canaz
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akbayır
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Mohammed ABF, Ahuja VK, Farghaly H. Role of frozen section in the intraoperative management of ovarian masses. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Borderline ovarian tumors and diagnostic dilemma of intraoperative diagnosis: could preoperative He4 assay and ROMA score assessment increase the frozen section accuracy? A multicenter case-control study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:803598. [PMID: 25431767 PMCID: PMC4238177 DOI: 10.1155/2014/803598] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/11/2014] [Accepted: 09/03/2014] [Indexed: 11/18/2022]
Abstract
The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P < 0.05), and overdiagnosis in 11.6% versus 0% (P < 0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.
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Ureyen I, Turan T, Cirik DA, Tasci T, Boran N, Bulbul D, Tulunay G. Frozen section in borderline ovarian tumors: is it reliable? Eur J Obstet Gynecol Reprod Biol 2014; 181:115-8. [PMID: 25145763 DOI: 10.1016/j.ejogrb.2014.07.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/21/2014] [Accepted: 07/29/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We reported the concordance of frozen/section (FS) diagnosis of borderline ovarian tumor (BOT) and identified the factors associated with the concordance. STUDY DESIGN FS results of the patients with a final diagnosis of BOT operated between 1990 and 2012 were analyzed. The FS results were reported as benign, rule out borderline tumor, borderline tumor, at least borderline tumor and malign tumor intraoperatively. The concordance of FS diagnosis was determined by comparing the FS result with the final pathological diagnosis. We accepted the FS concordant with the final pathology when the FS result was borderline tumor or at least borderline tumor, since we managed these patients in a similar way intraoperatively. Data regarding histological subtype, tumor size, age of the patients, menopausal status, presence of bilateral disease, preoperative Ca-125 level and the final diagnosis were evaluated. RESULTS FS results of 145 patients were analyzed. The concordance of FS analysis for the total group, for the ones with serous and mucinous BOT were 79%, 92% and 62%, respectively. Totally, 29 patients (20%) weren't staged intraoperatively due to inaccurate FS result. Mucinous histology and larger tumor size were associated with lower concordance of FS. Concordance wasn't associated with type of surgery (conservative vs radical), menopausal status, laterality of the tumor, age of the patients and Ca-125 level of the patients. CONCLUSION The high discrepancy rate of FS, especially in mucinous and larger tumors should be kept in mind during intraoperative decision-making based on FS analysis for BOT.
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Affiliation(s)
- Isin Ureyen
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Department, Etlik Street, 06010 Kecioren, Ankara, Turkey.
| | - Taner Turan
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Department, Etlik Street, 06010 Kecioren, Ankara, Turkey
| | - Derya Akdag Cirik
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Department, Etlik Street, 06010 Kecioren, Ankara, Turkey
| | - Tolga Tasci
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Department, Etlik Street, 06010 Kecioren, Ankara, Turkey
| | - Nurettin Boran
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Department, Etlik Street, 06010 Kecioren, Ankara, Turkey
| | - Dilek Bulbul
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Pathology Clinic, Etlik Street, 06010 Kecioren, Ankara, Turkey
| | - Gokhan Tulunay
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Department, Etlik Street, 06010 Kecioren, Ankara, Turkey
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Takemoto S, Ushijima K, Kawano R, Fukui A, Terada A, Fujimoto T, Imaishi H, Kamura T. Validity of Intraoperative Diagnosis at Laparoscopic Surgery for Ovarian Tumors. J Minim Invasive Gynecol 2014; 21:576-9. [DOI: 10.1016/j.jmig.2013.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 12/01/2022]
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Zhao SH, Qiang JW, Zhang GF, Ma FH, Cai SQ, Li HM, Wang L. Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation. Eur Radiol 2014; 24:2292-9. [PMID: 24871335 DOI: 10.1007/s00330-014-3236-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/15/2014] [Accepted: 05/12/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiating borderline from malignant epithelial tumours of the ovary. METHODS This retrospective study included 60 borderline epithelial ovarian tumours (BEOTs) in 48 patients and 65 malignant epithelial ovarian tumours (MEOTs) in 54 patients. DW imaging as well as conventional MR imaging was performed. Signal intensity on DW imaging was assessed and apparent diffusion coefficient (ADC) value was measured. The results were correlated with histopathology and cell density. RESULTS The majority of MEOTs showed high signal intensity on DW imaging, whereas most BEOTs showed low or moderate signal intensity (P = 0.000). The mean ADC value of the solid components in BEOTs (1.562 ± 0.346 × 10(-3) mm(2)/s) was significantly higher than in MEOTs (0.841 ± 0.209 × 10(-3) mm(2)/s). A threshold value of 1.039 × 10(-3) mm(2)/s permitted the distinction with a sensitivity of 97.0%, a specificity of 92.2% and an accuracy of 96.4%. There was an inverse correlation between ADC value and cell density (r = -0.609; P = 0.0000) which was significantly lower in BEOTs than in MEOTs. CONCLUSIONS DW imaging is useful for differentiating borderline from malignant epithelial tumours of the ovary. KEY POINTS DW MR imaging is useful for differentiating BEOTs from MEOTs. Patients with BEOTs are treated differently from patients with MEOTs. Conservative fertility-sparing laparoscopic surgery can be performed in patients with BEOTs. BEOTs often affect young women of childbearing age.
