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Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience

Received: 3 March 2019     Accepted: 9 April 2019     Published: 6 May 2019
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Abstract

Background: Borderline ovarian tumors (BOTs) account for a 10-15% subset of all primary ovarian epithelial neoplasms. Preoperative imaging and serologic markers are often inconclusive at distinguishing between benign, pre-malignant, and malignant ovarian tumor. Limitations at time of frozen section (FS) are relatively well known, and misinterpretation may occur potentially leading to over- and under-treatment. We evaluated all cases of BOTs submitted for FS in our institution to determine the accuracy of intraoperative diagnosis when compared with the final pathology, and possibly identify features that may guide surgical staging decision-making. Methods: We identified all intraoperative diagnoses of BOTs from our institution in a 12-year period. Clinical and pathologic data were abstracted. Intraoperative pathology diagnosis was compared to final pathologic diagnosis. Statistical analysis was performed using chi-square and logistic regression. Results: There were 80 cases included for analyses, of which 39 (48.8%) were serous borderline tumor (SBT), 18 (22.5%) mucinous borderline tumors (MBT), 1 (1.2%) endometrioid borderline tumor, and 22 (27.5%) at least borderline tumor (of various histologies). There were 13 cases with a discrepancy between FS and final diagnosis. In patients with a discrepancy where final pathology demonstrated carcinoma, 4/11 (36.3%) were not staged or had incomplete staging. Subsequently, 3/4 (75%) underwent a re-operation for staging purposes. In patients with discrepant pathology, discrepancy was more common 8/37 (21.6%) among non-gynecologic pathologists compared to 5/43 (11.6%) among gynecologic pathologists, but not statistically significant (p=0.23). When “at least borderline” tumor was diagnosed at FS, 10/22 (45%) had invasive malignancies on final pathology compared to diagnosis of BOT “only” on FS; on which 1/58 (1.7%) had invasive carcinoma. The cases with histologic diagnosis of BOT “only” were associated with significantly reduced discrepancy (OR 0.04 [95% CI 0.01-0.18], p< 0.001). Conclusion: In conclusion, use of intraoperative evaluation for ovarian tumors is a useful diagnostic tool but has its limitations. In intraoperative cases where pathologists call “at least borderline”, strong consideration for surgical staging should be contemplated with re-evaluation of preoperative testing. Moreover, when possible, direct communication between surgeon and pathologist at time of FS diagnosis of BOT may be valuable.

Published in Journal of Gynecology and Obstetrics (Volume 7, Issue 2)
DOI 10.11648/j.jgo.20190702.13
Page(s) 41-45
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Ovarian Tumor, Borderline, Intraoperative Diagnosis, Frozen Section

References
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[4] Tinelli R, Tinelli A, Tinelli FG, et al: Conservative surgery for borderline ovarian tumors: a review. Gynecol Oncol 100:185-91, 2006.
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[7] Timmerman D, Van Calster B, Testa AC, et al: Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol 36:226-34, 2010.
[8] Lin PS, Gershenson DM, Bevers MW, et al: The current status of surgical staging of ovarian serous borderline tumors. Cancer 85:905-11, 1999.
[9] Tinelli R, Malzoni M, Cosentino F, et al: Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors. Fertil Steril 92:736-41, 2009.
[10] Rao GG, Skinner E, Gehrig PA, et al: Surgical staging of ovarian low malignant potential tumors. Obstet Gynecol 104:261-6, 2004.
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[19] Bozdag H, Guzin K, Gocmen A, et al: The diagnostic value of frozen section for borderline ovarian tumours. J Obstet Gynaecol 36:626-30, 2016.
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[23] Ratnavelu ND, Brown AP, Mallett S, et al: Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev 3:CD010360, 2016.
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Cite This Article
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    Marilyn Huang, Matthew Schlumbrecht, Tegan Hunter, Mehrdad Nadji, Andre Pinto. (2019). Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience. Journal of Gynecology and Obstetrics, 7(2), 41-45. https://doi.org/10.11648/j.jgo.20190702.13

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    ACS Style

    Marilyn Huang; Matthew Schlumbrecht; Tegan Hunter; Mehrdad Nadji; Andre Pinto. Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience. J. Gynecol. Obstet. 2019, 7(2), 41-45. doi: 10.11648/j.jgo.20190702.13

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    AMA Style

    Marilyn Huang, Matthew Schlumbrecht, Tegan Hunter, Mehrdad Nadji, Andre Pinto. Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience. J Gynecol Obstet. 2019;7(2):41-45. doi: 10.11648/j.jgo.20190702.13

