Rose P G, Rubin R B, Nelson B E, Hunter R E, Reale F R
Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester.
Am J Obstet Gynecol. 1994 Sep;171(3):823-6. doi: 10.1016/0002-9378(94)90105-8.
Frozen-section evaluation of ovarian tumors can be used to establish a histopathologic diagnosis and guide the surgeon to perform the appropriate surgical procedure. A retrospective study was conducted to determine the accuracy of frozen-section diagnosis of ovarian tumors.
Frozen- and permanent-section diagnoses were divided into three categories (benign, borderline, and malignant). The sensitivity, specificity and predictive values, and 95% percent confidence intervals of each frozen-section diagnosis were determined.
Three hundred eighty-three ovarian tumors that underwent frozen-section evaluation between June 1983 and June 1993 were studied. The final histopathologic diagnosis was 61.1% benign, 7.6% borderline, and 31.3% malignant. Frozen section was accurate in 92.7% of all cases and inaccurate in 7.3%. The sensitivity for malignant tumors was 92.5% tumors (95% confidence intervals 87.7% to 97.2%), the sensitivity for borderline tumors was 44.8% (95% confidence interval 26.4% to 63.2%). The specificity for benign tumors was 92.0% (95% confidence interval 88.6% to 95.4%) but increased to 97.9% (95% confidence interval 96.1% to 99.7%) if borderline tumors were excluded. The positive predictive value and 95% confidence intervals were 92.0% (88.6% to 95.4%) for benign tumors, 65% (43.6% to 86.5%) for borderline tumors, and 99.1% (97.3% to 100.0%) for malignant tumors. Thirteen of 16 (81%) ovarian lymphomas and tumors metastatic to the ovary were correctly identified by intraoperative frozen section. The sensitivity for borderline serous tumors was 64.3% and for borderline mucinous tumors 30.8% (p = 0.48).
With the exception of borderline tumors, the sensitivity and specificity of frozen-section diagnosis of ovarian tumors are high. Borderline tumors remain difficult to accurately diagnose at frozen section because of the extensive sampling required. Frozen-section diagnoses have important implications regarding the type and extent of surgery performed at the initial operation.
卵巢肿瘤的冰冻切片评估可用于确立组织病理学诊断，并指导外科医生实施恰当的手术程序。开展了一项回顾性研究以确定卵巢肿瘤冰冻切片诊断的准确性。
冰冻切片诊断和永久切片诊断分为三类（良性、交界性和恶性）。确定了每种冰冻切片诊断的敏感性、特异性、预测值及95%置信区间。
对1983年6月至1993年6月间接受冰冻切片评估的383例卵巢肿瘤进行了研究。最终组织病理学诊断为61.1%为良性，7.6%为交界性，31.3%为恶性。冰冻切片在所有病例中的诊断准确率为92.7%，误诊率为7.3%。恶性肿瘤的敏感性为92.5%（95%置信区间87.7%至97.2%），交界性肿瘤的敏感性为44.8%（95%置信区间26.4%至63.2%）。良性肿瘤的特异性为92.0%（95%置信区间88.6%至95.4%），但排除交界性肿瘤后增至97.9%（95%置信区间96.1%至99.7%）。良性肿瘤的阳性预测值及95%置信区间为92.0%（88.6%至95.4%），交界性肿瘤为65%（43.6%至86.5%），恶性肿瘤为99.1%（97.3%至100.0%）。16例卵巢淋巴瘤及转移至卵巢的肿瘤中有13例（81%）通过术中冰冻切片得以正确诊断。交界性浆液性肿瘤的敏感性为64.3%，交界性黏液性肿瘤为30.8%（p = 0.48）。
除交界性肿瘤外，卵巢肿瘤冰冻切片诊断的敏感性和特异性较高。由于需要广泛取材，交界性肿瘤在冰冻切片时仍难以准确诊断。冰冻切片诊断对初次手术的手术类型和范围具有重要意义。
