Lavecchia Melissa, Dubey Anisha, Jimenez Waldo, Reade Clare J, Salehi Amir, Yang Ilun, Eiriksson Lua R
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
Juravinski Hospital & Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Int J Gynaecol Obstet. 2024 Jan;164(1):249-254. doi: 10.1002/ijgo.15008. Epub 2023 Jul 24.
To evaluate intraoperative factors predicting appendiceal pathology during gynecologic oncology surgery for suspected mucinous ovarian neoplasms.
We conducted a retrospective study on 225 patients with mucinous ovarian neoplasms who underwent surgery for an adnexal mass with concurrent appendectomy between 2000 and 2018. Regression analyses were used to evaluate intraoperative factors, such as frozen section of the ovarian mass and surgeon's impression of the appendix in predicting appendiceal pathology.
Most patients (77.8%) had a normal appendix on final pathology. Abnormal appendix cases (n = 26) included: metastasis from high-grade adenocarcinoma of the ovary (n = 1), neuroendocrine tumor of the appendix (n = 4), and low-grade appendiceal mucinous neoplasms (n = 26; 23 associated with a mucinous ovarian adenocarcinoma, 2 with a benign mucinous ovarian cystadenoma, and 1 with a borderline mucinous ovarian tumor). Combining normal intraoperative appearance of the appendix with benign or borderline frozen section yielded a negative predictive value of 85.1%, with 14.9% of patients being misclassified, and 6.0% having a neuroendocrine tumor or low-grade appendiceal neoplasm.
Benign or borderline frozen section of an ovarian mucinous neoplasm and normal appearing appendix have limited predictive value for appendiceal pathology. Appendectomy with removal of the mesoappendix should be considered in all cases of mucinous ovarian neoplasm, regardless of intraoperative findings.
评估在妇科肿瘤手术中，针对疑似黏液性卵巢肿瘤患者，预测阑尾病理情况的术中因素。
我们对2000年至2018年间因附件肿块并行阑尾切除术而接受手术的225例黏液性卵巢肿瘤患者进行了一项回顾性研究。采用回归分析来评估术中因素，如卵巢肿块的冰冻切片以及外科医生对阑尾的印象，以预测阑尾病理情况。
大多数患者（77.8%）最终病理显示阑尾正常。阑尾异常病例（n = 26）包括：卵巢高级别腺癌转移（n = 1）、阑尾神经内分泌肿瘤（n = 4）以及低级别阑尾黏液性肿瘤（n = 26；其中23例与黏液性卵巢腺癌相关，2例与良性黏液性卵巢囊腺瘤相关，1例与交界性黏液性卵巢肿瘤相关）。将阑尾术中外观正常与良性或交界性冰冻切片结果相结合，阴性预测值为85.1%，14.9%的患者被错误分类，6.0%的患者患有神经内分泌肿瘤或低级别阑尾肿瘤。
卵巢黏液性肿瘤的良性或交界性冰冻切片以及外观正常的阑尾对阑尾病理的预测价值有限。对于所有黏液性卵巢肿瘤病例，无论术中发现如何，均应考虑行阑尾切除术并切除阑尾系膜。
