1
|
Shao H, Wang N, Liu G. Factors Affecting the Diagnostic Discordance Between Frozen and Permanent Sections in Mucinous Ovarian Tumors. Int J Womens Health 2024; 16:853-863. [PMID: 38774151 PMCID: PMC11108062 DOI: 10.2147/ijwh.s458138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/11/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose To investigate the accuracy of intraoperative frozen section (FS) diagnosis for predicting the permanent section (PS) diagnosis of mucinous ovarian tumors and evaluate the factors affecting the diagnostic discordance. Patients and Methods This retrospective cohort study was performed in Tianjin Medical University General Hospital. All women who underwent ovarian surgery with FS between January 2011 and December 2022 were identified, and those with a diagnosis of mucinous ovarian tumor (MOT) by FS or PS were reviewed. Clinical and pathologic data were extracted. Results A total of 180 women were included, of which 141 (78.33%) had diagnostic concordance between FS and PS, yielding a sensitivity of 83.43% and a positive predictive value (PPV) of 92.76%. Under- and over-diagnosis occurred in 28 cases (15.56%) and 11 cases (6.11%). Tumor size > 13cm (OR 3.79, 95% CI 1.12-12.73) was an independent risk factor for under-diagnosis, and tumor size ≤ 13cm (OR 16.78, 95% CI 0.01-0.49), laparoscopic surgery (OR 0.14, 95% CI 0.02-0.92), the combination of other tumor components (including serous, Brenner tumor, and chocolate cyst; OR 7.00, 95% CI 1.19-41.12) were independently associated with over-diagnosis. The Kaplan-Meier survival curves and the Log rank test showed no significant difference between misdiagnosed and accurately diagnosed patients (all P > 0.05). Conclusion Intraoperative frozen pathology of MOT is problematic for under- and over-diagnosis. The incorrect diagnosis of FS was related to determining the extent of surgery but had no impact on the patients' long-term recurrence and survival outcomes. In future clinical practice, surgeons need to obtain material accurately and enhance communication with pathologists during the operation to improve the accuracy of FS diagnosis.
Collapse
Affiliation(s)
- Hua Shao
- Clinical Psychology Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Na Wang
- Gynecology and Obstetrics Department, Tianjin Haihe Hospital, Tianjin, People’s Republic of China
| | - Guoyan Liu
- Gynecology and Obstetrics Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Gynaecological Oncology Department, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People’s Republic of China
| |
Collapse
|
2
|
Salcedo-Hernández RA, Cantú-de-León DF, Pérez-Montiel D, García-Pérez L, Lino-Silva LS, Zepeda-Najar C, Barquet-Muñoz SA. The usefulness of intraoperative consultation for the diagnosis of borderline ovarian tumors. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:261. [PMID: 33708888 PMCID: PMC7940902 DOI: 10.21037/atm-20-3932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Borderline ovarian tumors (BTs) must be recognized during the surgery by intraoperative consultation (IOC) to guide surgical treatment; however, this diagnosis can be imprecise. Therefore, this study aimed to evaluate the diagnostic accuracy of IOC for the diagnosis of BT. Methods A retrospective cohort study was carried out including all women diagnosed with a pelvic tumor consecutively surgically treated from 2005 to 2015 with IOC. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) for the IOC and BTs. Results A total of 758 patients were enrolled, the median age was 44 years, the median tumor size was 11.8 cm, and the median CA-125 levels were 45.65 U/µL. After IOC, 458 (64.1%) cases were diagnosed as benign, 111 (14.7%) as BT, and 161 (21.2%) as malignant. The definitive diagnosis was a benign tumor in 448 (59.1%) cases, BT in 110 (14.5%), and 200 (26.4%) cases were malignant. The diagnostic accuracy of the IOC for BT diagnosis was 89.8% (sensitivity =65.5%, specificity =93.9%). The diagnosis performance of IOC for the diagnosis between BT and benign tumors (n=546) had a sensitivity of 69.9%, a specificity of 98.4%, and a diagnostic accuracy of 84%; meanwhile for the diagnosis between BT and malignant tumors (n=242) IOC had a sensitivity of 92.3%, a specificity of 81.7%, and a diagnostic accuracy of 87%. Conclusions For practitioners, knowing the accuracy and limitations of the IOC for BT enables the better selection of cases to perform a complete staging surgery.
