Advertisement

Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents

Published:October 06, 2022DOI:https://doi.org/10.1016/j.jpag.2022.10.001

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kelleher CM
        • Goldstein AM
        Adnexal masses in children and adolescents.
        Clin Obstet Gynecol. 2015; 58: 76-92
        • van Heerden J
        • Tjalma WA
        The multidisciplinary approach to ovarian tumours in children and adolescents.
        Eur J Obstet Gynecol Reprod Biol. 2019; 243: 103-110
        • Brown MF
        • Hebra A
        • McGeehin K
        • Ross III, AJ
        Ovarian masses in children: a review of 91 cases of malignant and benign masses.
        J Pediatr Surg. 1993; 28: 930-932
        • Eskander RN
        • Bristow RE
        • Saenz NC
        • Saenz CC
        A retrospective review of the effect of surgeon specialty on the management of 190 benign and malignant pediatric and adolescent adnexal masses.
        J Pediatr Adolesc Gynecol. 2011; 24: 282-285
        • Hazard FK
        • Longacre TA
        Ovarian surface epithelial neoplasms in the pediatric population: incidence, histologic subtype, and natural history.
        Am J Surg Pathol. 2013; 37: 548-553
        • Oltmann SC
        • Garcia N
        • Barber R
        • et al.
        Can we preoperatively risk stratify ovarian masses for malignancy?.
        J Pediatr Surg. 2010; 45: 130-134
        • Madenci AL
        • Levine BS
        • Laufer MR
        • et al.
        Preoperative risk stratification of children with ovarian tumors.
        J Pediatr Surg. 2016; 51: 1507-1512
        • Luczak J
        • Baglaj M
        Selecting treatment method for ovarian masses in children - 24 years of experience.
        J Ovarian Res. 2017; 10: 59
        • Ye G
        • Xu T
        • Liu J
        • et al.
        The role of preoperative imaging and tumor markers in predicting malignant ovarian masses in children.
        Pediatr Surg Int. 2020; 36: 333-339
        • Madenci AL
        • Vandewalle RJ
        • Dieffenbach BV
        • et al.
        Multicenter pre-operative assessment of pediatric ovarian malignancy.
        J Pediatr Surg. 2019; 54: 1921-1925
        • Renaud EJ
        • Somme S
        • Islam S
        • et al.
        Ovarian masses in the child and adolescent: an American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review.
        J Pediatr Surg. 2019; 54: 369-377
        • van den Akker PA
        • Zusterzeel PL
        • Aalders AL
        • et al.
        Use of risk of malignancy index to indicate frozen section analysis in the surgical care of women with ovarian tumors.
        Int J Gynaecol Obstet. 2016; 133: 355-358
        • Van Calster B
        • Valentin L
        • Froyman W
        • et al.
        Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study.
        BMJ. 2020; 370: m2614
        • Song T
        • Choi CH
        • Lee YY
        • et al.
        Pediatric borderline ovarian tumors: a retrospective analysis.
        J Pediatr Surg. 2010; 45: 1955-1960
        • Mitchell DG
        • Merton DA
        • Graziani LJ
        • et al.
        Right carotid artery ligation in neonates: classification of collateral flow with color doppler imaging.
        Radiology. 1990; 175: 117-123
      1. Ovarian Cancer. National Comprehensive Cancer Network. 2022

