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Asp M, Peber E, Kannisto P, Måsbäck A, Malander S. Ovarian tumor frozen section, a multidisciplinary affair. Acta Oncol 2022; 61:785-792. [PMID: 35611589 DOI: 10.1080/0284186x.2022.2076257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ovarian Cancer (OC) constitute the eighth most common cancers among women worldwide. Surgery remains the cornerstone in the management of OC. Intraoperative frozen section (FS) diagnosis is widely used to decide the surgery course. We aimed to assess the reliability of intraoperative FS diagnosis for treatment planning of patients with suspected OC from a multidisciplinary perspective. The clinical consequences of reclassification and the multidisciplinary management of the therapy plan, is the secondary aim of this study. To our knowledge, this information is sparely investigated. METHODS A single-center, retrospective population-based study of patients who underwent surgery for suspected OC between 2018 and 2020. Histopathological outcomes were classified as benign, borderline, or malignant. The FS diagnosis was the diagnostic test, and the final histopathology report was the gold standard. Diagnostic capability for treatment planning was assessed, and modifications made possible by overall clinical knowledge were discussed. RESULTS A total of 358 patients were identified, of whom 187 were included in the FS group. Overall accuracy was 89.8%, and 19 patients were reclassified; the malignancy grade of 15 tumors was underestimated. Prevalence, sensitivity, specificity, positive predictive value, and negative predictive value for invasive malignancies on FS were 54.0% (CI 46.6-61.3%), 88.1% (CI 80.2-93.7%), 98.8% (CI 93.7-99.9%), 98.9% (CI 92.7-99.8%), and 87.6% (CI 80.6-92.4%), respectively. Tumors incorrectly graded by FS tended to be of borderline-related. CONCLUSIONS The reliability of the FS methodology was an accurate test to help perform appropriate surgery and plan swift oncological treatment. FS is a reliable method to diagnose invasive malignancies and benign pathology. The communication between the pathologist, surgeon, and medical oncologist is highly important for both intraoperative decision-making and postoperative patient care.
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Affiliation(s)
- Mihaela Asp
- Division of Obstetrics and Gynaecology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ebba Peber
- Faculty of Medicine, Medical Program, Lund University, Lund, Sweden
| | - Päivi Kannisto
- Division of Clinical Genetics and Pathology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna Måsbäck
- Division of Clinical Genetics and Pathology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
| | - Susanne Malander
- Division of Oncology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
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De Decker K, Jaroch KH, Edens MA, Bart J, Kooreman LFS, Kruitwagen RFPM, Nijman HW, Kruse AJ. 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. [PMID: 33539545 PMCID: PMC8359269 DOI: 10.1111/aogs.14105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/26/2022]
Abstract
Introduction Frozen section diagnoses of borderline ovarian tumors are not always straightforward and a borderline frozen section diagnosis with suspicious features of invasive carcinoma (reported as “at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full surgical staging procedure. By performing a systematic review and meta‐analysis, the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses, as well as proportion of patients with a final diagnosis of invasive carcinoma in these cases, were assessed and compared, as quantification of this dilemma may help us with the issue of this clinical decision. Material and methods PubMed, EMBASE and Cochrane library databases were searched and studies discussing “at least borderline” frozen section diagnoses were included in the review. Numbers of specific frozen section diagnoses and subsequent final histological diagnoses were extracted and pooled analysis was performed to compare the proportion of patients diagnosed with invasive carcinoma following borderline and “at least borderline” frozen section diagnoses, presented as risk ratio and risk difference with 95% confidence intervals (95% CI). Results Of 4940 screened records, eight studies were considered eligible for quantitative analysis. A total of 921 women was identified and 230 (25.0%) of these women were diagnosed with “at least borderline” ovarian tumor at the time of frozen section. Final histological diagnoses were reported in five studies, including 61 women with an “at least borderline” diagnosis and 290 women with a straightforward borderline frozen section diagnosis. Twenty‐five of 61 women (41.0%) of the “at least borderline” group had invasive cancer at final diagnosis, compared with 28 of 290 women (9.7%) of the straightforward borderline frozen section group (risk difference −0.34, 95% CI −0.53 to −0.15; relative risk 0.25, 95% CI 0.13–0.50). Conclusions Women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis when compared with women with a straightforward borderline frozen section diagnosis (41.0% vs 9.7%). Especially in the serous subtype, and after preoperative consent, full staging during initial surgery might be considered in these cases to prevent a second surgical procedure.