Collapse
Affiliation(s)
| | | | | | | | | | - César Zepeda-Najar
- Surgical oncology, Hospital ángeles Tijuana, Tijuana, Baja California Norte, Mexico
| | | |
Collapse
|
3
|
Yoshida H, Tanaka H, Tsukada T, Abeto N, Kobayashi-Kato M, Tanase Y, Uno M, Ishikawa M, Kato T. 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 2020; 29:30-38. [PMID: 32955372 DOI: 10.1177/1066896920960518] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study examined the accuracy and pitfalls associated with frozen section diagnosis of primary ovarian tumors and ovarian metastases based on the 2014 World Health Organization classification (WHO) criteria and proposed improvements from a pathologist's perspective. METHODS We microscopically reviewed 871 cases of primary ovarian tumor (N = 802) and ovarian metastasis (N = 69) and compared the results of frozen sections with the final diagnosis. Malignant potential concordance (benign, borderline, or malignant) and specific discordant diagnosis rates were analyzed. Finally, we conducted a unique literature review of specific diagnostic errors in the frozen section diagnosis of primary ovarian tumors. RESULTS Of 802 primary ovarian tumors, 50 (6.2%) cases showed discordant diagnoses in which mucinous carcinoma (40.5%), low-grade serous carcinoma (LGSC; 31.3%), and mucinous borderline tumor (18.4%) were frequently misinterpreted. Of 69 ovarian metastases, all 4 cases of low-grade appendiceal mucinous neoplasm (LAMN) were misdiagnosed as primary ovarian mucinous tumor. A literature review revealed that mucinous/serous borderline tumor or carcinoma accounted for approximately 70% of 217 reported discordant diagnoses. CONCLUSION In the present study, the concordance rate of malignant potential of the tumor was comparable to that previously reported. Even in the 2014 WHO classification, primary ovarian mucinous borderline tumor/carcinoma and LGSC still comprised the majority of discordant cases. Grossing methods that reduce sampling error are required. LAMN was frequently misinterpreted as a benign or borderline ovarian mucinous tumor. To prevent this error, a differential algorithm integrating clinical information and gross findings should be developed.
Collapse
Affiliation(s)
| | - Hiroki Tanaka
- National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,JR Tokyo General Hospital, Shibuya-ku, Tokyo, Japan
| | - Takafumi Tsukada
- National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Naoko Abeto
- National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | | | | | - Masaya Uno
- National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | | | - Tomoyasu Kato
- National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| |
Collapse
|
4
|
Surgical management of ovarian tumors without the support of intraoperative pathology readings in Bhaktapur Cancer Hospital. Gynecol Oncol Rep 2020; 33:100589. [PMID: 32577489 PMCID: PMC7300083 DOI: 10.1016/j.gore.2020.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022] Open
Abstract
Intraoperative frozen section plays an important role in surgical management of ovarian masses. Many hospitals in low- and middle-income countries lack this intraoperative pathologic guidance. In this retrospective analysis, we assessed the management of 62 patients who underwent surgical treatment for ovarian masses at Bhaktapur Cancer Hospital in Nepal in light of the final histopathology results. Final histopathology found that 64.5% of the ovarian masses were malignant, 1.0% were borderline, and 30.6% were benign. 55 of the 62 total cases were considered "clinically suspicious" and 52 of the 62 cases underwent hysterectomy and staging procedures in addition to oophorectomy. There was no significant difference in the surgical management or in the postoperative complications when comparing benign, borderline, and malignant masses. Without the support of intraoperative frozen section, benign and malignant masses were treated the same way. The majority of benign cases were overtreated and were exposed to additional risks of postoperative complications. Several malignant cases were undertreated and required additional surgery to appropriately treat and stage malignant ovarian masses. Improved pathology support in Bhaktapur Cancer Hospital would result in better patient outcomes, fewer complications, and avoidance of additional staging surgeries.
Collapse
|
5
|
Zhang J, Song Y, Xia F, Zhu C, Zhang Y, Song W, Xu J, Ma X. Rapid and accurate intraoperative pathological diagnosis by artificial intelligence with deep learning technology. Med Hypotheses 2017; 107:98-99. [PMID: 28915974 DOI: 10.1016/j.mehy.2017.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/28/2017] [Indexed: 02/05/2023]
Abstract
Frozen section is widely used for intraoperative pathological diagnosis (IOPD), which is essential for intraoperative decision making. However, frozen section suffers from some drawbacks, such as time consuming and high misdiagnosis rate. Recently, artificial intelligence (AI) with deep learning technology has shown bright future in medicine. We hypothesize that AI with deep learning technology could help IOPD, with a computer trained by a dataset of intraoperative lesion images. Evidences supporting our hypothesis included the successful use of AI with deep learning technology in diagnosing skin cancer, and the developed method of deep-learning algorithm. Large size of the training dataset is critical to increase the diagnostic accuracy. The performance of the trained machine could be tested by new images before clinical use. Real-time diagnosis, easy to use and potential high accuracy were the advantages of AI for IOPD. In sum, AI with deep learning technology is a promising method to help rapid and accurate IOPD.
