Factors Predicting Inaccuracy Between Frozen Section Analysis and Postoperative Pathology Results: A Tertiary Center Experience

Year 2022, , 89 - 97, 29.10.2022

Utkan Sağır , Çiğdem Kılıç , Halis Doğukan Özkan , Fatih Kılıç , Mehmet Ünsal , Okan Aytekin , Çiğdem Mesci , Günsu Kimyon Cömert , Taner Turan

https://doi.org/10.52827/hititmedj.1126502

Abstract

FACTORS PREDICTING INACCURACY BETWEEN FROZEN SECTION ANALYSIS AND POSTOPERATIVE PATHOLOGY RESULTS: A TERTIARY CENTER EXPERIENCE

ABSTRACT

Objective: To evaluate the diagnostic accuracy and to identify the factors determining the
inaccuracy between FS analysis and postoperative pathology results in our hospital.
Materials and Methods: This study included 1435 patients with pelvic masses who underwent surgical intervention and FS consultation.
Results: On univariate analysis, menopausal state, abnormal uterine bleeding, preoperative
serum Ca125 level, preoperative leukocyte value, preoperative neutrophil value, tumor size,
presence of cystic component, pathological findings in Doppler USG, ascites and cell type were found to have statistical significance for benign / borderline / malign discrimination.
Menopausal state (p<0.0001), preoperative serum Ca125 level (p<0.0001) and tumor size
(p<0.0001) were identified as independent predictors for determining inaccuracy between
intraoperative and postoperative pathological evaluation. Inconsistency increased 2.5 times
with a serum Ca125 > 35 IU/ml, 3.8 times with tumor size> 79 mm and 5 times in
postmenopausal patients. For the discrimination of benign / borderline / malign definitions, FS results and final pathology results were compatible in 1250 (87%) patients while it was not in 185 (13%) patients.
Conclusions: Increased preoperative serum Ca125 level was a predictor for inaccuracy between FS examination and postoperative pathology results. Also, tumor size ≥80 mm and menopausal state were related to misdiagnosis in FS results. Maximal effort should be done to minimize preventable errors during intraoperative FS analysis.
Keywords: Frozen section, Pelvic mass, Inaccuracy, Borderline tumors

Keywords

Frozen section, Pelvic mass, Inaccuracy, Borderline tumors

Frozen/Section Sonuçları ile Postoperatif Patoloji Sonuçları Arasındaki Uyumsuzluğu Öngören Faktörler: Tersiyer Merkez Sonuçları

Abstract

ÖZ

Amaç: Hastanemizde FS analizi ile postoperatif patoloji sonuçları arasındaki tanısal doğruluğu değerlendirmek ve yanlışlığı belirleyen faktörleri belirlemek.
Gereç ve Yöntem: Bu çalışmaya cerrahi müdahale ve FS konsültasyonu uygulanan pelvik kitlesi olan 1435 hasta dahil edildi.
Bulgular: Tek değişkenli analizde Benign/Borderline/Malign tanılarının ayırımında; menopoz durumu, anormal uterin kanama, ameliyat öncesi serum Ca125 seviyesi, ameliyat öncesi lökosit değeri, ameliyat öncesi nötrofil değeri, tümör boyutu, kistik komponent varlığı, Doppler USG'de patolojik bulgular, asit ve hücre tipi istatistiksel olarak anlamlı bulundu.
Menopoz durumu (p<0,0001), preoperatif serum Ca125 düzeyi (p<0,0001) ve tümör boyutu (p<0,0001), intraoperatif ve postoperatif patolojik değerlendirme arasındaki yanlışlığı belirlemede bağımsız faktörler olarak belirlendi. Uyumsuzluk serum Ca125 > 35 IU/ml olduğunda 2.5 kat, tümör boyutu > 79 mm olduğunda 3,8 kat ve postmenopozal hastalarda 5 kat arttı. Benign / borderline / malign tanılarının ayrımında FS sonuçları ile nihai patoloji sonuçları 1250 (%87) hastada uyumluyken 185 (%13) hastada uyumlu değildi.
Sonuçlar: Artmış preoperatif serum Ca125 seviyesi, FS sonuçları ile postoperatif patoloji sonuçları arasındaki yanlışlığı predikte eden bir faktördür. Ayrıca FS sonuçlarında tümör boyutu ≥80 mm olduğunda ve menopozal durum yanlış tanı ile ilişkiliydi. İntraoperatif FS analizi sırasında önlenebilir hataları en aza indirmek için azami çaba gösterilmelidir.

