Over lezyonlarında beş yıllık intraoperatif konsültasyon sonuçlarımızın değerlendirmesi

Aim. Intraoperative consultation has an important role in the diagnosis and treatment of ovarian masses. During surgery, the correct classification as benign, borderline or malignant (primary/metastatic) provides to appropriate surgical staging. This retrospective study was undertaken to determine the accuracy of intraoperative consultation results in ovarian lesions and to review the diagnostic problems that may be causing the error. Method. Between January 2007December 2011, the diagnoses of 246 intraoperative consultations applied to the ovarian lesions were examined retrospectively. Twenty-five out of 246 of these sections belonged to the same patient. Frozen section diagnoses were compared with paraffin section diagnoses. Results. The mean age of the patients was 46.7±16 (17-87). There was an agreement in diagnosis between frozen and paraffin section in 96.3%. The sensitivity of malignant cases, 96.9%, specificity was 100%. The positive predictive value of malignant cases was 100%, negative predictive value of benign cases was 100%. In series had no false positive, false negative rate was 6%. Diagnosis had been deferred in 2.4% of the cases. The incompatible diagnoses caused by limited sampling during intraoperative consultation. There were metastatic tumors in 3.7%, mixed type tumors in 2%. Conclusion. The concensus between the gynecologist and the pathologist is very important in intraoperative consultation process. In our series, the sensitivity and specificity of the frozen application in ovarian lesions were high, and the our results are reliable. It was concluded that increasing the number of samples for especially in large tumors will decrease the false-negative rate.

Özet

Amaç. İntraoperatif konsültasyon, over kitlelerinin tanı ve tedavisinde önemli yeri olan bir uygulamadır. Ameliyat esnasında, histopatolojik incelemede overdeki kitlenin benign, borderline ve malign (primer/metastatik) olarak doğru sınıflandırılması uygun cerrahi evrelemenin yapılabilmesine olanak sağlar. Bu retrospektif çalışmanın amacı over lezyonlarında intraoperatif konsültasyon sonuçlarımızın doğruluk oranını saptamak ve hataya neden olabilecek tanı sorunlarını gözden geçirmektir. Yöntem. Ocak 2007-Aralık 2011 tarihleri arasında over lezyonlarına uygulanan ve 25’i aynı hastaya ait olan 246 frozen sonucu retrospektif olarak değerlendirildi. Frozen kesit tanıları parafin kesit tanıları ile karşılaştırıldı. Bulgular. Hastaların yaş ortalaması 46,7±16 (17-87) olarak saptandı. Frozen kesit sonuçlarının %96,3’ü parafin kesit tanıları ile uyumluydu. Malign olguların sensitivitesi %96,9; spesifitesi %100 idi. Malign olguların pozitif öngörücü değeri %100 ve benign olguların negatif öngörücü değeri %100 olarak saptandı. Yanlış pozitiflik saptanmayan seride, yanlış negatiflik oranı %6 iken, olguların %2,4’ünde tanı parafin takibe bırakılmıştı. Uyumsuz tanılarda hata nedeni intraoperatif konsültasyon sırasındaki örnekleme sayısının azlığına bağlandı. Olguların %3,7’si metastatik tümör iken, %2’si mikst tipte primer over tümörü idi. Sonuç. İntraoperatif konsültasyon sürecinde jinekolog ile patoloğun iletişimi oldukça önemlidir. Serimizde over lezyonlarında yapılan frozen uygulamasının sensitivitesi ve spesifitesi yüksek bulundu ve intraoperatif konsültasyon sonuçlarımızın güvenilir olduğu, özellikle büyük tümörlerde örnek sayısının arttırılması ile yanlış negatiflik oranının azalacağı sonucuna varıldı.

Anahtar sözcükler: Frozen kesit, parafin kesit, intraoperatif konsültasyon, over

 

Abstract

Aim. Intraoperative consultation has an important role in the diagnosis and treatment of ovarian masses. During surgery, the correct classification as benign, borderline or malignant (primary/metastatic) provides to appropriate surgical staging. This retrospective study was undertaken to determine the accuracy of intraoperative consultation results in ovarian lesions and to review the diagnostic problems that may be causing the error. Method. Between January 2007-December 2011, the diagnoses of 246 intraoperative consultations applied to the ovarian lesions were examined retrospectively. Twenty-five out of 246 of these sections belonged to the same patient. Frozen section diagnoses were compared with paraffin section diagnoses. Results. The mean age of the patients was 46.7±16 (17-87). There was an agreement in diagnosis between frozen and paraffin section in 96.3%. The sensitivity of malignant cases, 96.9%, specificity was 100%. The positive predictive value of malignant cases was 100%, negative predictive value of benign cases was 100%. In series had no false positive, false negative rate was 6%. Diagnosis had been deferred in 2.4% of the cases. The incompatible diagnoses caused by limited sampling during intraoperative consultation. There were metastatic tumors in 3.7%, mixed type tumors in 2%. Conclusion. The concensus between the gynecologist and the pathologist is very important in intraoperative consultation process. In our series, the sensitivity and specificity of the frozen application in ovarian lesions were high, and the our results are reliable. It was concluded that increasing the number of samples for especially in large tumors will decrease the false-negative rate.

Keywords: Frozen section, paraffin section, intraoperative consultation, ovary