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Affiliation(s)
- Shu Hui Zhao
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
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Basaran D, Salman MC, Boyraz G, Selcuk I, Usubutun A, Ozgul N, Yuce K. Accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass: retrospective analysis of 748 cases with multivariate regression analysis. Pathol Oncol Res 2014; 21:113-8. [PMID: 24848925 DOI: 10.1007/s12253-014-9795-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass and to define the clinicopathological factors associated with misdiagnosis during frozen section evaluation. METHODS The clinicopathological data of patients who underwent exploratory laparotomy for adnexal mass were reviewed. Results of the intraoperative frozen section and permanent histology reports were compared. Univariate and multivariate analyses were performed to reveal factors associated with misdiagnosis. RESULTS The study group consisted of 748 patients. Of these patients, 509 (68.0%) had benign, 43 (5.7%) had borderline, 196 (26.2%) had malignant histological diagnosis at permanent section. The overall agreement between intraoperative frozen section and permanent pathology was 96.8%. Twenty four out of 745 cases (3.8%) were misdiagnosed by frozen section. Univariate analysis showed that borderline histology (p < 0.0001) and tumor size larger than 10 cm (p = 0.012) were associated with misdiagnosis. According to multivariate analysis, borderline histology (OR: 22.6, p < 0.0001) was the only independent predictor for misdiagnosis during frozen examination. CONCLUSION The frozen section evaluation of the adnexal mass is highly accurate. However, tumor size greater than 10 cm and borderline histology are the factors that adversely influence the accuracy of intraoperative frozen section. Clinicians must be aware of these pitfalls during intraoperative decision making following frozen section report.
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Affiliation(s)
- Derman Basaran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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Basaran D, Salman MC, Calis P, Ozek A, Ozgul N, Usubütün A, Yuce K. Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis. J OBSTET GYNAECOL 2014; 34:429-34. [PMID: 24734941 DOI: 10.3109/01443615.2014.902043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of our study was to evaluate the accuracy of frozen section (FS) in borderline ovarian tumours (BOT) and to define the factors associated with misdiagnosis during FS evaluation. We performed a retrospective review of patients who underwent exploratory laparotomy for an adnexal mass, from January 2007 to July 2012, at a tertiary oncology centre in Turkey. Patients with a diagnosis of BOT either in FS or in permanent pathology were identified. Agreement between FS diagnosis and permanent histology was observed in 37/59 patients (62.7%), which gave a sensitivity and a positive predictive value of 71.2% and 84.1%, respectively. In patients with a diagnosis of BOT by frozen section only (n = 44), the diagnosis was consistent with permanent histopathology in 37/44 patients (84.1%). Frozen section interpreted a malignant tumour as BOT (under-diagnosis) in 6/44 (13.6%) of cases and interpreted a benign lesion as BOT (over-diagnosis) in 1/44 (2.3%) of cases. Slide review of discrepant cases revealed that major pathological causes of under-diagnosis were misinterpretation and sampling errors. Univariate analysis showed that presence of bilateral tumour and positive peritoneal cytology were associated with under-diagnosis. We concluded that, despite significant risk of under-diagnosis, FS analysis is an accurate method for intraoperative diagnosis of BOTs.
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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; 5:99-103. [PMID: 25114460 DOI: 10.1007/s13193-014-0311-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/24/2014] [Indexed: 11/30/2022] Open
Abstract
Surgical management of ovarian lesions vary considerably depending on the nature of the lesion. As the preoperative imaging and serum tumor marker levels are of limited value in the proper categorization of ovarian lesions, intraoperative pathological assessment is commonly requested for a primary diagnosis. Aim of the study is to assess the accuracy of the frozen section in the diagnosis of ovarian masses in our center and to analyze the causes of diagnostic discrepancies. In this retrospective study, frozen section diagnosis of 233 cases of ovarian masses was compared with the permanent section diagnosis. The overall accuracy of frozen section was 91.85 %. The sensitivity of frozen section diagnosis for benign, borderline and malignant tumors was 99.2, 88.46 and 82.95 % respectively. The corresponding specificity was 96.5, 93.23 and 99.3 %. There were 19 discordant cases including 18 false negative cases and one false positive case. Frozen section is an important diagnostic tool to determine the nature of ovarian masses. Careful macroscopic examination, evaluation of multiple sections along with clinical and radiological findings helps to reduce false positive and false negative results. Frozen section examination has limitations especially in cases of borderline tumors. This modality is most effective when the pathologist and surgeon are aware of the advantages and limitations.