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Affiliation(s)
- Koen De Decker
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, The Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Joost Bart
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Loes F S Kooreman
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arnold-Jan Kruse
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, The Netherlands.,Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Altman AD, Lefas G, Power L, Lambert P, Lotocki R, Dean E, Nachtigal MW. Rate of Appendiceal Metastasis with Non-Serous Epithelial Ovarian Cancer in Manitoba. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:180-185. [PMID: 28826644 DOI: 10.1016/j.jogc.2017.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study sought to evaluate the rate of appendiceal involvement in non-serous mucinous and endometrioid-associated epithelial ovarian cancers. METHODS The Manitoba Cancer Registry and CancerCare database were used to find all women with non-serous epithelial ovarian, fallopian tube, or primary peritoneal cancer between 1995 and 2011. All patients with an appendectomy were then identified, and their final pathology findings were reviewed. Women who did not receive treatment or lacked follow-up were excluded. RESULTS We identified 338 patients from 1995-2011 with no prior appendectomy. Of these, 16.6% received an appendectomy, and 22.8% were clinically evaluated. Most cases within this cohort were mucinous (62%) and stage 1 (63%). Four appendiceal metastases were identified (7.2%), and one half appeared clinically normal at the time of surgery (3.6%). Within the mucinous histologic type, 32.7% of patients received an appendectomy, with a metastatic rate of 5.7%. Of the 127 endometrioid cases, only 10 patients received an appendectomy, and 2 were found to have metastases. No metastases were found in the 85 patients in the clear cell cohort, only 5 of whom received an appendectomy. CONCLUSION Routine appendectomy or clinical assessment of the appendix is valuable for all non-serous ovarian cancers. The rate of involvement for endometriosis-associated ovarian cancers may be significantly higher than expected, and further studies need to be conducted.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB.
| | - Georgia Lefas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Laura Power
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB
| | - Robert Lotocki
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB
| | - Erin Dean
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Division of Gynecologic Oncology, CancerCare Manitoba, Winnipeg, MB
| | - Mark W Nachtigal
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB
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Brun JL, Fritel X, Aubard Y, Borghese B, Bourdel N, Chabbert-Buffet N, Collinet P, Deffieux X, Dubernard G, Huchon C, Kalfa N, Lahlou N, Marret H, Pienkowski C, Sevestre H, Thomassin-Naggara I, Levêque J. Management of presumed benign ovarian tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol 2014; 183:52-8. [DOI: 10.1016/j.ejogrb.2014.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
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Basaran D, Salman MC, Boyraz G, Selcuk I, Usubutun A, Ozgul N, Yuce K. Accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass: retrospective analysis of 748 cases with multivariate regression analysis. Pathol Oncol Res 2014; 21:113-8. [PMID: 24848925 DOI: 10.1007/s12253-014-9795-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass and to define the clinicopathological factors associated with misdiagnosis during frozen section evaluation. METHODS The clinicopathological data of patients who underwent exploratory laparotomy for adnexal mass were reviewed. Results of the intraoperative frozen section and permanent histology reports were compared. Univariate and multivariate analyses were performed to reveal factors associated with misdiagnosis. RESULTS The study group consisted of 748 patients. Of these patients, 509 (68.0%) had benign, 43 (5.7%) had borderline, 196 (26.2%) had malignant histological diagnosis at permanent section. The overall agreement between intraoperative frozen section and permanent pathology was 96.8%. Twenty four out of 745 cases (3.8%) were misdiagnosed by frozen section. Univariate analysis showed that borderline histology (p < 0.0001) and tumor size larger than 10 cm (p = 0.012) were associated with misdiagnosis. According to multivariate analysis, borderline histology (OR: 22.6, p < 0.0001) was the only independent predictor for misdiagnosis during frozen examination. CONCLUSION The frozen section evaluation of the adnexal mass is highly accurate. However, tumor size greater than 10 cm and borderline histology are the factors that adversely influence the accuracy of intraoperative frozen section. Clinicians must be aware of these pitfalls during intraoperative decision making following frozen section report.
