OJOG  Vol.5 No.1 , January 2015
Accuracy of Intraoperative Frozen Section in the Diagnosis of Ovarian Neoplasms

Objective: The aim of the work is to evaluate the accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms in Zagazig University. Design: A prospective cross sectional cohort study. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The most appropriate area thought to be representative of lesion was chosen. The number of sections frozen was depended on the type and size of the tumor. Seven to eight μm sections were obtained and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). The diagnosis obtained by intraoperative frozen section based on cellularity and cell morphology was compared with final histopathological diagnosis in terms of diagnostic sensitivity, to differentiate between benign and malignant lesions. Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: There was no statisticaly significant differencre in the studied patients as regard the clinical data, macroscopic and intraoperative picture, while there was statisticaly significat association as regard the laterality of the ovarian masses. The validity of frozen section in the diagnosis of benign tumour was 100% with 100% accuracy, specificity, positive predictive value, negative predictive value, while sensitivity & negative prediction for borderline tumour and specificity & positive prediction of malignant tumour were 100%, specifecity for borderline tumours was 95% while the positive predictive value was 33.3% with 96% accuracy for both malignant and borderline tumours. Conclusion: Intraoperative frozen section is accurate for rapid diagnosis of ovarian tumors. It can help surgeons avoid under-treatment or overtreatment of patients. Our study was designed prospectively using a small number of patients. The door is open to larger studies using a larger number of patients to be performed in order to substantiate our results.

Cite this paper
Abdelghany, A. , Arafa, E. , Madkour, N. , Nossair, W. , Mohamed, E. , Abdelsalam, W. and Salem, A. (2015) Accuracy of Intraoperative Frozen Section in the Diagnosis of Ovarian Neoplasms. Open Journal of Obstetrics and Gynecology, 5, 14-22. doi: 10.4236/ojog.2015.51003.
[1]   DiSaia, P.J. and Creasman, W.T. (2008) The Adnexal Mass and Early Ovarian Cancer. 7th Edition, Clinical Gynecologic Oncology, Mosby, Chapter 10, 283-312.

[2]   Russell, P., Robboy, S. and Anderson, M. (2002) The Ovary: Normal Appearances and Non-Neoplastic Conditions. In: Robboy, S.J., Anderson, M.C. and Russell, P., Eds., Pathology of the Female Reproductive Tract, Churchill Livingstone, London, 475-526.

[3]   Walsh, P. and Cooper, N. (2005) Cancer Ovary Atlas of the United Kingdom and Ireland. 193-201.

[4]   Redman, C., Duffy, S., Bromham, N. and Francis, K., NICE, Clinical Guidelines, No. 122. Guideline Development Group (2011) Recognition and Initial Management of Ovarian Cancer: Summary of NICE Guidance. BMJ, 342, d2073.

[5]   Khunamornpong, S. and Siriaunkgul, S. (2003) Scrape Cytology of the Ovaries: Potential Role in Intraoperative Consultation of Ovarian Lesions. Diagnostic Cytopathology, 28, 250-257.

[6]   Stewart, C.J., Brennan, B.A., Hammond, I.G., et al. (2006) Intraoperative Assessment of Ovarian Tumors: A 5-Year Review with Assessment of Discrepant Diagnostic Cases. The International Journal of Gynecological Pathology, 25, 216-222.

[7]   Deb, P., Malik, A. and Sinha, K.K. (2011) Intraoperative Scrape Cytology: Adult Granulosa Cell Tumor of Ovary. Journal of Cytology, 28, 207-209. http://dx.doi.org/10.4103/0970-9371.86350

[8]   Ilvan, S., Ramazanoglu, R., Akyildiz, E.U., et al. (2005) The Accuracy of Frozen Section (Intraoperative Consultation) in the Diagnosis of Ovarian Masses. Gynecologic Oncology, 97, 395-399.

[9]   Geomini, P., Bremer, G., Kruitwagen, R., et al. (2005) Diagnostic Accuracy of Frozen Section Diagnosis of the Adnexal Mass: A Metaanalysis. Gynecologic Oncology, 96, 1-9.

[10]   Baker, P. and Oliva, E. (2008) A Practical Approach to Intraoperative Consultation in Gynecological Pathology. The International Journal of Gynecological Pathology, 27, 353-365.

