ABSTRACT
Study Objective
Describe the current practice patterns and diagnostic accuracy of frozen section (FS)
pathology for children and adolescents with ovarian masses
Design
Prospective cohort study from 2018 to 2021
Setting
Eleven children's hospitals
Participants
Females age 6-21 years undergoing surgical management of an ovarian mass
Interventions
Obtaining intraoperative FS pathology
Main Outcome Measure
Diagnostic accuracy of FS pathology
Results
Of 691 patients who underwent surgical management of an ovarian mass, FS was performed
in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients,
12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy
with or without other procedures. FS results were disparate from final pathology in
7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for
identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on
FS included serous borderline tumor (n = 1), mucinous borderline tumor (n = 2), mucinous carcinoma (n = 1), and immature teratoma (n = 1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS
underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the
9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%)
had malignant final pathology.
Conclusions
FSs are infrequently utilized for pediatric and adolescent ovarian masses and could
be inaccurate for predicting malignancy and guiding operative decision-making. We
recommend continued assessment and refinement of guidance before any standardization
of use of FS to assist with intraoperative decision-making for surgical resection
and staging in children and adolescents with ovarian masses.
Key Words
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Article info
Publication history
Published online: October 06, 2022
Accepted:
October 2,
2022
Received in revised form:
September 12,
2022
Received:
July 11,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of Interest Statement: All authors declare they have no conflicts of interest or financial disclosures, including financial, consultant, institutional, and other relationships that could lead to bias or conflicts of interest.
The findings of this study were presented at the NASPAG 36th Annual Clinical & Research Meeting on April 7th, 2022, in Chicago, Illinois.
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
