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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.
References
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Fig. 1.
Study flow chart. AGC, advanced gastric cancer; GB, gallbladder; HCC, hepatocelluar carcinoma; PTC, parathyroid cancer. * Samples were not available for frozen section diagnosis; these cases included 52 patients with unilateral and two patients with bilateral mucinous benign ovarian tumors. In addition, nine patients with bilateral benign mucinous tumors had frozen sections available for only one ovarian tumor.
Table 1.
Characteristics of patients (n=1,032)
| Variables | Values |
|---|---|
| Age (yr) | |
| Mean±SD | 40.5±14.9 |
| ≤40* | 561 (54.4) |
| >40* | 471 (45.6) |
| Parity | |
| Nulliparous | 324 (31.4) |
| Parous | 708 (68.6) |
| Menopause | |
| No | 804 (77.9) |
| Yes | 228 (22.1) |
| Histology of tumor | |
| Pure mucinous tumor | 981 (95.1) |
| Mixed tumor | 51 (4.9) |
| Tumor size (cm) | |
| Mean±SD | 12.4±7.1 |
| ≤12* | 592 (57.4) |
| >12* | 440 (42.6) |
| Bilaterality of tumor | |
| Unilateral | 997 (96.6) |
| Bilateral | 35 (3.4) |
| Septa in tumor | |
| Unilocular | 359 (34.8) |
| Multilocular | 673 (65.2) |
| Solid portion in tumor | |
| No | 808 (78.3) |
| Yes | 224 (21.7) |
| Type of adnexal surgery | |
| Cystectomy | 146 (14.1) |
| Oophorectomy or salpingo-oophorectomy | 886 (85.9) |
| Results of frozen biopsy | |
| Benign mucinous tumor | 722 (72.0) |
| Borderline mucinous tumor | 228 (22.1) |
| Invasive mucinous carcinoma | 82 (7.9) |
| Results of final pathology | |
| Benign mucinous tumor | 662 (64.1) |
| Borderline mucinous tumor | 272 (26.4) |
| Invasive mucinous carcinoma | 98 (9.5) |
Table 2.
The accuracy of frozen biopsy in mucinous ovarian tumors (n=1,032)
Table 3.
Factors associated with upgrade of frozen diagnosis at final pathology report (n=950)
| Variables | Final pathology report | p-value | |
|---|---|---|---|
| Not upgraded | Upgraded | ||
| Age (yr) | 0.729 | ||
| ≤40* | 485 (91.3) | 46 (8.7) | |
| >40* | 380 (90.7) | 39 (9.3) | |
| Parity | 0.072 | ||
| Nulliparous | 264 (88.6) | 34 (11.4) | |
| Parous | 601 (92.2) | 51 (7.8) | |
| Menopause | 0.292 | ||
| No | 693 (91.5) | 64 (8.5) | |
| Yes | 172 (89.1) | 21 (10.9) | |
| Histology of tumor | 0.003 | ||
| Pure mucinous tumor | 827 (91.7) | 75 (8.3) | |
| Mixed tumor | 38 (79.2) | 10 (20.8) | |
| Tumor size (cm) | <0.001 | ||
| ≤12* | 542 (95.6) | 25 (4.4) | |
| >12* | 323 (84.3) | 60 (15.7) | |
| Bilaterality of tumor | >0.999 | ||
| Unilateral | 837 (91.0) | 83 (9.0) | |
| Bilateral | 28 (93.3) | 2 (6.7) | |
| Septa in tumor | <0.001 | ||
| Unilocular | 341 (97.4) | 9 (2.6) | |
| Multilocular | 524 (87.3) | 76 (12.7) | |
| Solid portion in tumor | <0.001 | ||
| No | 754 (94.0) | 48 (6.0) | |
| Yes | 111 (75.0) | 37 (25.0) | |
| Type of adnexal surgery | 0.011 | ||
| Cystectomy | 141 (96.6) | 5 (3.4) | |
| Oophorectomy or salpingo-oophorectomy | 724 (90.0) | 80 (10.0) | |
Table 4.
Factors associated with upgrade to invasive mucinous carcinoma of frozen diagnosis at final pathology report (n=950)
| Variables | Final pathology report | p-value | |
|---|---|---|---|
| Not upgraded | Upgraded | ||
| Age (yr) | 0.224 | ||
| ≤40* | 519 (97.7) | 12 (2.3) | |
| >40* | 404 (96.4) | 15 (3.6) | |
| Parity | 0.823 | ||
| Nulliparous | 289 (97.0) | 9 (3.0) | |
| Parous | 634 (97.2) | 18 (2.8) | |
| Menopause | 0.028 | ||
| No | 740 (97.8) | 17 (2.2) | |
| Yes | 183 (94.8) | 10 (5.2) | |
| Histology of tumor | 0.745 | ||
| Pure mucinous tumor | 876 (97.1) | 26 (2.9) | |
| Mixed tumor | 47 (97.9) | 1 (2.1) | |
| Tumor size (cm) | 0.001 | ||
| ≤12* | 559 (98.6) | 8 (1.4) | |
| >12* | 364 (95.0) | 19 (5.0) | |
| Bilaterality of tumor | 0.869 | ||
| Unilateral | 894 (97.2) | 26 (2.8) | |
| Bilateral | 29 (96.7) | 1 (3.3) | |
| Septa in tumor | 0.001 | ||
| Unilocular | 348 (99.4) | 2 (0.6) | |
| Multilocular | 575 (95.8) | 25 (4.2) | |
| Solid portion in tumor | <0.001 | ||
| No | 796 (99.3) | 6 (0.7) | |
| Yes | 127 (85.8) | 21 (14.2) | |
| Type of adnexal surgery | 0.015 | ||
| Cystectomy | 146 (100.0) | 0 (0) | |
| Oophorectomy or salpingo-oophorectomy | 777 (96.6) | 2.7 (3.4) | |
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