Öz
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.
Anahtar Kelimeler
Frozen section paraffin section intraoperative consultation ovary
Kaynakça
- Yeo EL, Yu KM, Poddar NC, Hui PK, Tang LC. The accuracy of intraoperative frozen section in the diagnosis of ovarian tumors. J Obstet Gynaecol Res 1998; 24: 189-95.
- Twaalfhoven FC, Peters AA, Trimbos JB, Hermans J, Fleuren GJ. The accuracy of frozen section diagnosis of ovarian tumors. Gynecol Oncol 1991; 41: 189-92. Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008; 27: 353-65.
- Ismiil N, Ghorab Z, Nofech-Mozes S, Plotkin A, Covens A, Osborne R, Kupets R, Khalifa MA. Intraoperative consultation in gynecologic pathology: a 6-year audit at a tertiary care medical center. Int J Gyenecol Cancer 2009; 19: 152-7.
- Zarbo RJ, Hoffman GG, Howanitz PJ. Interinstitutional comparison of frozensection consultation. A College of American Pathologists Q-Probe study of 79,647 consultations in 297 North American institutions. Arch Pathol Lab Med 1991; 115: 1187-94.
- Cross PA, Naik R, Patel A, Nayar AG, Hemming JD, Williamson SL, Henry JA, Edmondson RJ, Godfrey KA, Galaal K, Kucukmetin A, Lopes AD. Intraoperative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012; 119: 194-201.
- Yermez E, Ata N, Sekü İ, Balsak D, Sancı M, İspahi Ç. Frozeni Borderline Gelen Over Tümörlerinin Frozen ve Kalıcı Histopatolojik Sonuçlarının Karşılaştırılması. Türkiye Klinikleri J Gynecol Obst 2006; 16: 165-9.
- Fırat P, Mocan G, Usubütün A, Özdamar Ş, Küçükali T, Ayhan A. Overin germ hücreli neoplazmları: İntraoperatif konsültasyonun tanı değeri. Patoloji Bülteni 2000; 17: 155-8.
- Usubütün A, Küçükali T. Cerrahi patolojide ve jinekolojik onkolojide “frozen section”. Ankara Patoloji Bülteni 1999; 16: 46-8.
- İlker A, Aykut B, Müge H, İbrahim HM, Ülkü OB, Şener G, Suna S. Accuracy of intra-operative frozen section in the diagnosis of ovarian tumours. J Pak Med Assoc 2011; 61: 856-8.
- Pongsuvareeyakul T, Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Siriaunkgul S. Accuracy of frozen-section diagnosis of ovarian mucinous tumors. Int J Gynecol Cancer 2012; 22: 400-6.
- Chen EY, Lee KR, Nucci MR. Intraoperative evaluation of ovarian tumors. In Crum CP, Nucci MR, Lee KR (Eds). Diagnostic Gynecologic and Obstetric Pathology. Second ed., Philadelphia, Elsevier Saunders 2011; 800-7.
- Wang KG, Chen TC, Wang TY, Yang YC, Su TH. Accuracy of frozen section diagnosis in gynecology. Gynecol Oncol 1998; 70: 105-10.
- Bige Ö, Koyuncuoğlu M, Saygılı U, Kaymaz C, Doğan E, Celiloğlu M. Frozen Kesit İncelemesinin Over Kaynaklı Neoplazileri Teşhis Etmedeki Doğruluk Oranı: Patoloğun Rolü: Dokuz Eylül Üniversitesi Hastanesi Tecrübesi. Türkiye Klinikleri J Gynecol Obst 2007; 17: 255-61.
Öz
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, ovaryAnahtar Kelimeler
Kaynakça
- Yeo EL, Yu KM, Poddar NC, Hui PK, Tang LC. The accuracy of intraoperative frozen section in the diagnosis of ovarian tumors. J Obstet Gynaecol Res 1998; 24: 189-95.
- Twaalfhoven FC, Peters AA, Trimbos JB, Hermans J, Fleuren GJ. The accuracy of frozen section diagnosis of ovarian tumors. Gynecol Oncol 1991; 41: 189-92. Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008; 27: 353-65.
- Ismiil N, Ghorab Z, Nofech-Mozes S, Plotkin A, Covens A, Osborne R, Kupets R, Khalifa MA. Intraoperative consultation in gynecologic pathology: a 6-year audit at a tertiary care medical center. Int J Gyenecol Cancer 2009; 19: 152-7.
- Zarbo RJ, Hoffman GG, Howanitz PJ. Interinstitutional comparison of frozensection consultation. A College of American Pathologists Q-Probe study of 79,647 consultations in 297 North American institutions. Arch Pathol Lab Med 1991; 115: 1187-94.
- Cross PA, Naik R, Patel A, Nayar AG, Hemming JD, Williamson SL, Henry JA, Edmondson RJ, Godfrey KA, Galaal K, Kucukmetin A, Lopes AD. Intraoperative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012; 119: 194-201.
- Yermez E, Ata N, Sekü İ, Balsak D, Sancı M, İspahi Ç. Frozeni Borderline Gelen Over Tümörlerinin Frozen ve Kalıcı Histopatolojik Sonuçlarının Karşılaştırılması. Türkiye Klinikleri J Gynecol Obst 2006; 16: 165-9.
- Fırat P, Mocan G, Usubütün A, Özdamar Ş, Küçükali T, Ayhan A. Overin germ hücreli neoplazmları: İntraoperatif konsültasyonun tanı değeri. Patoloji Bülteni 2000; 17: 155-8.
- Usubütün A, Küçükali T. Cerrahi patolojide ve jinekolojik onkolojide “frozen section”. Ankara Patoloji Bülteni 1999; 16: 46-8.
- İlker A, Aykut B, Müge H, İbrahim HM, Ülkü OB, Şener G, Suna S. Accuracy of intra-operative frozen section in the diagnosis of ovarian tumours. J Pak Med Assoc 2011; 61: 856-8.
- Pongsuvareeyakul T, Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Siriaunkgul S. Accuracy of frozen-section diagnosis of ovarian mucinous tumors. Int J Gynecol Cancer 2012; 22: 400-6.
- Chen EY, Lee KR, Nucci MR. Intraoperative evaluation of ovarian tumors. In Crum CP, Nucci MR, Lee KR (Eds). Diagnostic Gynecologic and Obstetric Pathology. Second ed., Philadelphia, Elsevier Saunders 2011; 800-7.
- Wang KG, Chen TC, Wang TY, Yang YC, Su TH. Accuracy of frozen section diagnosis in gynecology. Gynecol Oncol 1998; 70: 105-10.
- Bige Ö, Koyuncuoğlu M, Saygılı U, Kaymaz C, Doğan E, Celiloğlu M. Frozen Kesit İncelemesinin Over Kaynaklı Neoplazileri Teşhis Etmedeki Doğruluk Oranı: Patoloğun Rolü: Dokuz Eylül Üniversitesi Hastanesi Tecrübesi. Türkiye Klinikleri J Gynecol Obst 2007; 17: 255-61.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2014 |
| Yayımlandığı Sayı | Yıl 2014 |