术中冰冻切片诊断卵巢肿瘤的准确性。

Accuracy of intraoperative frozen section in diagnosis of ovarian tumors.

作者信息

Wootipoom V, Dechsukhum C, Hanprasertpong J, Lim A

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.

出版信息

J Med Assoc Thai. 2006 May;89(5):577-82.

PMID:16756039

Abstract

OBJECTIVE

To determine the accuracy of intraoperative frozen section diagnosis of ovarian tumors according to malignancy status.

MATERIAL AND METHOD

From May, 1999 to October, 2004 at Songklanagarind Hospital, a total of 229 ovarian specimens were transferred from the operating room to the Department of Pathology for intraoperative frozen section. All cases of deferred diagnosis and disagreement between frozen and permanent paraffin section were reviewed.

RESULTS

Intraoperative frozen section diagnosis of all 229 ovarian specimens revealed 54.1% benign tumors, 8.3% borderline tumors, 30.6% malignant tumors, and 7% deferred diagnoses. The final paraffin section diagnoses revealed 52.4% benign tumors, 9.2% borderline tumors, and 38.4% malignant tumors. Mean tumor diameter of the agreement cases were 12.58 +/- 5.39 cm, disagreement cases were 17.64 +/- 6.83 cm, and deferred cases were 19.33 +/- 6.50 cm. The mean diameter of mucinous tumors was significantly different comparing between disagreement cases to agreement cases and deferred cases to agreement cases. The overall accuracy was 89.7%. Sensitivity was highest in the benign group at 98.2% and lowest in the borderline group at 57.1%. The sensitivity and specificity for benign, borderline, and malignant tumors were 98.2%, 57.1%, 86.1%, and 87.0%, 96.4%, 98.5%, respectively. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for benign, borderline, malignant tumors were 89.5%, 63.2%, 97.1% and 97.8%, 95.4%, 92.3%, respectively.

CONCLUSION

Intraoperative frozen section diagnosis appears to be an accurate technique for the histopathologic diagnosis of ovarian tumors. However, limitations in use of frozen section must be recognized such as large specimens, especially mucinous subtype. Regular re-evaluation or consultation concerning disagreements between frozen section diagnosis and final permanent paraffin diagnosis should be conducted by both surgeons and pathologists as part of quality assurance to determine the most appropriate intraoperative management for patients with ovarian tumors.

摘要

目的

根据恶性程度确定卵巢肿瘤术中冰冻切片诊断的准确性。

材料与方法

1999年5月至2004年10月期间，宋卡那加拉医院共有229份卵巢标本从手术室送至病理科进行术中冰冻切片检查。对所有延迟诊断病例以及冰冻切片与石蜡永久切片诊断不一致的病例进行了回顾。

结果

对所有229份卵巢标本的术中冰冻切片诊断显示，良性肿瘤占54.1%，交界性肿瘤占8.3%，恶性肿瘤占30.6%，延迟诊断占7%。最终石蜡切片诊断显示，良性肿瘤占52.4%，交界性肿瘤占9.2%，恶性肿瘤占38.4%。诊断一致病例的肿瘤平均直径为12.58±5.39厘米，诊断不一致病例为17.64±6.83厘米，延迟诊断病例为19.33±6.50厘米。黏液性肿瘤在诊断不一致病例与诊断一致病例之间以及延迟诊断病例与诊断一致病例之间的平均直径存在显著差异。总体准确率为89.7%。良性组的敏感性最高，为98.2%，交界性组最低，为57.1%。良性、交界性和恶性肿瘤的敏感性和特异性分别为：98.2%、57.1%、86.1%以及87.0%、96.4%、98.5%。良性、交界性、恶性肿瘤的阳性预测值（PPV）和阴性预测值（NPV）分别为89.5%、63.2%、97.1%以及97.8%、95.4%、92.3%。