IMR Press / EJGO / Volume 40 / Issue 4 / DOI: 10.12892/ejgo4717.2019
Open Access Original Research
Is intraoperative frozen examination sufficiently reliable for ovarian tumors: 11 years experience at a single center
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1 Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey
2 Department of Pathology, University of Gaziantep, Gaziantep, Turkey
Eur. J. Gynaecol. Oncol. 2019 , 40(4), 628–633; https://doi.org/10.12892/ejgo4717.2019
Revised: 4 June 2018 | Published: 10 August 2019
Abstract

Objectives: To demonstrate the safety of intraoperative frozen section (IFS) examination in epithelial, borderline, sex-cord stromal (SCST), and germ-cell (GCT) ovarian tumors and to report causes of misdiagnosis in IFS. Materials and Methods: Six hundred forty-nine patients with ovarian masses who underwent IFS examination between January 2006 and December 2016 were evaluated retrospectively. The cases were grouped as benign, malignant, borderline, and deferred according to the IFS outcome. Cases that were deferred to permanent section were excluded from the study. According to the permanent paraffin section (PPS) results, epithelial ovarian tumor (EOT), borderline ovarian tumor (BOT), SCST, and GCT subgroups were formed in addition to benign, malignant, and borderline groupings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IFS were calculated for each group. Univariate and multivariate analyses were performed to identify the causes of misdiagnosis in IFS. Results: The IFS results were malignant, benign, and borderline in 130, 429, and 58 cases; respectively. According to PPS outcome, 143 patients were diagnosed as malignant, 423 were benign, and 51 were borderline. Four-hundred and nine (75.74%) cases were epithelial, 70 (12.96%) cases were GCT, and 61 (11.29%) cases were in the SCST subgroup. Sensitivity, specificity, PPV, and NPV of IFS were 97.89%, 99.60%, 98.94%, and 99.20% in EOT, 66.67%, 95.38%, 40.0%, and 98.41% in GCT, 78.57%, 100%, 100%, and 94.0% in SCST, 78.43%, 96.82%, 68.97%, and 98.03% in borderline tumors, respectively. The most important factors causing misdiagnosis in IFS were mucinous and borderline histology (p = 0.016,OR=2.54; p = 0.001, OR = 5.74) and tumor size larger than 10 cm (p = 0.017, OR = 2.45). Conclusions: IFS examination is an effective and reliable method for intraoperative management of ovarian tumors despite some limitations in large tumors (> 10 cm), particularly in tumors of mucinous, teratoma, and borderline histology when evaluated by non-gynecopathologists.

Keywords
Frozen section
Ovarian tumor
Epithelial tumor
Germ-cell tumor
Sex-cord stromal tumor
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