Accuracy of frozen section diagnosis and factors associated with final pathological diagnosis upgrade of mucinous ovarian tumors

Jeong-Yeol Park; Sang-Hun Lee; Kyu-Rae Kim; Young-Tak Kim; Joo-Hyun Nam

doi:10.3802/jgo.2019.30.e95

Journal List > J Gynecol Oncol > v.30(6) > 1148325

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Lee, Kim, Kim, and Nam: Accuracy of frozen section diagnosis and factors associated with final pathological diagnosis upgrade of mucinous ovarian tumors

Original Article

J Gynecol Oncol 2019;30(6):e95.

Published online: 4 November 2019

DOI: https://doi.org/10.3802/jgo.2019.30.e95

Accuracy of frozen section diagnosis and factors associated with final pathological diagnosis upgrade of mucinous ovarian tumors

Jeong-Yeol Park^1,, Sang-Hun Lee², Kyu-Rae Kim³, Young-Tak Kim¹, Joo-Hyun Nam¹

¹Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

³Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to Jeong-Yeol Park Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan of College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. E-mail: catgut1-0@hanmail.net

Received 4 February 2019 Revised 21 April 2019 Accepted 12 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Ovarian Neoplasm, Mucinous, Frozen Section, Diagnosis, Accuracy

References

1. Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet. 2014; 384:1376–88.

2. Hata K, Hata T, Manabe A, Kitao M. Ovarian tumors of low malignant potential: transvaginal Doppler ultrasound features. Gynecol Oncol. 1992; 45:259–64.

3. Gotlieb WH, Soriano D, Achiron R, Zalel Y, Davidson B, Kopolovic J, et al. CA 125 measurement and ultrasonography in borderline tumors of the ovary. Am J Obstet Gynecol. 2000; 183:541–6.

4. Ratnavelu ND, Brown AP, Mallett S, Scholten RJ, Patel A, Founta C, et al. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016; 3:CD010360.

5. Twaalfhoven FC, Peters AA, Trimbos JB, Hermans J, Fleuren GJ. The accuracy of frozen section diagnosis of ovarian tumors. Gynecol Oncol. 1991; 41:189–92.

6. Rose PG, Rubin RB, Nelson BE, Hunter RE, Reale FR. Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors. Am J Obstet Gynecol. 1994; 171:823–6.

7. Pinto PB, Andrade LA, Derchain SF. Accuracy of intraoperative frozen section diagnosis of ovarian tumors. Gynecol Oncol. 2001; 81:230–2.

8. Gol M, Baloglu A, Yigit S, Dogan M, Aydin C, Yensel U. Accuracy of frozen section diagnosis in ovarian tumors: is there a change in the course of time? Int J Gynecol Cancer. 2003; 13:593–7.

9. Ilvan S, Ramazanoglu R, Ulker Akyildiz E, Calay Z, Bese T, Oruc N. The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol. 2005; 97:395–9.

10. Taskiran C, Erdem O, Onan A, Bozkurt N, Yaman-Tunc S, Ataoglu O, et al. The role of frozen section evaluation in the diagnosis of adnexal mass. Int J Gynecol Cancer. 2008; 18:235–40.

11. Rakhshan A, Zham H, Kazempour M. Accuracy of frozen section diagnosis in ovarian masses: experience at a tertiary oncology center. Arch Gynecol Obstet. 2009; 280:223–8.

12. Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ. Intraoperative assessment of ovarian tumors: a 5-year review with assessment of discrepant diagnostic cases. Int J Gynecol Pathol. 2006; 25:216–22.

13. Brun JL, Cortez A, Rouzier R, et al. Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors. Am J Obstet Gynecol. 2008; 199:244. e1–7.

14. Puls L, Heidtman E, Hunter JE, Crane M, Stafford J. The accuracy of frozen section by tumor weight for ovarian epithelial neoplasms. Gynecol Oncol. 1997; 67:16–9.

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

16. FIGO (International Federation of Gynecology and Obstetrics) annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2003; 83(Suppl 1):ix–xxii. 1–229.

17. Meinhold-Heerlein I, Fotopoulou C, Harter P, Kurzeder C, Mustea A, Wimberger P, et al. The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications. Arch Gynecol Obstet. 2016; 293:695–700.

18. Fauvet R, Boccara J, Dufournet C, Poncelet C, Daraï E. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol. 2005; 16:403–10.

19. Ronnett BM, Kajdacsy-Balla A, Gilks CB, Merino MJ, Silva E, Werness BA, et al. Mucinous borderline ovarian tumors: points of general agreement and persistent controversies regarding nomenclature, diagnostic criteria, and behavior. Hum Pathol. 2004; 35:949–60.

20. Storms AA, Sukumvanich P, Monaco SE, Beriwal S, Krivak TC, Olawaiye AB, et al. Mucinous tumors of the ovary: diagnostic challenges at frozen section and clinical implications. Gynecol Oncol. 2012; 125:75–9.

21. Pongsuvareeyakul T, Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Siriaunkgul S. Accuracy of frozen-section diagnosis of ovarian mucinous tumors. Int J Gynecol Cancer. 2012; 22:400–6.

22. Bige O, Demir A, Saygili U, Gode F, Uslu T, Koyuncuoglu M. Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology. Gynecol Oncol. 2011; 123:43–6.

23. Lehner R, Wenzl R, Heinzl H, Husslein P, Sevelda P. Influence of delayed staging laparotomy after laparoscopic removal of ovarian masses later found malignant. Obstet Gynecol. 1998; 92:967–71.

24. Houck K, Nikrui N, Duska L, Chang Y, Fuller AF, Bell D, et al. Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol. 2000; 95:839–43.

25. Kim JH, Kim TJ, Park YG, Lee SH, Lee CW, Song MJ, et al. Clinical analysis of intraoperative frozen section proven borderline tumors of the ovary. J Gynecol Oncol. 2009; 20:176–80.

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)

Values are presented as number (%). SD, standard deviation.

^* Divided by mean values.

Table 2.

The accuracy of frozen biopsy in mucinous ovarian tumors (n=1,032)

Variables	Final pathology			Total
Variables	Benign tumor	Borderline tumor	Invasive carcinoma	Total
Frozen biopsy
Benign tumor	656	58	8	722
Borderline tumor	6	203	19	228
Invasive carcinoma	0	11	71	82
Total	662	272	98	1,032

Table 3.

Factors associated with upgrade of frozen diagnosis at final pathology report (n=950)

Variables	Final pathology report		p-value
Variables	Not upgraded	Upgraded	p-value
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)

Values are presented as number (%).

^* Divided by mean values

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
Variables	Not upgraded	Upgraded	p-value
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)

Values are presented as number (%).

^* Divided by mean values.

TOOLS

Similar articles