[11]   Medeiros, L.R., Rosa, D.D., Edelweiss, M.I., Stein, A.T., Bozzetti, M.C., Zelmanowicz, A., et al. (2005) Accuracy of Frozen-Section Analysis in the Diagnosis of Ovarian Tumors: A Systematic Quantitative Review. International Journal of Gynecological Cancer, 15, 192-202. http://dx.doi.org/10.1111/j.1525-1438.2005.15203.x

[12]   Morice, P., Camatte, S., El Hassan, J., Pautier, P., Duvillard, P. and Castaigne, D. (2001) Clinical Outcomes and Fertility after Conservative Treatment of Ovarian Borderline Tumors. Fertility and Sterility, 75, 92-96. http://dx.doi.org/10.1016/S0015-0282(00)01633-2

[13]   Morice, P., Camatte, S., Wickart-Poque, F., Rouzier, R., Pautier, P., Pomel, C., et al. (2002) Conservative Management of Malignant and Borderline Ovarian Tumor. Bulletin du Cancer, 89, 1019-1026.

[14]   Moodley, M., Moodley, J. and Chikosi, A.B. (2000) Ovarian Carcinoma, Pericardial Metastasis and Human Immunodeficiency Virus Infection. International Journal of Gynecological Cancer, 10, 82-83.

[15]   Molina, D. and Hurteau, J. (2002) Ovarian Germ Cell Tumors. Current Problems in Obstetrics, Gynecology and Fertility, 25, 230-236.

[16]   Ghaemmaghami, F., Fakour, F., Zarchi, M.K., Behtash, N., Gilani, M.M., Mousavi, A., et al. (2008) Clinical Assessment, Gross Examination, Frozen Section of Ovarian Masses: Do Patients Benefit? Archives of Gynecology and Obstetrics, 278, 209-213. http://dx.doi.org/10.1007/s00404-007-0553-8

[17]   Tempfer, C.B., Polterauer, S., Bentz, E.K., Reinthaller, A. and Hefler, L.A. (2007) Accuracy of Intraoperative Frozen Section Analysis in Borderline Tumors of the Ovary: A Retrospective Analysis of 96 Cases and Review of the Literature. Gynecologic Oncology, 107, 248-252.

[18]   Heatley, M.K. (2012) A Systematic Review of Papers Examining the Use of Intraoperative Frozen Section in Predicting the Final Diagnosis of Ovarian Lesions. International Journal of Gynecological Pathology, 31, 111-115. http://dx.doi.org/10.1097/PGP.0b013e318226043b

[19]   Ilker, A., Aykut, B., Muge, H., Ibrahim, H.M., Ulku, O.B., Sener, G., et al. (2011) Accuracy of Intra-Operative Frozen Section in the Diagnosis of Ovarian Tumours. Journal of Pakistan Medical Association, 61, 856-858.

[20]   Houck, K., Nikrui, N., Duska, L., Chang, Y., Fuller, A.F., Bell, D., et al. (2000) Borderline Tumors of the Ovary: Correlation of Frozen and Permanent Histopathologic Diagnosis. Obstetrics & Gynecology, 95, 839-843. http://dx.doi.org/10.1016/S0029-7844(99)00656-0

[21]   Suprasert, P., Khunamornpong, S., Phusong, A., Settakorn, J. and Siriaungkul, S. (2008) Accuracy of Intra-Operative Frozen Sections in the Diagnosis of Ovarian Masses. Asian Pacific Journal of Cancer Prevention, 9, 737-740.

[22]   Pavlakis, K., Messini, I., Vrekoussis, T., Yiannou, P., Panoskaltsis, T. and Voulgaris, Z. (2009) Intraoperative Assessment of Epithelial and Non-Epithelial Ovarian Tumors: A 7-Year Review. European Journal of Gynaecological Oncology, 30, 657-660.

[23]   Tangjitgamol, S., Jesadapatrakul, S., Manusirivithaya, S. and Sheanakul, C. (2004) Accuracy of Frozen Section in Diagnosis of Ovarian Mass. International Journal of Gynecological Cancer, 14, 212-219. http://dx.doi.org/10.1111/j.1048-891X.2004.014202.x

[24]   Wootipoom, V., Dechsukhum, C., Hanprasertpong, J., et al. (2006) Accuracy of Intraopera-Tive Frozen Section in Diagnosis of Ovarian Tumors. Journal of the Medical Association of Thailand, 89, 577-582.

[25]   Usubutun, A., Altinok, G. and Kucukali, T. (1998) The Value of Intraoperative Consultation (Frozen Section) in the Diagnosis of Ovarian Neoplasms. Acta Obstetricia et Gynecologica Scandinavica, 77, 1013-1016.

[26]   Wasinghon, P., Suthippintawong, C. and Tuipae, S. (2008) The Accuracy of Intraoperative Frozen Sections in the Diagnosis of Ovarian Tumors. Journal of the Medical Association of Thailand, 91, 1791-1795.

[27]   Rakhshan, A., Zham, H. and Kazempour, M. (2009) Accuracy of Frozen Section Diagnosis in Ovarian Masses: Experience at a Tertiary Oncology Center. Archives of Gynecology and Obstetrics, 280, 223-228. http://dx.doi.org/10.1007/s00404-008-0899-6