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Affiliation(s)
- Renu Sukumaran
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala 695011 India
| | - Thara Somanathan
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala 695011 India
| | - Anitha Mathews
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala 695011 India
| | - Jayasree Kattor
- Division of Pathology, Regional Cancer Centre, Trivandrum, Kerala 695011 India
| | - Suchetha Sambasivan
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala India
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Abstract
Ovarian cancer is the fifth most common cancer affecting women in the UK today, with associated statistics illustrating a steadily increasing rate, particularly in women aged 65 and over (Cancer Research UK, 2013). There are no recognised preventative measures and no effective screening tool. Although evidence suggests that the majority of women experience a variety of non-specific symptoms in the year before diagnosis, the disease it is not commonly recognised until an advanced stage, leading to increased mortality and morbidity. This highlights the need to raise awareness among health professionals and women as a whole, as early recognition undoubtedly improves ovarian cancer survival. Best clinical practice in the UK for the recognition and initial management of ovarian cancer is provided by the National Institute for Health and Care Excellence (NICE). Clinical guideline CG 122 (NICE, 2011) and quality standard QS 18 (NICE, 2012) use relevant clinical evidence to define high-quality care standards for ovarian cancer management. Accurate staging of ovarian cancer is essential to the provision of individualised care and management. However, there is currently no single test that provides a reliable indicator of ovarian malignancy. At present, risk-of-malignancy scores are calculated by serum cancer antigen 125 (CA 125) levels, ultrasound score and menopausal status. These are widely used to identify women who are at high risk and require referral to a specialised gynaecological oncology service. Women diagnosed with ovarian cancer require information and support. The clinical nurse specialist acts as a key worker, providing communication, support and holistic care throughout a woman's cancer journey. The value of this role cannot be underestimated. Surgery followed by platinum-based chemotherapy is the usual standard treatment pathway, although individualised assessment and management may deviate from it. Early disease may be successfully treated with surgery alone; advanced disease may require complex management and treatment. New treatments such as bevacizumab show promise of improving ovarian cancer outcomes.
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Sevestre H, Ikoli JF, Al Thakfi W. Anatomie et cytologie pathologiques des tumeurs supposées bénignes de l’ovaire. ACTA ACUST UNITED AC 2013; 42:715-21. [DOI: 10.1016/j.jgyn.2013.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ma FH, Zhao SH, Qiang JW, Zhang GF, Wang XZ, Wang L. MRI appearances of mucinous borderline ovarian tumors: pathological correlation. J Magn Reson Imaging 2013; 40:745-51. [PMID: 24395397 DOI: 10.1002/jmri.24408] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/21/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the MRI features of mucinous borderline ovarian tumors (MBOT). MATERIALS AND METHODS MRI morphology of 30 MBOT proven MBOT by surgery and pathology was retrospectively studied and correlated with the histopathological findings. On MRI, tumors were classified into three morphological categories: (i) unilocular cyst in five (17%) tumors. (ii) multilocular cyst in 23 (76%) tumors. (iii) solid mass in 2 (7%) tumors. MRI features of tumors were identified including the multilocularity (23/30, 77%), honeycomb loculi (15/30, 50%), signal discrepancy (different signal intensity on T1WI and T2WI) (19/30, 63%), thickened wall or septa (>3 mm) (16/30, 53%). RESULTS Intestinal type and endocervical type of MBOT, two distinctly histologic subtypes, were found in 20 (67%) and 10 (33%) tumors respectively. There were a higher prevalence of multilocularity (P = 0.026), honeycomb loculi (P = 0.025), and signal discrepancy (P = 0.024) in intestinal type than endocervical type of MBOT. CONCLUSION Typical MRI features of MBOT are large multilocular tumors with honeycomb loculi, heterogeneous signal intensity of the loculi, and thickened wall or septa.
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Affiliation(s)
- Feng Hua Ma
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Zhao SH, Qiang JW, Zhang GF, Wang SJ, Qiu HY, Wang L. MRI in differentiating ovarian borderline from benign mucinous cystadenoma: pathological correlation. J Magn Reson Imaging 2013; 39:162-6. [PMID: 24123278 DOI: 10.1002/jmri.24083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/22/2013] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate MRI in differentiating borderline mucinous cystadenoma (MC) from benign MC of the ovary. MATERIALS AND METHODS We studied MR images of 26 benign MCs and 24 borderline MCs of the ovary. The following MRI features of tumors were evaluated and compared between two groups: laterality, shape, size, loculation, signal intensity of the fluid, thickness of the septation and the wall, and vegetations. The results of the MRI were then compared with the pathological findings. RESULTS Honeycomb loculi, high signal intensity on T1WI, and low signal intensity on T2WI of the intracystic content, thickened septation or wall (≥5 mm), and vegetations (≥5 mm) were significantly more common in borderline MC than in benign MC with the sensitivity and specificity of identifying borderline MC of 50.0% and 80.8%, 41.7% and 96.2%, 45.8% and 96.2%, and 62.5% and 96.2%, respectively. The presence of any one of the following features-honeycomb loculi with a low signal intensity on T2WI, thickened septation or wall (≥5 mm), and vegetations (≥5 mm)-yielded the sensitivity, specificity, and accuracy of identifying borderline MC of 91.7%, 92.3%, and 92.0%, respectively. CONCLUSION MRI has the ability to accurately demonstrate the morphological characteristics of ovarian MC and reliably differentiate borderline MC from benign MC.
