Comparative Diagnostic Accuracy of Frozen Sections and Scrape Cytology in Ovarian Neoplasms

Role of scrape cytology smear preparation in the diagnosis of ovarian masses-utility and pitfalls

BACKGROUND

Scrape cytology technique is useful for rapid intraoperative diagnosis of ovarian mass lesions that acts as an adjunct to frozen section examination. Though ovaries can be accessed by laparoscopy and USG guided FNAC, there are controversial reports regarding the safety of these procedures. The present study has been designed to evaluate the role of scrape cytology in a variety of ovarian mass lesions.

OBJECTIVES

To study the cyto-morphology of ovarian mass lesions and to evaluate the role of scrape cytology technique in correctly diagnosing the ovarian lesions taking histopathological diagnosis as gold standard.

MATERIAL AND METHODS

This is a prospective observational study done on 61 ovarian mass lesions as received from the Obstetrics and Gynecology department of our Institution.

RESULT

Out of 61 cases, 58 (95.08%) cases were correctly diagnosed with respect to categorization and typing. The age ranged from 14 to 65 years with the mean age being 38.1 years. On histopathology, out of 61 cases, 39 (63.93%) were epithelial along with sub categorization of benign, borderline, and malignant, 13 (22.9%) were germ cell tumors, 5(8.19%) were sex cord stromal tumors, 3 (4.91%) were hemorrhagic cysts and the remaining 1 (1.63%) was massive ovarian edema. Thus, on comparing with histopathology, the sensitivity and specificity of scrape cytology technique were 93.55% and 96.67%, and the diagnostic accuracy was 95.08%.

CONCLUSION

Scrape cytology of ovarian lesions can give quick and reliable results. Also, proper training of cytopathologists chiefly regarding the sampling technique, gross presentation of ovarian lesions and interpretation of scrape cytology smears is needed. Further studies to provide standard guidelines and reporting criteria will prove to be helpful.

Diagnostic Utility and Accuracy of Scrape Cytology in Evaluation of Neoplastic Lesions

Background

Frozen section, intraoperative fine needle aspiration cytology (FNAC) and imprint cytology have been used traditionally by the surgical pathology laboratories for rapid intraoperative diagnosis of tumors. Scrape cytology is a modification of imprint cytology that involves lightly scraping or brushing cells from freshly cut surface of the surgically removed tumor specimens. The present study was carried out to evaluate the utility of scrape cytology in diagnostic evaluation of tumors.

Material and Methods

A prospective study was carried out at a tertiary care teaching hospital in Central India. A total of 50 consecutively received specimens in the Department of Pathology and Laboratory Medicine with clinical or radiological suspicion of neoplasia were included in the study. Scrape smears were prepared from freshly cut surface of tumor specimens received unfixed or in 10% formalin.

Results

Overall, the scrape cytology diagnosis was concordant with final histopathological diagnosis in 48 out of 50 cases with a diagnostic accuracy of 96%. The sensitivity was 90.9% (CI-58.72% to 99.77%) and specificity was 97.4%(CI-86.52% to 99.94%). Positive predictive value and negative predictive value were 90.91% and 97.44%, respectively.

Conclusion

Scrape cytology is a cost-effective and reasonably accurate cytodiagnostic technique for rapid tumor diagnosis. Scrape cytology can be a useful supplementary tool to frozen section, and may be applied for rapid diagnosis where frozen section technique is not available. The material and knowledge obtained from scrape cytology of routinely received histopathological specimens can be utilized as a teaching material and may help unveil diagnostic cytopathological features of infrequent cytologically encountered lesions.

The role of preoperative imaging and tumor markers in predicting malignant ovarian masses in children

PURPOSE

To investigate the clinicopathololgic characteristics and the predicting value of preoperative imaging and tumor markers in children with ovarian masses.

METHODS

Patients admitted in Shanghai children's hospital with ovary neoplasms between 2010.01 and 2015.12 were retrospectively analyzed. The medical records including age at operation, presentation of symptoms and signs, tumor marker, imaging, pathology, tumor diameter and surgical choice were reviewed. All data were analyzed using SPSS 17.0 RESULTS: A total of 139 patients were included, among which 116 were benign neoplasms and 23 malignant tumors. There was significance difference relation with the tumor diameter, character, torsion and tumor markers, but not the age, position, calculi, and symptoms. The risk factors include tumor diameters ≥ 10 cm, the odds ratio (OR) was 11, 95% confidence interval (CI) was 3-36, solid/complex tumor (OR 6, 95% CI 2, 14) and positive in tumor markers (OR 84, 95% CI 20, 345). Among the patients with benign neoplasms, 77 of them had laparoscopic ovarian cystectomy while 23 patients with malignant tumors had salpingo-oophorectomy and omentum resection.

CONCLUSION

Preoperative imaging and tumor markers could help identifying the malignant ovarian masses in children. If tumor diameter ≥ 10 cm, solid/complex in imaging and tumor markers abnormal, a radical resection is mandatory; otherwise, an ovarian-sparing surgery is recommended.