Menzin A W, Rubin S C, Noumoff J S, LiVolsi V A
Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Gynecol Oncol. 1995 Nov;59(2):183-5. doi: 10.1006/gyno.1995.0004.
While the accuracy of frozen section in the diagnosis of invasive ovarian neoplasms has been previously addressed, the frozen section diagnosis of borderline ovarian tumors has been less well characterized. The distinction between benign and borderline lesions is critical to the proper operative management of these patients. The records of 48 patients that had a frozen section diagnosis of borderline ovarian malignancy during surgical exploration between 1986 and 1993 were reviewed. Thirty-one patients were Stage I, 2 patients were Stage II, 10 patients were Stage III, and 5 patients were unstaged. Clarifying phrases were used frequently in the frozen section report, and these terms were categorized as "rule out" borderline tumor, borderline tumor, and "at least" borderline tumor. Of 33 cases with a frozen section report of borderline or at least borderline malignancy, no case were subsequently found to be benign. Errors in the intraoperative management could have occurred in 3 of 48 cases (6.25%), when benign neoplasms were thought to be of borderline malignancy on frozen section. However, in each of these cases, the clarifying term rule out was used, indicating the equivocal nature of the frozen section findings. Thirteen of the 48 patients (27.1%) were found to have a focus of invasive cancer within a borderline tumor on final pathologic review; the primary tumors in these 13 cases ranged in maximal diameter from 5 to 26 cm and were of varying histologic types. The level of experience of the pathologist responsible for the frozen section did not influence the accuracy of frozen section determination noted in this study. A frozen section evaluation identifying a borderline ovarian malignancy is accurate in excluding the presence of benign pathology. It is crucial to understand the meaning of specific clarifying terms used in frozen section diagnoses.
虽然冰冻切片在侵袭性卵巢肿瘤诊断中的准确性此前已有探讨，但冰冻切片对卵巢交界性肿瘤的诊断特征描述较少。良性与交界性病变的区分对于这些患者的正确手术管理至关重要。回顾了1986年至1993年间手术探查时冰冻切片诊断为卵巢交界性恶性肿瘤的48例患者的记录。31例为Ⅰ期，2例为Ⅱ期，10例为Ⅲ期，5例分期不明。冰冻切片报告中频繁使用了澄清性短语，这些术语被归类为“排除”交界性肿瘤、交界性肿瘤和“至少”交界性肿瘤。在33例冰冻切片报告为交界性或至少交界性恶性的病例中，随后未发现良性病例。48例中有3例（6.25%）可能发生了术中管理错误，即冰冻切片时将良性肿瘤误诊为交界性恶性肿瘤。然而，在每例此类病例中，都使用了澄清性术语“排除”，表明冰冻切片结果具有模棱两可的性质。48例患者中有13例（27.1%）在最终病理检查时发现交界性肿瘤内有浸润癌灶；这13例病例中的原发肿瘤最大直径为5至26 cm，组织学类型各异。本研究中负责冰冻切片的病理学家的经验水平并未影响冰冻切片判定的准确性。识别卵巢交界性恶性肿瘤的冰冻切片评估在排除良性病理方面是准确的。理解冰冻切片诊断中使用的特定澄清性术语的含义至关重要。
