Frozen Section in the Management of Ovarian and Uterine Tumors: The Past 5 Years in a Tertiary Centre

Abstract

Objective Intraoperative frozen section (IFS) is a valuable resource, and its use in gynecological pathology has not been sufficiently emphasized. The main goal of the present study is to evaluate the reliability and agreement rates between IFS and the final paraffin section (PS) and determine how reliable IFS is.

Methods A retrospective study of all IFSs performed on uterine tumors and suspicious adnexal masses between January 2012 and December 2016 (excluding metastases) at the department of obstetrics and gynecology of the Centro Hospitalar Tondela Viseu. Frozen versus permanent section diagnosis were compared regarding the histologic type of the tumor, and the depth of myometrial invasion.

Results A total of 286 cases were eligible for the present study, including 102 (35.7%) IFSs of uterine tumors, and 184 (64.3%) IFSs of ovarian tumors. The overall rate of deferred cases was 5.2% (15/286). The accuracy of the diagnosis in cases of endometrial carcinoma was 96.25% (77/80). Among the ovarian tumors, misdiagnoses occurred in 2 cases (1.1%), corresponding to a borderline tumor (serous type) and a clear cell intracystic adenocarcinoma.

Conclusion The IFS analysis plays an important role in selected situations and is associated to a high sensitivity and specificity in cases of ovarian and endometrial tumors. Its high accuracy is almost universally associated with the possibility of obtaining an optimal surgical treatment at the time of the first surgical approach.

Resumo

Objetivo O diagnóstico intraoperatório por congelação é um recurso importante cujo uso em patologia ginecológica não tem sido suficientemente enfatizado. O objetivo do presente estudo foi avaliar as taxas de concordância entre o diagnóstico intraoperatório por congelação e o estudo anatomopatológico definitivo e determinar o quanto o diagnóstico intraoperatório por congelação é um método confiável.

Métodos Um estudo retrospectivo de todos os diagnósticos intraoperatórios por congelação realizados em tumores uterinos e massas anexiais suspeitas entre janeiro e 2012 e dezembro de 2016 (excluindo metástases) no serviço de ginecologia e obstetrícia do Centro Hospitalar Tondela Viseu. Comparação do diagnóstico intraoperatório por congelação com o resultado do estudo definitivo em relação ao tipo histológico do tumor e profundidade de invasão miometrial.

Resultados Um total de 286 casos foram elegíveis para o estudo, incluindo 102 (35.7%) tumores uterinos e 184 (64.3%) tumores ovarianos. A taxa global de casos deferidos foi de 5.2% (15/286). Entre os tumores uterinos, a acuidade de diagnóstico nos casos de carcinoma endometrial foi de 96.25% (77/80). Entre os tumores ovarianos, não se verificou concordância em 2 casos (1.1%), correspondendo a um tumor borderline do tipo seroso e a um adenocarcinoma de células claras intracístico.

Conclusão O diagnóstico intraoperatório por congelação apresenta-se com um importante papel em situações selecionadas, sendo acompanhado de elevada taxa de sensibilidade e especificidade para tumores endometriais e ovarianos. A sua elevada acuidade diagnóstica encontra-se associada à possibilidade de obter um tratamento cirúrgico adequado na primeira abordagem cirúrgica

Keywords

intraoperative frozen section - ovarian tumors - uterine tumors

Palavras-chave

diagnóstico intraoperatório por congelação - tumores do ovário - tumores uterinos

