Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Gynecol Cancer. 2012 Mar;22(3):400-6. doi: 10.1097/IGC.0b013e31823dc328.
The objective of the study was to evaluate the diagnostic accuracy of intraoperative frozen sections of ovarian mucinous tumors and to identify the features associated with an inaccurate diagnosis.
Cases of ovarian mucinous tumors (benign, low malignant potential [LMP] or borderline, primary malignant, and metastatic) diagnosed by frozen section or final histology were recruited. Frozen-section diagnoses were compared with the final histologic diagnoses. Possible variables associated with diagnostic discrepancy were analyzed.
A comparison of the diagnoses was done in 195 cases (102 benign, 61 LMP, 18 primary malignant, and 14 metastatic). Diagnostic agreement was observed in 164 cases (84.1%) and discrepancy in 31 cases (15.9%). The sensitivity of frozen-section diagnosis was low in LMP (67.2%) and malignant tumors (55.6%). The specificity was the lowest in the benign category (78.5%). The positive predictive values of all categories were less than 90% (range, 83.3%-85.7%). Diagnostic discrepancy was associated with tumor size of greater than 13 cm (P = 0.019) and the number of frozen sections of 4 or more (P = 0.035). However, in a multivariate analysis, there was no independent predictor of diagnostic discrepancy. The number of frozen sections 4 or more was strongly associated with tumor size of greater than 13 cm (P = 0.004).
The sensitivity of frozen-section diagnosis of LMP and malignant mucinous tumors was low. The inaccuracy of a frozen-section diagnosis of ovarian mucinous tumors may be related to a tumor size of greater than 13 cm. Increasing the number of intraoperative samples over 3 sections per case may not effectively increase the accuracy of frozen-section diagnosis in mucinous tumors.
本研究旨在评估卵巢黏液性肿瘤术中冷冻切片的诊断准确性，并确定与诊断不准确相关的特征。
本研究纳入了经冷冻切片或最终组织学诊断为卵巢黏液性肿瘤（良性、低恶性潜能[LMP]或交界性、原发性恶性和转移性）的病例。将冷冻切片诊断与最终组织学诊断进行比较。分析与诊断差异相关的可能变量。
对 195 例（102 例良性、61 例 LMP、18 例原发性恶性和 14 例转移性）病例的诊断进行了比较。164 例（84.1%）诊断一致，31 例（15.9%）诊断不一致。LMP（67.2%）和恶性肿瘤（55.6%）的冷冻切片诊断敏感性较低。良性组的特异性最低（78.5%）。所有类别（83.3%-85.7%）的阳性预测值均低于 90%。诊断差异与肿瘤大小大于 13cm（P=0.019）和冷冻切片数量大于 4 个（P=0.035）有关。然而，在多变量分析中，没有独立的诊断差异预测因素。冷冻切片数量大于 4 个与肿瘤大小大于 13cm强烈相关（P=0.004）。
LMP 和恶性黏液性肿瘤冷冻切片诊断的敏感性较低。卵巢黏液性肿瘤冷冻切片诊断的不准确性可能与肿瘤大小大于 13cm 有关。每例增加 3 个以上的术中样本可能无法有效提高黏液性肿瘤冷冻切片诊断的准确性。