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Affiliation(s)
- Shu Hui Zhao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Azuar AS, Bourdel N, Ferrarrese G, Dauplat J, Mage G, Canis M. Laparoscopic restaging of borderline ovarian tumours (BLOT): a retrospective study of 142 cases. Eur J Obstet Gynecol Reprod Biol 2013; 168:87-91. [PMID: 23395007 DOI: 10.1016/j.ejogrb.2012.12.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 12/06/2012] [Accepted: 12/30/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES PRIMARY OBJECTIVE To analyse the impact of restaging, on recurrences and survival, in BLOT. SECONDARY OBJECTIVE To cluster patients who could be exempted from restaging. STUDY DESIGN This retrospective study, included patients operated for a BLOT, between January 1990, and December 2007, in gynaecological surgery units of the University Hospital of Clermont-Ferrand. Two groups were evaluated: patients with and without optimal restaging. RESULTS One hundred and forty-two patients were included. Optimal initial staging rate was 38.7% (n=55). Among the eighty-seven women not initially staged, two groups were compared: restaged (n=45) and non-restaged patients (n=42). Mean follow-up was 80.5 months. Overall survival was 93.7%. Relapse rate was 7.7% (n=11). Disease free survival (DFS) was 88% after a mean follow-up of 80.5 months. One death was noted. Optimal restaging rate was 31.7% (n=45, 43 by laparoscopy). Mean follow-up was of 87.1 months among restaged patients, 84.5 months among non-restaged patients (p=0.93). Relapse incidence was significantly higher in non restaged, than in restaged patients (p=0.008). DFS was significantly longer among restaged than non-restaged patients, (p=0.072). Younger age (p=0.04), conservative treatment (p<10(-4)) or non-diploidy (p=0.04) increased the incidence of relapse. CONCLUSIONS When initial staging is missing, restaging improves the patients outcome in comparison to non-restaged groups. Laparoscopy is a valuable surgical option. This study suggests that a selected group of patients, older than 30 years old, submitted to a radical treatment, presenting a diploid, non micropapillar, mucinous BLOT, without visible implants during careful peritoneal inspection, could be exempted from restaging. They represented 11.6% of our population.
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Affiliation(s)
- A S Azuar
- Department of Obstetrics and Gynaecology, Universitary Hospital Estaing, Clermont-Ferrand, France.
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The role of frozen sections in gynaecological oncology: survey of practice in the United Kingdom. Eur J Obstet Gynecol Reprod Biol 2013. [DOI: 10.1016/j.ejogrb.2012.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lax S, Tamussino K, Prein K, Lang P. Schnellschnittdiagnostik bei Erkrankungen des weiblichen Genitaltrakts. DER PATHOLOGE 2012; 33:430-40. [DOI: 10.1007/s00292-012-1597-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Storms AA, Sukumvanich P, Monaco SE, Beriwal S, Krivak TC, Olawaiye AB, Kanbour-Shakir A. Mucinous tumors of the ovary: Diagnostic challenges at frozen section and clinical implications. Gynecol Oncol 2012; 125:75-9. [DOI: 10.1016/j.ygyno.2011.12.424] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
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Abstract
ObjectiveThe objective of the study was to evaluate the diagnostic accuracy of intraoperative frozen sections of ovarian mucinous tumors and to identify the features associated with an inaccurate diagnosis.MethodsCases of ovarian mucinous tumors (benign, low malignant potential [LMP] or borderline, primary malignant, and metastatic) diagnosed by frozen section or final histology were recruited. Frozen-section diagnoses were compared with the final histologic diagnoses. Possible variables associated with diagnostic discrepancy were analyzed.ResultsA comparison of the diagnoses was done in 195 cases (102 benign, 61 LMP, 18 primary malignant, and 14 metastatic). Diagnostic agreement was observed in 164 cases (84.1%) and discrepancy in 31 cases (15.9%). The sensitivity of frozen-section diagnosis was low in LMP (67.2%) and malignant tumors (55.6%). The specificity was the lowest in the benign category (78.5%). The positive predictive values of all categories were less than 90% (range, 83.3%–85.7%). Diagnostic discrepancy was associated with tumor size of greater than 13 cm (P = 0.019) and the number of frozen sections of 4 or more (P = 0.035). However, in a multivariate analysis, there was no independent predictor of diagnostic discrepancy. The number of frozen sections 4 or more was strongly associated with tumor size of greater than 13 cm (P = 0.004).ConclusionsThe sensitivity of frozen-section diagnosis of LMP and malignant mucinous tumors was low. The inaccuracy of a frozen-section diagnosis of ovarian mucinous tumors may be related to a tumor size of greater than 13 cm. Increasing the number of intraoperative samples over 3 sections per case may not effectively increase the accuracy of frozen-section diagnosis in mucinous tumors.
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Shih K, Garg K, Soslow R, Chi D, Abu-Rustum N, Barakat R. Accuracy of frozen section diagnosis of ovarian borderline tumor. Gynecol Oncol 2011; 123:517-21. [DOI: 10.1016/j.ygyno.2011.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/05/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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Schorge JO, Eisenhauer EE, Chi DS. Current surgical management of ovarian cancer. Hematol Oncol Clin North Am 2011; 26:93-109. [PMID: 22244664 DOI: 10.1016/j.hoc.2011.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgical management of ovarian cancer requires excellent judgment and mastery of a wide array of procedures. Involvement of a gynecologic oncologist improves outcomes. Staging of apparent stage I disease is important. Minimally invasive techniques provide advantages. Primary debulking surgery provides the best long-term survival of any strategy in advanced ovarian cancer. Aggressive surgical paradigms have the greatest success. Further cytoreductive surgery may be appropriate. Most relapsed patients require management of bowel obstruction at some point. Palliative intervention can enhance quality of life. Surgical correction may extend survival. For end-stage patients with progressive disease, the treating gynecologic oncologist must manage expectations.