        • Olawaiye AB
        • Zhao C
        Clinical view of gynecologic intraoperative frozen section diagnosis.
        Gynecol Obstet Clin Med. 2022; 2: 6-8
        • Naik R
        • Cross P
        • Lopes A
        • et al.
        True” versus “apparent” stage I epithelial ovarian cancer value of frozen section analysis.
        Int J Gynecol Cancer. 2006; 16: 41-46
        • Pinto PB
        • Andrade LA
        • Derchain SF
        Accuracy of intraoperative frozen section diagnosis of ovarian tumors.
        Gynecol Oncol. 2001; 81: 230-232
        • Geomini P
        • Bremer G
        • Kruitwagen R
        • Mol BW
        Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis.
        Gynecol Oncol. 2005; 96: 1-9
        • Takemoto S
        • Ushijima K
        • Kawano R
        • et al.
        Validity of intraoperative diagnosis at laparoscopic surgery for ovarian tumors.
        J Minim Invasive Gynecol. 2014; 21: 576-579
        • Medeiros LR
        • Edelweiss MI
        • Stein AT
        • et al.
        Accuracy of frozen-section analysis in the diagnosis of ovarian tumors: a systematic quantitative review.
        Int J Gynecol Cancer. 2005; 15: 192-202
        • Yoshida H
        • Tanaka H
        • Tsukada T
        • et al.
        Diagnostic discordance in intraoperative frozen section diagnosis of ovarian tumors: a literature review and analysis of 871 cases treated at a Japanese cancer center.
        Int J Surg Pathol. 2021; 29: 30-38
        • Stankovic ZB
        • Sedlecky K
        • Savic D
        • et al.
        Ovarian preservation from tumors and torsions in girls: prospective diagnostic study.
        J Pediatr Adolesc Gynecol. 2017; 30: 405-412
        • Tempfer CB
        • Polterauer S
        • Bentz EK
        • et al.
        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: 248-252
        • Bozdag H
        • Guzin K
        • Gocmen A
        • et al.
        The diagnostic value of frozen section for borderline ovarian tumours.
        J Obstet Gynaecol. 2016; 36: 626-630
        • De Decker K
        • Jaroch KH
        • Edens MA
        • et al.
        Frozen section diagnosis of borderline ovarian tumors with suspicious features of invasive cancer is a devil's dilemma for the surgeon: a systematic review and meta-analysis.
        Acta Obstet Gynecol Scand. 2021; 100: 1369-1376
        • Tangjitgamol S
        • Jesadapatrakul S
        • Manusirivithaya S
        • Sheanakul C
        Accuracy of frozen section in diagnosis of ovarian mass.
        Int J Gynecol Cancer. 2004; 14: 212-219
        • Rose PG
        • Rubin RB
        • Nelson BE
        • et al.
        Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors.
        Am J Obstet Gynecol. 1994; 171: 823-826
        • 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. 2016; 3CD010360
        • Geomini PM
        • Zuurendonk LD
        • Bremer GL
        • et al.
        The impact of size of the adnexal mass on the accuracy of frozen section diagnosis.
        Gynecol Oncol. 2005; 99: 362-366
        • Taskiran C
        • Erdem O
        • Onan A
        • et al.
        The role of frozen section evaluation in the diagnosis of adnexal mass.
        Int J Gynecol Cancer. 2008; 18: 235-240
        • Brun JL
        • Cortez A
        • Rouzier R
        • et al.
        Factors influencing the use and accuracy of frozen section diagnosis of epithelial ovarian tumors.
        Am J Obstet Gynecol. 2008; 199 (e241-247): 244
        • Bige O
        • Demir A
        • Saygili U
        • et al.
        Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology.
        Gynecol Oncol. 2011; 123: 43-46
        • Malipatil R
        • Crasta JA
        How accurate is intraoperative frozen section in the diagnosis of ovarian tumors?.
        J Obstet Gynaecol Res. 2013; 39: 710-713
        • Hashmi AA
        • Naz S
        • Edhi MM
        • et al.
        Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience.
        World J Surg Oncol. 2016; 14: 91
        • Gonzalez DO
        • Cooper JN
        • Aldrink JH
        • et al.
        Variability in surgical management of benign ovarian neoplasms in children.
        J Pediatr Surg. 2017; 52: 944-950
        • Bergeron LM
        • Bishop KC
        • Hoefgen HR
        • et al.
        Surgical management of benign adnexal masses in the pediatric/adolescent population: an 11-year review.
        J Pediatr Adolesc Gynecol. 2017; 30: 123-127
        • Lawrence AE
        • Minneci PC
        • Deans KJ
        Ovary-sparing surgery for benign pediatric ovarian masses.
        Curr Opin Pediatr. 2019; 31: 386-390
        • Aldrink JH
        • Gonzalez DO
        • Sales SP
        • et al.
        Using quality improvement methodology to improve ovarian salvage for benign ovarian masses.
        J Pediatr Surg. 2017; 53: 67-72