Department of Obstetrics and Gynaecology, Isala Hospital, Zwolle, The Netherlands.
Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
J Ovarian Res. 2021 Oct 22;14(1):139. doi: 10.1186/s13048-021-00897-8.
A frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma ("at least borderline" or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and "at least borderline" frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes.
A retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or "at least borderline" frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis.
A total of 223 women were included, of which 41 women (18.4%) were diagnosed with "at least borderline" at frozen section. Thirteen of forty-one women (31.7%) following "at least borderline" frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an "at least borderline" frozen section diagnosis.
Overall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with "at least borderline" frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an "at least borderline" diagnosis may decrease the risk of surgical over-treatment.
对于具有可疑浸润性癌特征的交界性卵巢肿瘤（“至少交界性”或同义描述）的冰冻切片诊断，我们面临着是否进行全面卵巢癌分期手术的困境。对这种困境进行量化可能有助于我们解决这个临床决策问题。本研究评估和比较了直接交界性和“至少交界性”冰冻切片诊断的患病率，以及这些女性中最终病理诊断为浸润性癌的比例，特别关注组织学亚型。
在荷兰的三家医院进行了一项回顾性队列研究。在其中一家医院，对 2007 年 1 月至 2018 年 7 月期间接受卵巢手术并进行围手术期冰冻切片评估的所有女性进行了识别，并纳入了交界性或“至少交界性”冰冻切片诊断和交界性卵巢肿瘤或浸润性癌的最终诊断。
共纳入 223 名女性，其中 41 名女性（18.4%）在冰冻切片时被诊断为“至少交界性”。在 41 名“至少交界性”冰冻切片诊断的女性中，有 13 名（31.7%）和 182 名直接交界性冰冻切片诊断的女性中，有 14 名（7.7%）在石蜡切片评估时被诊断为浸润性癌（p<0.001）。与直接交界性冰冻切片诊断相比，在浆液性肿瘤中，被诊断为浸润性癌的女性比例从 3.1%增加到 35.7%（p=0.001），在粘液性肿瘤中从 10.0%增加到 21.7%（p=0.129），而在其他组织学亚型中，“至少交界性”冰冻切片诊断的女性比例从 50.0%增加到 75.0%（p=0.452）。
总体而言，与具有明确交界性冰冻切片诊断的女性相比，被诊断为“至少交界性”冰冻切片诊断的女性在最终诊断时更有可能患有癌（7.7%比 31.7%）。特别是在浆液性肿瘤中，在获得术前同意后，在初次手术时可能需要考虑进行全面分期，以防止未分期女性进行二次手术或化疗。需要进一步研究评估在“至少交界性”诊断的情况下增加取样是否可以降低过度手术治疗的风险。
