Di Berardino Stefano, Bizzarri Nicolò, Ciancia Marianna, Moro Francesca, Padial Urtueta Belen, Marchetti Claudia, Zannoni Gian Franco, Scambia Giovanni, Fagotti Anna
UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
UOC Ginecologia Oncologica, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
Int J Gynecol Cancer. 2025 Aug;35(8):101746. doi: 10.1016/j.ijgc.2025.101746. Epub 2025 Feb 21.
Frozen section (FS) has been shown to have high accuracy in determining ovarian malignancy. However, its utility in guiding surgical approaches, particularly, lymph node staging, for early-stage epithelial ovarian cancer remains unclear. This study aimed to evaluate the post-test positive probability of FSs in identifying cases requiring lymph node or peritoneal staging. The secondary aims were sensitivity, specificity, and accuracy assessments.
This retrospective study analyzed patients undergoing surgery for early-stage epithelial ovarian cancer with FS performed on ovarian masses between July 2007 and March 2023 at a tertiary center. The FS results were compared with the final histology (gold standard paraffin sections). The FS cases were categorized based on further actions as follows: lymph node staging (type A), peritoneal staging only (type B), or no additional procedures (type C). The patients were divided into group 1 (requiring lymph node and peritoneal staging) and group 2 (requiring only peritoneal staging). A comparison between specialized and general pathology diagnoses was also performed. Incorrect FS assessments were classified as under-diagnosed or over-diagnosed.
Of the 715 patients, group 1 had appropriate staging in 425 of 447 cases, with 4.9% over-treatment. In group 2, staging was correct in 109 of 195 cases, with 44.1% under-treatment. For type A FSs, the post-test positive probability was 95% (95% CI 93% to 97%), with sensitivity, specificity, and accuracy rates of 76.4%, 86.1%, and 78.6%, respectively. For type B FSs, the post-test positive probability was 56% (95% CI 50% to 61%), with sensitivity, specificity, and accuracy rates of 68.6%, 84.5%, and 81%, respectively. There was no significant difference in the agreement between the specialized and general pathology groups (p = 0.92).
Frozen sections suggestive of a cancer diagnosis requiring peritoneal and lymph node staging in a population with apparent early-stage epithelial ovarian cancer are highly reliable. In the case of FSs suggesting only peritoneal staging, malignancy is frequently underestimated.
冰冻切片（FS）已被证明在确定卵巢恶性肿瘤方面具有很高的准确性。然而，其在指导手术方式，特别是早期上皮性卵巢癌的淋巴结分期方面的效用仍不明确。本研究旨在评估FS在识别需要淋巴结或腹膜分期的病例中的检测后阳性概率。次要目的是进行敏感性、特异性和准确性评估。
这项回顾性研究分析了2007年7月至2023年3月在一家三级中心接受早期上皮性卵巢癌手术且对卵巢肿块进行了FS的患者。将FS结果与最终组织学结果（金标准石蜡切片）进行比较。根据进一步的操作将FS病例分为以下几类：淋巴结分期（A类）、仅腹膜分期（B类）或无需额外操作（C类）。将患者分为第1组（需要淋巴结和腹膜分期）和第2组（仅需要腹膜分期）。还对专科病理诊断和普通病理诊断进行了比较。FS评估错误分为诊断不足或诊断过度。
在715例患者中，第1组447例中有425例分期合适，过度治疗率为4.9%。在第2组中，195例中有109例分期正确，治疗不足率为44.1%。对于A类FS，检测后阳性概率为95%（95%CI 93%至97%），敏感性、特异性和准确率分别为76.4%、86.1%和78.6%。对于B类FS，检测后阳性概率为56%（95%CI 50%至61%），敏感性、特异性和准确率分别为68.6%、84.5%和81%。专科病理组和普通病理组之间的一致性无显著差异（p = 0.92）。
对于明显早期上皮性卵巢癌患者，提示需要腹膜和淋巴结分期的癌症诊断的冰冻切片高度可靠。在仅提示腹膜分期的FS病例中，恶性肿瘤常被低估。