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Affiliation(s)
- John O Schorge
- Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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Zheng CH, Zhang L, Ng VTY, Shiu SCK, Huang DS. Molecular pattern discovery based on penalized matrix decomposition. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2011; 8:1592-1603. [PMID: 21519114 DOI: 10.1109/tcbb.2011.79] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A reliable and precise identification of the type of tumors is crucial to the effective treatment of cancer. With the rapid development of microarray technologies, tumor clustering based on gene expression data is becoming a powerful approach to cancer class discovery. In this paper, we apply the penalized matrix decomposition (PMD) to gene expression data to extract metasamples for clustering. The extracted metasamples capture the inherent structures of samples belong to the same class. At the same time, the PMD factors of a sample over the metasamples can be used as its class indicator in return. Compared with the conventional methods such as hierarchical clustering (HC), self-organizing maps (SOM), affinity propagation (AP) and nonnegative matrix factorization (NMF), the proposed method can identify the samples with complex classes. Moreover, the factor of PMD can be used as an index to determine the cluster number. The proposed method provides a reasonable explanation of the inconsistent classifications made by the conventional methods. In addition, it is able to discover the modules in gene expression data of conterminous developmental stages. Experiments on two representative problems show that the proposed PMD-based method is very promising to discover biological phenotypes.
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Affiliation(s)
- Chun-Hou Zheng
- College of Electrical Engineering and Automation, Anhui University, Hefei, Anhui 230039, China.
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Song T, Choi CH, Kim HJ, Kim MK, Kim TJ, Lee JW, Bae DS, Kim BG. Accuracy of frozen section diagnosis of borderline ovarian tumors. Gynecol Oncol 2011; 122:127-31. [DOI: 10.1016/j.ygyno.2011.03.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 03/20/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
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Koskas M, Madelenat P, Yazbeck C. [Ovarian low malignant potential tumor: how to preserve fertility?]. ACTA ACUST UNITED AC 2009; 37:942-50. [PMID: 19819742 DOI: 10.1016/j.gyobfe.2009.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 11/26/2022]
Abstract
Ovarian low malignant potential tumor account for 10 to 20 percent of ovarian epithelial tumors. They differ from typical ovarian cancers in that they do not grow into the ovarian stroma. Likewise, if they spread outside the ovary, for example, into the abdominal cavity, they do not usually grow into the lining of the abdomen. These cancers tend to affect women at a younger age than the typical ovarian cancers and are less life-threatening than most ovarian cancers. Guidelines for surgical treatment of borderline ovarian tumors are similar to those for ovarian cancer and include hysterectomy with bilateral salpingo-oophorectomy. However, patients with borderline ovarian tumors tend to be younger than women with invasive ovarian cancer. For many of these patients, fertility is an important issue. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Despite infrequent data, this observation has been expanded to include women with advanced-stage disease. Recurrence is noted more often after this type of treatment, but does not seem to have a negative effect on survival. Management of conservative treatment (complete staging, cystectomy or oophorectomy, oophorectomy or adnexectomy) are still under debate since none avoids the malignant transformation risk. Thus, close follow-up is mandatory and the optimal moment for final oophorectomy remains unclear. When ovarian preservation is impossible, oocyte/ovarian cryopreservation or emergency ovarian induction before the surgical procedure to obtain embryos are promising but still under evaluated options.
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Affiliation(s)
- M Koskas
- Service de gynécologie-obstétrique, maternité Aline-de-Crépy, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
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Kim JH, Kim TJ, Park YG, Lee SH, Lee CW, Song MJ, Lee KH, Hur SY, Bae SN, Park JS. Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary. J Gynecol Oncol 2009; 20:176-80. [PMID: 19809552 DOI: 10.3802/jgo.2009.20.3.176] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/07/2009] [Accepted: 09/07/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We have assessed the accuracy of frozen section diagnosis and the outcomes of misdiagnosis in borderline tumors of the ovary (BTO) according to frozen section. METHODS All pathology reports with BTO in both frozen and permanent section analyses between 1994 and 2008 at Seoul St. Mary's Hospital were reviewed. Frozen section diagnosis and permanent section histology reports were compared. Logistic regression models were conducted to evaluate the correlation of patient and tumor characteristics with diagnostic accuracy. The clinical outcomes of misdiagnosis were evaluated. RESULTS Agreement between frozen section diagnosis and permanent histology was observed in 63 of 101 patients (62.4%). Among the 76 patients with frozen section proven BTO, under-diagnosis and over-diagnosis occurred in 8 of 76 (10.5%) and 5 of 76 patients (6.6%), respectively. Mean diameter of under-diagnosed tumor was larger than matched BTO (21.0+/-11.4 vs. 13.7+/-7.1; p=0.021). Tumor size 20 cm was determined as the optimal cut-off for under-diagnosis (50% sensitivity, 87.3% specificity). Among 8 under-diagnosed patients, no patient relapsed. Among 5 over-diagnosed patients, 2 patients < 35 years of age had fertility-preserving surgery. CONCLUSION Although frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian tumors, over-diagnosis and under-diagnosis are relatively frequent in frozen proven BTO. Surgical decision-making for BTO based on frozen section diagnosis should be done carefully, especially in large tumors.
