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

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

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.

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.
jgo-30-e95f1.tif
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
Benign tumor Borderline tumor Invasive carcinoma
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
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)  

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
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)  

Values are presented as number (%).

* Divided by mean values.

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