Collapse
Affiliation(s)
- Jing Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China; Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Yanlin Song
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Fan Xia
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Chenjing Zhu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Yingying Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Wenpeng Song
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| |
Collapse
|
6
|
van den Akker PAJ, Zusterzeel PLM, Aalders AL, Snijders MPLM, Samlal RAK, Vollebergh JHA, Kluivers KB, Massuger LFAG. 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; 133:355-8. [PMID: 26971261 DOI: 10.1016/j.ijgo.2015.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/06/2015] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the importance of the risk of malignancy index (RMI) in the decision to perform frozen section analysis among women with ovarian tumors. METHODS A retrospective study was conducted in 11 centers in the Netherlands. Women who underwent surgical treatment of an ovarian mass with unknown histology between January 2005 and September 2009 were included. The RMI was calculated retrospectively. Frozen section analysis and RMI values were assessed for patients with benign, borderline, and malignant ovarian tumors on final histopathology. RESULTS Overall, 670 women were included. Frozen sections were performed in 323 (48.2%) patients, of whom 206 (63.8%) were diagnosed with benign ovarian tumors, 55 (17.0%) with borderline tumors, and 62 (19.2%) with malignant tumors. Overall, 109 (16.3%) women had an RMI below 20, 106 (97.2%) of whom had benign histology results. Among 235 patients with an RMI over 100, 3 (1.3%) postmenopausal women had malignancies that were missed because frozen sections were not performed. CONCLUSION Women with an RMI below 20 have a low risk of malignancy and therefore do not require frozen section analysis. Postmenopausal women with an RMI greater than 100 should be referred to centers where frozen sections can be performed, and proper facilities and expertise are available to perform staging procedures if necessary.
Collapse
Affiliation(s)
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anette L Aalders
- Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Marc P L M Snijders
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Rahul A K Samlal
- Department of Obstetrics and Gynecology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Jos H A Vollebergh
- Department of Obstetrics and Gynecology, Bernhoven Hospital, Uden, Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
7
|
Rosenthal EL, Warram JM, de Boer E, Basilion JP, Biel MA, Bogyo M, Bouvet M, Brigman BE, Colson YL, DeMeester SR, Gurtner GC, Ishizawa T, Jacobs PM, Keereweer S, Liao JC, Nguyen QT, Olson JM, Paulsen KD, Rieves D, Sumer BD, Tweedle MF, Vahrmeijer AL, Weichert JP, Wilson BC, Zenn MR, Zinn KR, van Dam GM. Successful Translation of Fluorescence Navigation During Oncologic Surgery: A Consensus Report. J Nucl Med 2015; 57:144-50. [PMID: 26449839 DOI: 10.2967/jnumed.115.158915] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/24/2015] [Indexed: 11/16/2022] Open
Abstract
Navigation with fluorescence guidance has emerged in the last decade as a promising strategy to improve the efficacy of oncologic surgery. To achieve routine clinical use, the onus is on the surgical community to objectively assess the value of this technique. This assessment may facilitate both Food and Drug Administration approval of new optical imaging agents and reimbursement for the imaging procedures. It is critical to characterize fluorescence-guided procedural benefits over existing practices and to elucidate both the costs and the safety risks. This report is the result of a meeting of the International Society of Image Guided Surgery (www.isigs.org) on February 6, 2015, in Miami, Florida, and reflects a consensus of the participants' opinions. Our objective was to critically evaluate the imaging platform technology and optical imaging agents and to make recommendations for successful clinical trial development of this highly promising approach in oncologic surgery.
Collapse
Affiliation(s)
- Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Stanford, California
| | - Jason M Warram
- Division of Otolaryngology, Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Esther de Boer
- Division of Otolaryngology, Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - James P Basilion
- Case Center for Imaging Research, NFCR Center for Molecular Imaging, Department of Radiology Case Western Reserve University, Cleveland, Ohio
| | - Merrill A Biel
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Bogyo
- Department of Pathology, Stanford School of Medicine, Stanford, California Department of Cancer Biology Program, Stanford School of Medicine, Stanford, California
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Brian E Brigman
- Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Yolonda L Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven R DeMeester
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Geoffrey C Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Takeaki Ishizawa
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Stijn Keereweer
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joseph C Liao
- Department of Urology and Bio-X Program, Stanford University School of Medicine, Stanford, California
| | - Quyen T Nguyen
- Division of Head and Neck Surgery, University of California San Diego, San Diego, California
| | - James M Olson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington Seattle Children's Hospital & Regional Medical Center, Seattle, Washington
| | - Keith D Paulsen
- Department of Diagnostic Radiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Baran D Sumer
- Department of Otolaryngology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael F Tweedle
- Department of Radiology, The Wright Center for Innovation in Biomedical Imaging, The Ohio State University, Columbus, Ohio
| | | | - Jamey P Weichert
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Brian C Wilson
- Princess Margaret Cancer Centre, UHN, Toronto, Ontario, Canada Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Zenn
- Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Kurt R Zinn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gooitzen M van Dam
- Department of Surgery, Nuclear Medicine and Molecular Imaging and Intensive Care, University Medical Center Groningen, University of Groningen, The Netherlands, on behalf of the International Society of Image Guided Surgery (ISIGS)
| |
Collapse
|