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Affiliation(s)
- Jin Hwi Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea School of Medicine, Seoul, Korea
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Kim K, Chung H, Kim J, Park N, Song Y, Kang S. Clinical impact of under-diagnosis by frozen section examination is minimal in borderline ovarian tumors. Eur J Surg Oncol 2009; 35:969-73. [DOI: 10.1016/j.ejso.2009.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 03/03/2009] [Accepted: 03/05/2009] [Indexed: 11/26/2022] Open
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Liu CS, Nagarsheth NP, Nezhat FR. Laparoscopy and Ovarian Cancer: A Paradigm Change in the Management of Ovarian Cancer? J Minim Invasive Gynecol 2009; 16:250-62. [DOI: 10.1016/j.jmig.2009.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 12/29/2008] [Accepted: 01/08/2009] [Indexed: 11/26/2022]
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Jha UP, Swasti. Using Intra-Operative Frozen Section (IFS) in Gynaecological Oncology. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Brun JL, Cortez A, Rouzier R, Callard P, Bazot M, Uzan S, Daraï E. Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors. Am J Obstet Gynecol 2008; 199:244.e1-7. [PMID: 18486086 DOI: 10.1016/j.ajog.2008.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 12/27/2007] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to study factors influencing the use and accuracy of frozen section diagnosis (FSD) of ovarian tumors. STUDY DESIGN Surgery was performed in 414 patients with epithelial ovarian tumors between 2001 and 2006. Factors were identified by univariate and multivariate analysis. RESULTS FSD was requested in 274 patients: 152 benign, 55 borderline, and 67 malignant tumors. Age 50 years or older, tumor size 10 cm or greater, and preoperative evidence of malignancy were associated with FSD request. The sensitivity and specificity of FSD for benign, borderline, and malignant tumors were 97% and 81%, 62% and 96%, and 88% and 99%, respectively. The histologic type (mucinous), tumor size (less than 10 cm), the borderline component (less than 10%), and the pathologist's experience predicted misdiagnosis of borderline tumors. Spread outside the ovary was the only significant predictor of accurate FSD of malignant tumors. CONCLUSION FSD is less accurate for borderline than benign and malignant ovarian tumors. The pathologist's experience is a major determinant of diagnostic accuracy.
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Semaan AY, Abdallah RT, Mackoul PJ. The role of laparoscopy in the treatment of early ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 2008; 139:121-6. [PMID: 18433977 DOI: 10.1016/j.ejogrb.2008.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/10/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022]
Abstract
Laparoscopic management of early ovarian cancer (EOC) has constituted a controversial issue since it was first described. Recent data reinforced the arguments supporting the use of laparoscopy in the management of EOC. Advances in laparoscopy have enabled surgeons to meet the International Federation of Gynecology and Obstetrics' criteria for staging of EOC. Although most study results are encouraging, the sample size is still too small to be able to draw definite conclusions. Frequently cited concerns such as accuracy of staging, intraabdominal tumor rupture and port site metastasis should not be used as arguments against laparoscopic management of EOC. Clinical evidence is clearly in favor of a larger role for laparoscopy in the management of EOC. This should encourage studies with larger sample sizes to confirm the validity of laparoscopic management of EOC.
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Affiliation(s)
- Assaad Y Semaan
- The George Washington University, Department of Obstetrics and Gynecology, Washington, DC 20037, USA.
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41
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Obermair A, Hiebl S. Laparoscopy in the treatment of ovarian tumours of low malignant potential. Aust N Z J Obstet Gynaecol 2008; 47:438-44. [PMID: 17991106 DOI: 10.1111/j.1479-828x.2007.00776.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Laparoscopy is increasingly used by gynaecologists for the investigation of adnexal masses. Uncertainty exists whether ovarian tumours of low malignant potential can effectively be treated by laparoscopy, whether staging bears a benefit for all patients, whether port-site metastases are a problem and how long patients need to be followed up after surgery. This review summarises the evidence to address these important questions.
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Affiliation(s)
- Andreas Obermair
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, and Medical School, University of Queensland, Heston, Queensland, Australia.
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42
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Taskiran C, Erdem O, Onan A, Bozkurt N, Yaman-Tunc S, Ataoglu O, Guner H. The role of frozen section evaluation in the diagnosis of adnexal mass. Int J Gynecol Cancer 2008; 18:235-40. [PMID: 17587313 DOI: 10.1111/j.1525-1438.2007.00995.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to evaluate the accuracy of frozen section diagnosis in patients who were subjected to the exploratory laparotomy for pelvic mass. Overall, 207 patients were included in this study and the mean age of the patients was 50.9 ± 14.9 years (range, 18–84 years). Of these patients, 98 (47%) had benign, 16 (8%) had borderline, and 93 (45%) had malignant histologies at permanent section. The diagnosis at frozen section was deferred for three patients (1.4%) and these patients were excluded from the further analyses. The overall discordance rate was 5.3%. To calculate the sensitivity and specificity values, 2 × 2 contingency tables were constructed in two ways. In the first calculation, borderline histology was considered malignant, and the sensitivity and specificity rates were 97% and 92%, respectively. In the second analysis, it was accepted as benign, and these values were 100% and 98%, respectively. To determine the possible factors related with discordant diagnoses, age, menopausal status, tumoral size, laterality of tumors, and histologic diagnoses were analyzed. Significant association was noted for size and borderline and mucinous histologies. In patients with borderline histology, the discordance rate was 40%. This value for the remaining patients was 3.2% (P< 0.001). The rate of misdiagnosis was 17.4% for mucinous tumors, whereas it was 4.8% for the remaining epithelial tumors (P= 0.03). Frozen section evaluation revealed high sensitivity and specificity values in this study. To increase the accuracy of diagnosis, further diagnostic markers are needed especially for patients with large lesions, borderline tumors, and mucinous histologies.
