Intraoperative Frozen Section Analysis

The reliability and accuracy of frozen-section diagnosis are critical determinants in the selection of the appropriate surgical procedure. Medeiros and colleagues72 performed a quantitative meta-analysis of 14 studies that estimate the accuracy of frozen

Table 7-3. Surgical Outcomes of 20 Patients Who Underwent Comprehensive Laparoscopic Surgical Staging for Apparent Stage I Ovarian Cancer and 30 Patients Who Underwent Laparotomy

Group 1 Laparoscopy

Group 2 Laparotomy

Variables

Group (N = 20)

Group (N = 30)

P Value

Number of nodes

Left pelvic

5.8 ± 2.9

7.1 ± 4.3

.30

Right pelvic

6.5 ± 3.9

7.6 ± 3.8

.31

Left para-aortic

2.9 ± 1.7

4.8 ± 4.2

.08

Right para-aortic

3.8 ± 1.8

4.4 ± 2.8

.36

Omental specimen (cm3)

186 ± 178

347 ± 378

.09

Site of metastasis (%)

2 (10)

3 (10)

1.00

Uterus

1 (5)

1 (3)

Nodes

1 (5)

2 (7)

Omentum

0

0

Other surgery (%)

Estimated blood loss (mL) 235 ± 138 367 ± 208 .003

Hospital stay (days) 3.1 ± 0.7 5.8 ± 2.6 <.001

Estimated blood loss (mL) 235 ± 138 367 ± 208 .003

Hospital stay (days) 3.1 ± 0.7 5.8 ± 2.6 <.001

From Chi DS, Abu-Rustum NR, Sonoda Y, et al: The safety and efficacy of laparoscopic surgical staging of apparent stage I ovarian and fallopian tube cancers. Am J Obstet Gynecol 192:1614-1619, 2005, Table II.

section in the diagnosis of ovarian tumors. Among the broad sample of ovarian tumors in this systematic review, 71% were benign, 5.9% were borderline, and 22.7% were malignant. The pooled sensitivity rates for benign and malignant ovarian tumors were 99% and 94%. The positive frozen-section results for malignancy increased the probability of ovarian cancer to 98%, whereas a negative result reduced the probability of cancer to 1.6%. The pooled sensitivity for borderline ovarian tumors, however, was low at 66% owing to the greater incidence of false-negative results. Insufficient tumor removal, technical problems in sampling, and the range of experience of pathologist may have contributed to the reduced sensitivity among borderline cases, resulting in a post-test probability of borderline tumors that was only 51% when compared with malignant tumors.72 Thus, in patients in whom the result is a diagnosis of borderline tumor in the frozen section, the surgeon should still consider performing comprehensive staging.

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