Accuracy of Frozen Section in Diagnosis of Ovarian Mass
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2010-03-26
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Vajira Medical Journal
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Abstract Accuracy of Frozen Section in Diagnosis of Ovarian Mass Siriwan Tangjitgamol MD* Somneuk Jesadapatrakul MD** Sumonmal Manusirivithaya MD* *Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital **Department of Pathology, BMA Medical College and Vajira Hospital Objective: To determine the accuracy of frozen section compared to permanent section according to status of malignancy and histologic cell type. Study design: Diagnostic study. Subjects: Frozen and permanent pathological reports of 212 ovarian masses from 212 women who underwent ovarian resection at BMA Medical College and Vajira Hospital from January 1, 1992 to December 31, 2002 were studied. Methods: All frozen and subsequent permanent pathological reports of ovarian masses from the studied group were reviewed. The data of age, tumor size, number of frozen and permanent sections of the ovarian masses, the results of frozen and permanent section were taken from the pathological report. The pathological slides were reviewed when there was discrepancy of frozen and permanent section diagnosis, in deferred diagnosis for status of malignancy and/ or histologic cell type. Main outcome measures: Accuracy, sensitivity, specificity, positive predictive value, negative predictive value of frozen section. Results: From 212 ovarian masses, there were 13 deferred cases which frozen section diagnosis for status of malignancy could not be given. Statistical analysis was then performed in 199 cases.. The overall accuracy was 90.9%. Sensitivity of frozen section diagnosis was highest in the benign group at 99.1%, next was in the malignant group at 86.1% and lowest in borderline group at 50%. The specificity were 90.7, 94.6 and 100.0% in the benign, borderline and malignant groups respectively. Positive and negative predictive values of benign, borderline and malignant groups were 93.3, 41.2, 100.0% and 98.7, 96.2, 92.7%, respectively. All inaccurate diagnosis were in the common epithelial group. When the statistical data were analyzed according to histology subgroup of common epithelial tumor, sensitivity in diagnosis malignant and borderline mucinous were lower than non-mucinous tumor, 62.5% and 41.7% compared to 96.9% and 50.0% respectively. For diagnosis of the histologic cell type, frozen section had 91.9% accuracy. Thirteen out or 16 incorrect histologic diagnosis cases (81.3%) were in the common epithelial group while only three cases were germ cell tumor. Conclusion: The accuracy of frozen section in diagnosis of frozen section in diagnosis of ovarian mass was generally high according to both status of malignancy and histologic cell type. There were exception in tumors with large size, mucinous or borderline tumor which yielded lower accuracy, sensitivity, specificity and positive predictive value than the other groups. The surgeon should recognize these limitations and appraise the test result together with other clinical data. This is to achieve for the correct final diagnosis and the proper management for the patient. Key word: frozen section, ovarian mass, accuracy, malignancy, histologic cell type Vajira Med J 2003 ; 47 : 17 - 28
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Vajira Medical Journal; Vol. 47 No. 1 January - April 2003; 17-28