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Affiliation(s)
- C Taskiran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Gazi University, Ankara, Turkey.
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Kho RM, Magrina JF, Magtibay PM. Pathologic findings and outcomes of a minimally invasive approach to ovarian remnant syndrome. Fertil Steril 2007; 87:1005-9. [PMID: 17478171 DOI: 10.1016/j.fertnstert.2006.12.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 12/11/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review outcomes and pathologic findings of a primarily minimally invasive approach to ovarian remnant syndrome. DESIGN Data were abstracted from medical records documenting bilateral salpingo-oophorectomy and subsequent treatment between 1996 and 2006 for pathologically confirmed ovarian remnant tissue. Follow-up was by mailed questionnaires and telephone interviews. SETTING Tertiary care academic medical institution. PATIENT(S) Twenty patients (mean age, 48 years) receiving treatment for ovarian remnant tissue after prior bilateral salpingo-oophorectomy. INTERVENTION(S) Primarily minimally invasive approach (conventional laparoscopy and robot-assisted laparoscopy) for removal of ovarian remnant tissue. MAIN OUTCOME MEASURE(S) Postoperative complications and recurrence. RESULT(S) The 20 patients had a mean follow-up of 30 months. Indications were endometriosis in 8 and ovarian neoplasm in 6. Eighteen patients presented with pain, and 2 presented with a pelvic mass. Nineteen had laparoscopy (14 conventional; 5 robotic), and 1 had laparotomy. Remnant ovarian tissue was associated with endometriosis in 5 and corpus luteum in 3. Two patients had malignancy in remnant ovarian tissue. Postoperative complications included pneumonia (1 case). Follow-up identified no recurrence. CONCLUSION(S) Ovarian remnant syndrome can be managed safely and successfully with minimally invasive surgery. Risk of carcinoma mandates surgical resection.
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Affiliation(s)
- Rosanne M Kho
- Department of Obstetrics and Gynecology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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44
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Heller DS. Pathologist-clinician communication: The role of the pathologist as consultant to the minimally invasive gynecologic surgeon. J Minim Invasive Gynecol 2007; 14:4-8. [PMID: 17218221 DOI: 10.1016/j.jmig.2006.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 06/30/2006] [Accepted: 07/08/2006] [Indexed: 11/23/2022]
Affiliation(s)
- Debra S Heller
- Department of Pathology & Laboratory Medicine, University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07101, USA.
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45
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Fauvet R, Poncelet C, Daraï E. Faisabilité et limites du traitement cœlioscopique des tumeurs frontières de l'ovaire. ACTA ACUST UNITED AC 2006; 34:470-8. [PMID: 16677839 DOI: 10.1016/j.gyobfe.2006.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 03/28/2006] [Indexed: 01/15/2023]
Abstract
Borderline ovarian tumours (BOT) are mainly diagnosed in young women with early stage disease. Due to the absence of specific pre operative criteria for BOT, a laparoscopy is usually performed. A review of the literature found no pejorative data on laparoscopic approach for BOT. Strict surgical procedures must be performed to avoid incomplete surgical staging, cells dissemination and port-site metastases. The limits of the laparoscopic management are the stage of disease and the tumour size. Laparoscopic treatment of BOT for women with early stage disease is feasible. This treatment should be evaluated in specialized centres for women with advanced stage diseases and/or peritoneal implants.
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Affiliation(s)
- R Fauvet
- Service de gynécologie--obstétrique, CHI Poissy--Saint-Germain-en-Laye, Poissty, France
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46
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Wingo SN, Knowles LM, Carrick KS, Miller DS, Schorge JO. Retrospective cohort study of surgical staging for ovarian low malignant potential tumors. Am J Obstet Gynecol 2006; 194:e20-2. [PMID: 16647891 DOI: 10.1016/j.ajog.2005.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 11/04/2005] [Accepted: 11/15/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the benefit of surgically staging ovarian low malignant potential tumors. STUDY DESIGN This was a retrospective cohort study of all ovarian low malignant potential tumors that were diagnosed by frozen section or final pathologic review from 2003 to 2005. RESULTS Twenty-two of 32 patients (69%) were staged surgically. Sixteen low malignant potential tumors were stage I by final pathologic review, and 4 tumors were upstaged to stage II-III disease. Two other patients had early invasive ovarian carcinoma, despite a frozen section that suggested low malignant potential; 1 patient received adjuvant chemotherapy. The tumors of 10 women (31%) were unstaged. Frozen section suspicion of low malignant potential (P = .003) and surgery by a gynecologic oncologist (P < .001) correlated with staging. Preoperative CA-125, intraoperative blood loss, and postoperative hospitalization were increased in patients with staged disease (each P < .05). Two women who underwent fertility-sparing surgery experienced a recurrence in the contralateral ovary. CONCLUSION Surgical staging of ovarian low malignant potential tumors has limited value for most patients, unless invasive carcinoma is diagnosed by final pathologic review.