Keywords

Pelvik kitle, Borderline tümörler, Frozen/Section, Uyumsuzluk

References

• References 1) Köse MF, Turan AT. Pelvic masses and adnexal torsion. J Surg Med Sci 2006; 2(24):78-82.
• 2) Leibman AJ, Kruse B, McSweeney MB. Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses. Am J Roentgenol 1988; 151(1):89-92.
• 3) Grimes DA, Hughes JM. Use of multiphasic oral contraceptives and hospitalizations of women with functional ovarian cysts in the United States. Obstet Gynecol 1989; 73(6):1037-9.
• 4) Bell R, Petticrew M, Sheldon T. The performance of screening tests for ovarian cancer: results of a systematic review. Br J Obstet Gynaecol 1998; 105(11):1136-1147.
• 5) Ilvan S, Ramazanoglu R, Akyildiz U, Calay E, Bese T, Oruc N. The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol 2005; 97(2):395-9.
• 6) Tinelli A, Vergara D, Martignago R, Leo G, Pisano M, Malvasi A. An outlook on ovarian cancer and borderline ovarian tumors: focus on genomic and proteomic findings. Curr Genomics 2009; 10(4):240-9.
• 7) Pinto PB, Andrade LA, Derchain SF. Accuracy of intraoperative frozen section diagnosis of ovarian tumors. Gynecol Oncol 2001; 81(2):230-2.
• 8) Geomini P, Bremer G, Kruitwagen R, Mol BWJ. Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a meta-analysis. Gynecol Oncol 2005; 96(1):1-9.
• 9) Dankwa EK, Davies JD. Frozen section diagnosis: an audit. J Clin Pathol 1985; 38(11):1235-40.
• 10) Jaafar H. Intraoperative frozen section consultation: concepts, applications and limitations. Malays J Med Sci 2006; 13(1):4-12.
• 11) Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalance and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis. Reproductive Health 2018; 15(1):195.
• 12) Sukumaran R, Somanathan T, Mathews A, Kattor J, Sambasivan S, Nair RP. Role of frozen section in intraoperative assessment of ovarian masses: a tertiary oncology center experience. Indian J Surg Oncol 2014; 5(2):99-103.
• 13) Huang Z, Li L, Li C, Ngaujah S, Yao S, Chu R, et al. Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors. J Cancer 2018; 9(16):2817-24.
• 14) Tempfer CB, Polterauer S, Bentz EK, Reinthaller A, Hefler LA. Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynecol Oncol 2007; 107(2):248-52.
• 15) Ismiil N, Ghorab Z, Nofech-Mozes S. Intraoperative consultation in gynecologic pathology: a 6-year audit at a tertiary care medical center. Int J Gynecol Cancer 2009; 19(1):152-7.
• 16) Akrivos N, Thomakos N, Satiropoulou M, Rodolakis A, Antsaklis A. Intraoperative consultation in ovarian pathology. Gynecol Obstet Invest 2010; 70(3):193-9.
• 17) Zhang W, Jia S, Xiang Y, Yang J, Jia C, Leng J. Factors associated with misdiagnosis of frozen section of mucinous borderline ovarian tumors. J Int Med Res 2019; 47(1):96-104.
• 18) Ureyen I, Turan T, Cirik DA, Tasci T, Boran N, Bulbul D, et al.. Frozen Section in Borderline Ovarian Tumors: Is It Reliable? Eur J Obstet Gynecol Reprod Biol 2014; 181: 115-118.
• 19) Turan T, Oguz E, Unlubilgin E, Tulunay G, Boran N, Demir OF, et al. Accuracy of frozen-section evaluation for myometrial invasion and grade in endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2003; 167(1):90-5.