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  • @article{10.11648/j.jgo.20190702.13,
      author = {Marilyn Huang and Matthew Schlumbrecht and Tegan Hunter and Mehrdad Nadji and Andre Pinto},
      title = {Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {7},
      number = {2},
      pages = {41-45},
      doi = {10.11648/j.jgo.20190702.13},
      url = {https://doi.org/10.11648/j.jgo.20190702.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20190702.13},
      abstract = {Background: Borderline ovarian tumors (BOTs) account for a 10-15% subset of all primary ovarian epithelial neoplasms. Preoperative imaging and serologic markers are often inconclusive at distinguishing between benign, pre-malignant, and malignant ovarian tumor. Limitations at time of frozen section (FS) are relatively well known, and misinterpretation may occur potentially leading to over- and under-treatment. We evaluated all cases of BOTs submitted for FS in our institution to determine the accuracy of intraoperative diagnosis when compared with the final pathology, and possibly identify features that may guide surgical staging decision-making. Methods: We identified all intraoperative diagnoses of BOTs from our institution in a 12-year period. Clinical and pathologic data were abstracted. Intraoperative pathology diagnosis was compared to final pathologic diagnosis. Statistical analysis was performed using chi-square and logistic regression. Results: There were 80 cases included for analyses, of which 39 (48.8%) were serous borderline tumor (SBT), 18 (22.5%) mucinous borderline tumors (MBT), 1 (1.2%) endometrioid borderline tumor, and 22 (27.5%) at least borderline tumor (of various histologies). There were 13 cases with a discrepancy between FS and final diagnosis. In patients with a discrepancy where final pathology demonstrated carcinoma, 4/11 (36.3%) were not staged or had incomplete staging. Subsequently, 3/4 (75%) underwent a re-operation for staging purposes. In patients with discrepant pathology, discrepancy was more common 8/37 (21.6%) among non-gynecologic pathologists compared to 5/43 (11.6%) among gynecologic pathologists, but not statistically significant (p=0.23). When “at least borderline” tumor was diagnosed at FS, 10/22 (45%) had invasive malignancies on final pathology compared to diagnosis of BOT “only” on FS; on which 1/58 (1.7%) had invasive carcinoma. The cases with histologic diagnosis of BOT “only” were associated with significantly reduced discrepancy (OR 0.04 [95% CI 0.01-0.18], pConclusion: In conclusion, use of intraoperative evaluation for ovarian tumors is a useful diagnostic tool but has its limitations. In intraoperative cases where pathologists call “at least borderline”, strong consideration for surgical staging should be contemplated with re-evaluation of preoperative testing. Moreover, when possible, direct communication between surgeon and pathologist at time of FS diagnosis of BOT may be valuable.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience
    AU  - Marilyn Huang
    AU  - Matthew Schlumbrecht
    AU  - Tegan Hunter
    AU  - Mehrdad Nadji
    AU  - Andre Pinto
    Y1  - 2019/05/06
    PY  - 2019
    N1  - https://doi.org/10.11648/j.jgo.20190702.13
    DO  - 10.11648/j.jgo.20190702.13
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 41
    EP  - 45
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20190702.13
    AB  - Background: Borderline ovarian tumors (BOTs) account for a 10-15% subset of all primary ovarian epithelial neoplasms. Preoperative imaging and serologic markers are often inconclusive at distinguishing between benign, pre-malignant, and malignant ovarian tumor. Limitations at time of frozen section (FS) are relatively well known, and misinterpretation may occur potentially leading to over- and under-treatment. We evaluated all cases of BOTs submitted for FS in our institution to determine the accuracy of intraoperative diagnosis when compared with the final pathology, and possibly identify features that may guide surgical staging decision-making. Methods: We identified all intraoperative diagnoses of BOTs from our institution in a 12-year period. Clinical and pathologic data were abstracted. Intraoperative pathology diagnosis was compared to final pathologic diagnosis. Statistical analysis was performed using chi-square and logistic regression. Results: There were 80 cases included for analyses, of which 39 (48.8%) were serous borderline tumor (SBT), 18 (22.5%) mucinous borderline tumors (MBT), 1 (1.2%) endometrioid borderline tumor, and 22 (27.5%) at least borderline tumor (of various histologies). There were 13 cases with a discrepancy between FS and final diagnosis. In patients with a discrepancy where final pathology demonstrated carcinoma, 4/11 (36.3%) were not staged or had incomplete staging. Subsequently, 3/4 (75%) underwent a re-operation for staging purposes. In patients with discrepant pathology, discrepancy was more common 8/37 (21.6%) among non-gynecologic pathologists compared to 5/43 (11.6%) among gynecologic pathologists, but not statistically significant (p=0.23). When “at least borderline” tumor was diagnosed at FS, 10/22 (45%) had invasive malignancies on final pathology compared to diagnosis of BOT “only” on FS; on which 1/58 (1.7%) had invasive carcinoma. The cases with histologic diagnosis of BOT “only” were associated with significantly reduced discrepancy (OR 0.04 [95% CI 0.01-0.18], pConclusion: In conclusion, use of intraoperative evaluation for ovarian tumors is a useful diagnostic tool but has its limitations. In intraoperative cases where pathologists call “at least borderline”, strong consideration for surgical staging should be contemplated with re-evaluation of preoperative testing. Moreover, when possible, direct communication between surgeon and pathologist at time of FS diagnosis of BOT may be valuable.
    VL  - 7
    IS  - 2
    ER  - 

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Author Information
  • Department of Obstetrics & Gynecology, University of Miami, Miami, USA

  • Department of Obstetrics & Gynecology, University of Miami, Miami, USA

  • Miller School of Medicine, University of Miami, Miami, USA

  • Department of Pathology, University of Miami, Miami, USA

  • Department of Pathology, University of Miami, Miami, USA

  • Sections