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Affiliation(s)
- Shana N Wingo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA
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Bazot M, Nassar-Slaba J, Thomassin-Naggara I, Cortez A, Uzan S, Daraï E. MR imaging compared with intraoperative frozen-section examination for the diagnosis of adnexal tumors; correlation with final histology. Eur Radiol 2006; 16:2687-99. [PMID: 16547708 DOI: 10.1007/s00330-006-0163-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 12/08/2005] [Accepted: 01/12/2006] [Indexed: 12/27/2022]
Abstract
The aim was to compare the accuracy of magnetic resonance imaging (MRI) and intraoperative consultation (IC) for the diagnosis of adnexal masses, with reference to final histology. MRI was performed in 136 women with sonographically indeterminate adnexal masses. IC included macroscopic and frozen-section examination. Macroscopic examination and MRI determined size, nature, and presence of vegetations or solid portions within masses. All masses were characterized as benign or malignant according to previously published MR imaging and histopathologic criteria. Sensitivities, specificities, and predictive values for the diagnosis of malignancy of MRI and IC were assessed. Histology revealed 168 adnexal masses (99 benign, 23 borderline and 46 invasive). Frozen sections were examined in 151 cases. Among the 151 adnexal masses studied by both MRI and IC, respective sensitivities, specificities, positive and predictive values of both methods for the diagnosis of malignancy were 89.7% and 84.5%, 91.4% and 100%, 86.7% and 100%, and 93.4% and 91.3%. Sensitivities of MR imaging and frozen section for the diagnosis of serous versus mucinous borderline tumors were 33.3% and 93.3%, and 62.5% and 12.5%, respectively. MRI is less accurate than IC for characterizing adnexal masses. However, MRI may increase the relevance of IC for borderline mucinous tumors.
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Affiliation(s)
- Marc Bazot
- Department of Radiology, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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48
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Abstract
Gynecologic malignancies are most often diagnosed in postmenopausal women, but these malignancies also arise in premenopausal women, in whom issues of fertility can be a major concern. An increasing number of women are delaying childbearing. This has led to a significant increase in the number of women diagnosed with a gynecologic malignancy before desired completion of childbearing. Many of the standard treatments for these malignancies result in permanent sterility; however, there are now options for select young women who desire to preserve fertility. Patients should be told that data on fertility-sparing procedures are limited and that many of these options are of an experimental, nonstandard nature. The care of these patients is challenging and complex and requires a multidisciplinary approach, which should include gynecologic oncologists, reproductive endocrinologists, and perinatologists.
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Affiliation(s)
- Mario M Leitao
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA
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49
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Morice P. Borderline tumours of the ovary and fertility. Eur J Cancer 2005; 42:149-58. [PMID: 16326097 DOI: 10.1016/j.ejca.2005.07.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 07/27/2005] [Indexed: 11/29/2022]
Abstract
Standard management of borderline ovarian tumours (BOT) is historically radical and based on hysterectomy, bilateral salpingo-oophorectomy and peritoneal staging. But, as 1/3 of BOTs are diagnosed in patients aged less than 40 years, treatments preserving fertility-potential (with preservation of the uterus and at least part of one ovary) has seen great developments in the last decade. Such treatments increase the rate of recurrences (between 15% and 35% depending on the type of conservative surgery), but without any impact on patient survival as most recurrent diseases are of the borderline type, easily curable and with excellent prognosis. The spontaneous pregnancy rate is nearly 50%. In case of persistent infertility, it seems that the use of ovarian induction or in vitro fertilization procedures could be proposed in selected cases. Follow-up is essential and based on clinical examination and routine ultrasonography. The interest of completion surgery (removal of the retained ovary) in patients who obtained pregnancy remains debated. In conclusion, conservative management of at least part of one ovary and uterus could be safely proposed at least to patients with early stage BOT, in order to preserve fertility-potential. The rate of recurrence is increased but without any impact on survival.
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Affiliation(s)
- P Morice
- Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
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50
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Rao GG, Skinner EN, Gehrig PA, Duska LR, Miller DS, Schorge JO. Fertility-sparing surgery for ovarian low malignant potential tumors. Gynecol Oncol 2005; 98:263-6. [PMID: 15964063 DOI: 10.1016/j.ygyno.2005.04.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 04/06/2005] [Accepted: 04/20/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Ovarian low malignant potential (LMP) tumors have an excellent prognosis when treated by surgical resection. Conservative management usually involves leaving behind the uterus and contralateral adnexa to allow future childbearing. The purpose of this study was to determine the outcome of women treated with fertility-sparing surgery. METHODS All patients diagnosed with ovarian LMP tumors between 1984 and 2003 were identified at three institutions. Data were retrospectively extracted from clinical records. RESULTS Thirty-eight (15%) of 249 women with LMP tumors underwent fertility-sparing surgery. Twenty-three were nulliparous and four primiparous. Thirty-three (87%) underwent unilateral salpingo-ophorectomy and five (13%) cystectomy. Fourteen patients also had contralateral cystectomy or biopsy. Thirty-four (89%) were stage I, one (3%) stage II and three (8%) stage III. Most tumors had serous (55%) or mucinous (42%) histology. No patients received adjuvant therapy. Six (16%) of 38 recurred after a median follow-up of 26 months: five in the remaining ovary were salvaged with surgical resection alone, and none died from recurrent LMP tumor. Five women delivered six term infants during post-treatment surveillance. CONCLUSION Fertility-sparing surgery for ovarian LMP tumors is an option for motivated patients. Preservation of the contralateral adnexa increases the risk of recurrence, but surgical resection is usually curative.
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Affiliation(s)
- Gautam G Rao
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, J7.124, Dallas, TX 75390-9032, USA
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