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Affiliation(s)
- Derman Basaran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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Basaran D, Salman MC, Calis P, Ozek A, Ozgul N, Usubütün A, Yuce K. Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis. J OBSTET GYNAECOL 2014; 34:429-34. [PMID: 24734941 DOI: 10.3109/01443615.2014.902043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of our study was to evaluate the accuracy of frozen section (FS) in borderline ovarian tumours (BOT) and to define the factors associated with misdiagnosis during FS evaluation. We performed a retrospective review of patients who underwent exploratory laparotomy for an adnexal mass, from January 2007 to July 2012, at a tertiary oncology centre in Turkey. Patients with a diagnosis of BOT either in FS or in permanent pathology were identified. Agreement between FS diagnosis and permanent histology was observed in 37/59 patients (62.7%), which gave a sensitivity and a positive predictive value of 71.2% and 84.1%, respectively. In patients with a diagnosis of BOT by frozen section only (n = 44), the diagnosis was consistent with permanent histopathology in 37/44 patients (84.1%). Frozen section interpreted a malignant tumour as BOT (under-diagnosis) in 6/44 (13.6%) of cases and interpreted a benign lesion as BOT (over-diagnosis) in 1/44 (2.3%) of cases. Slide review of discrepant cases revealed that major pathological causes of under-diagnosis were misinterpretation and sampling errors. Univariate analysis showed that presence of bilateral tumour and positive peritoneal cytology were associated with under-diagnosis. We concluded that, despite significant risk of under-diagnosis, FS analysis is an accurate method for intraoperative diagnosis of BOTs.
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Turóczi Z, Arányi P, Lukáts Á, Garbaisz D, Lotz G, Harsányi L, Szijártó A. Muscle fiber viability, a novel method for the fast detection of ischemic muscle injury in rats. PLoS One 2014; 9:e84783. [PMID: 24454750 PMCID: PMC3890280 DOI: 10.1371/journal.pone.0084783] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022] Open
Abstract
Acute lower extremity ischemia is a limb- and life-threatening clinical problem. Rapid detection of the degree of injury is crucial, however at present there are no exact diagnostic tests available to achieve this purpose. Our goal was to examine a novel technique - which has the potential to accurately assess the degree of ischemic muscle injury within a short period of time - in a clinically relevant rodent model. Male Wistar rats were exposed to 4, 6, 8 and 9 hours of bilateral lower limb ischemia induced by the occlusion of the infrarenal aorta. Additional animals underwent 8 and 9 hours of ischemia followed by 2 hours of reperfusion to examine the effects of revascularization. Muscle samples were collected from the left anterior tibial muscle for viability assessment. The degree of muscle damage (muscle fiber viability) was assessed by morphometric evaluation of NADH-tetrazolium reductase reaction on frozen sections. Right hind limbs were perfusion-fixed with paraformaldehyde and glutaraldehyde for light and electron microscopic examinations. Muscle fiber viability decreased progressively over the time of ischemia, with significant differences found between the consecutive times. High correlation was detected between the length of ischemia and the values of muscle fiber viability. After reperfusion, viability showed significant reduction in the 8-hour-ischemia and 2-hour-reperfusion group compared to the 8-hour-ischemia-only group, and decreased further after 9 hours of ischemia and 2 hours of reperfusion. Light- and electron microscopic findings correlated strongly with the values of muscle fiber viability: lesser viability values represented higher degree of ultrastructural injury while similar viability results corresponded to similar morphological injury. Muscle fiber viability was capable of accurately determining the degree of muscle injury in our rat model. Our method might therefore be useful in clinical settings in the diagnostics of acute ischemic muscle injury.
