Usubütün A, Altinok G, Küçükali T
Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey.
Acta Obstet Gynecol Scand. 1998 Nov;77(10):1013-6.
Frozen Section is an important diagnostic tool to determine the nature of ovarian masses. However, like other diagnostic tools, frozen section also has some pitfalls. We aimed to discuss the source and the nature of inaccuracies associated with this procedure.
In this retrospective study 360 cases of ovarian masses examined by frozen section were re-evaluated. The sensitivity, specificity and predictive values of frozen section diagnosis of ovarian tumors were calculated. The reasons for the erroneous frozen-section diagnoses were discussed.
Overall diagnostic agreement for ovarian lesions was 94.2%. Disagreements were found in nine cases (2.5%). Diagnosis was deferred to permanent sections in 12 cases (3.3%). The sensitivity for malignant tumors was 93.1% and specificity was 99.2%. The sensitivity for benign tumors was 99.2% and specificity was 92.1%. Most problematic cases were mucinous tumors, followed by tumors resembling fibrothecomas, in addition sections without viable tissue fragments or presence of extensive hemorrhage and necrosis also obscured the frozen diagnosis. Another factor was the lack of an effective communication between the surgeon and the pathologist.
For an effective usage of this method not only the pathologist but also the surgeons must know the pitfalls of this method and also there must be good communication between the pathologist and the surgeon. Especially deferred cases should be minimized by good communication. In fact it's an intraoperative consultation method that enables the pathologist to gather all the preoperative, intraoperative findings and to be familiar with the further treatment plan of the patient.
冰冻切片是确定卵巢肿物性质的重要诊断工具。然而，与其他诊断工具一样，冰冻切片也存在一些缺陷。我们旨在探讨与该程序相关的不准确之处的来源和性质。
在这项回顾性研究中，对360例经冰冻切片检查的卵巢肿物病例进行了重新评估。计算了冰冻切片诊断卵巢肿瘤的敏感性、特异性和预测值。讨论了冰冻切片诊断错误的原因。
卵巢病变的总体诊断一致性为94.2%。在9例（2.5%）中发现存在分歧。12例（3.3%）的诊断被推迟至石蜡切片。恶性肿瘤的敏感性为93.1%，特异性为99.2%。良性肿瘤的敏感性为99.2%，特异性为92.1%。大多数问题病例是黏液性肿瘤，其次是类似纤维卵泡膜瘤的肿瘤，此外，没有存活组织碎片或存在广泛出血和坏死的切片也会使冰冻诊断变得模糊。另一个因素是外科医生和病理学家之间缺乏有效的沟通。
为了有效使用该方法，不仅病理学家，外科医生也必须了解该方法的缺陷，并且病理学家和外科医生之间必须有良好的沟通。特别是通过良好的沟通应尽量减少诊断推迟的情况。实际上，这是一种术中会诊方法，使病理学家能够收集所有术前、术中的发现，并熟悉患者的进一步治疗计划。