• References

• 1 Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008; 27 (03) 353-365 Doi: 10.1097/PGP.0b013e31815c24fe
• 2 Quinlivan JA, Petersen RW, Nicklin JL. Accuracy of frozen section for the operative management of endometrial cancer. BJOG 2001; 108 (08) 798-803 Doi: 10.1016/S0306-5456(00)00196-0
• 3 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 (01) 43-46 Doi: 10.1016/j.ygyno.2011.06.030
• 4 Malviya VK, Deppe G, Malone Jr JM, Sundareson AS, Lawrence WD. Reliability of frozen section examination in identifying poor prognostic indicators in stage I endometrial adenocarcinoma. Gynecol Oncol 1989; 34 (03) 299-304
• 5 Kucera E, Kainz C, Reinthaller A. , et al. Accuracy of intraoperative frozen-section diagnosis in stage I endometrial adenocarcinoma. Gynecol Obstet Invest 2000; 49 (01) 62-66 Doi: 10.1159/000010215
• 6 Shim JU, Rose PG, Reale FR, Soto H, Tak WK, Hunter RE. Accuracy of frozen-section diagnosis at surgery in clinical stage I and II endometrial carcinoma. Am J Obstet Gynecol 1992; 166 (05) 1335-1338 Doi: 10.1016/0002-9378(92)91600-F
• 7 Case AS, Rocconi RP, Straughn Jr JM. , et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol 2006; 108 (06) 1375-1379 Doi: 10.1097/01.AOG.0000245444.14015.00
• 8 Frumovitz M, Slomovitz BM, Singh DK. , et al. Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer. J Am Coll Surg 2004; 199 (03) 388-393 10.1016/j.jamcollsurg.2004.05.258
• 9 Creasman WT, Mutch DE, Herzog TJ. ASTEC lymphadenectomy and radiation therapy studies: are conclusions valid?. Gynecol Oncol 2010; 116 (03) 293-294 Doi: 10.1016/j.ygyno.2009.10.065
• 10 Fanning J, Tsukada Y, Piver MS. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990; 37 (01) 47-50 Doi: 10.1016/0090-8258(90)90306-6
• 11 Hashmi AA, Naz S, Edhi MM. , et al. Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience. World J Surg Oncol 2016; 14: 91 Doi: 10.1186/s12957-016-0849-x
• 12 Cross PA, Naik R, Patel A. , et al. Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012; 119 (02) 194-201 Doi: 10.1111/j.1471-0528.2011.03129.x
• 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 (03) 244.e1-244.e7 Doi: 10.1016/j.ajog.2008.04.002
• 14 Pinto PB, Andrade LA, Derchain SF. Accuracy of intraoperative frozen section diagnosis of ovarian tumors. Gynecol Oncol 2001; 81 (02) 230-232 Doi: 10.1006/gyno.2001.6133
• 15 Houck K, Nikrui N, Duska L. , et al. Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol 2000; 95 (6 Pt 1): 839-843
• 16 Zorlu CG, Kuscu E, Ergun Y, Aydogdu T, Cobanoglu O, Erdas O. Intraoperative evaluation of prognostic factors in stage I endometrial cancer by frozen section: how reliable?. Acta Obstet Gynecol Scand 1993; 72 (05) 382-385 Doi: 10.3109/00016349309021118
• 17 Medeiros LR, Rosa DD, Edelweiss MI. , et al. Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review. Int J Gynecol Cancer 2005; 15 (02) 192-202 Doi: 10.1111/j.1525-1438.2005.15203.x
• 18 Bhurgri Y, Shaheen Y, Kayani N. , et al. Incidence, trends and morphology of ovarian cancer in Karachi (1995-2002). Asian Pac J Cancer Prev 2011; 12 (06) 1567-1571
• 19 Kayikçioglu F, Pata O, Cengiz S. , et al. Accuracy of frozen section diagnosis in borderline ovarian malignancy. Gynecol Obstet Invest 2000; 49 (03) 187-189 Doi: 10.1159/000010244
• 20 Kumar S, Bandyopadhyay S, Semaan A. , et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One 2011; 6 (09) e21912 Doi: 10.1371/journal.pone.0021912
• 21 Altintas A, Cosar E, Vardar MA, Demir C, Tuncer I. Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma. Eur J Gynaecol Oncol 1999; 20 (04) 329-331
• 22 Fishman A, Altaras M, Bernheim J, Cohen I, Beyth Y, Tepper R. The value of transvaginal sonography in the preoperative assessment of myometrial invasion in high and low grade endometrial cancer and in comparison to frozen section in grade 1 disease. Eur J Gynaecol Oncol 2000; 21 (02) 128-130
• 23 Stephan JM, Hansen J, Samuelson M. , et al. Intra-operative frozen section results reliably predict final pathology in endometrial cancer. Gynecol Oncol 2014; 133 (03) 499-505 Doi: 10.1016/j.ygyno.2014.03.569
• 24 Turan T, Karadag B, Karabuk E. , et al. Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia. Asian Pac J Cancer Prev 2012; 13 (05) 1953-1956 Doi: 10.7314/APJCP.2012.13.5.1953