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Affiliation(s)
- Zsolt Turóczi
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Péter Arányi
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Ákos Lukáts
- Department of Human Morphology and Developmental Biology, Semmelweis University, Budapest, Hungary
| | - Dávid Garbaisz
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Gábor Lotz
- 2 Department of Pathology, Semmelweis University, Budapest, Hungary
| | - László Harsányi
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Attila Szijártó
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
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Sevestre H, Ikoli JF, Al Thakfi W. Anatomie et cytologie pathologiques des tumeurs supposées bénignes de l’ovaire. ACTA ACUST UNITED AC 2013; 42:715-21. [DOI: 10.1016/j.jgyn.2013.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oge T, Yalcin OT, Ozalp SS, Kebapci M, Aydin Y, Telli E. Sonographically guided core biopsy: a minimally invasive procedure for managing adnexal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2023-2027. [PMID: 24154907 DOI: 10.7863/ultra.32.11.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department. METHODS We reviewed the medical records of 55 patients who underwent sonographically guided core biopsies in our gynecologic oncology department between 2010 and 2013. Patients with suspected ovarian malignancies who were unsuitable for optimal debulking surgery and patients at risk for higher morbidity and mortality because of a poor performance status, suspected nongynecologic tumors, and peritoneal tuberculosis were indicated for sonographically guided biopsy. RESULTS The indications for sonographically guided core biopsy were candidacy for suboptimal cytoreduction (n = 32 [58.2%]), a poor performance status (n = 11 [20.0%]), and suspected nongynecologic tumors (n = 12 [21.8%]). Histopathologic evaluations revealed primary ovarian tumors in 36 patients (65.5%). Tuberculosis was found to be the second most common disease (n = 8 [14.5%]) among the patients who underwent core biopsies. In 2 patients (3.6%), histologic examination revealed metastatic colorectal cancer. CONCLUSIONS Sonographically guided core biopsy may be preferred as a minimally invasive procedure for managing adnexal masses, particularly in patients with advanced ovarian cancer and high comorbidities who might benefit from neoadjuvant chemotherapy and in cases of suspected nongynecologic tumors, including pelvic tuberculosis.
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Affiliation(s)
- Tufan Oge
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, 26100 Eskisehir, Turkey.
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Peptide-fluorescent bacteria complex as luminescent reagents for cancer diagnosis. PLoS One 2013; 8:e54467. [PMID: 23349898 PMCID: PMC3548802 DOI: 10.1371/journal.pone.0054467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 12/11/2012] [Indexed: 12/22/2022] Open
Abstract
Currently in clinic, people use hematoxylin and eosin stain (H&E stain) and immunohistochemistry methods to identify the generation and genre of cancers for human pathological samples. Since these methods are inaccurate and time consuming, developing a rapid and accurate method to detect cancer is urgently demanded. In our study, binding peptides for lung cancer cell line A549 were identified using bacteria surface display method. With those binding peptides for A549 cells on the surface, the fluorescent bacteria (Escherichia coli with stably expressed green fluorescent protein) were served as specific detecting reagents for the diagnosis of cancers. The binding activity of peptide-fluorescent bacteria complex was confirmed by detached cancer cells, attached cancer cells and mice tumor xenograft samples. A unique fixation method was developed for peptide-bacteria complex in order to make this complex more feasible for the clinic use. This peptide-fluorescent bacteria complex has great potential to become a new diagnostic tool for clinical application.
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