Comparative Study between Intraoperative Frozen Section and Scrape Smear Cytology in the Diagnosis of Ovarian Neoplasm

Amany M. Abdelghany, Essa M. Arafa, Nadia M. Madkour, Wael S. Nossair^*, Ekramy A. Mohamed, Walid A. Abdelsalam, Amira A. Salem

Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

DOI: 10.4236/ojog.2015.51005                

Abstract

Objective: The aim of this work is to compare between intraoperative frozen section and scrape smear cytology in the diagnosis of ovarian neoplasm. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The area was scraped with a sharp scalpel or the end of a glass slide, depending upon the type of tissue. A semifluid drop thus obtained was spread over a glass slide. One to four slides per case were taken from different representative areas. The slides were labelled and immediately put into 95% ethyl alcohol and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of benign ovarian masses were 100%, 95.2%, 96.7%, 100% and 98% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of border line ovarian masses were 100%, 93.4%, 25%, 100% and 94% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of malignant ovarian masses were 80%, 100%, 100%, 88.2% and 92% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of benign ovarian masses were 100%, 100%, 100%, 100% and 100% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of borderline ovarian masses were 100%, 95.9%, 33.3%, 100% and 96% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of malignant ovarian masses were 90%, 100%, 100%, 93.8% and 96% respectively. Conclusion: Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparations were helpful in supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in the intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.

Keywords

Frozen Section, Intraoperative Assessment, Scrape Smear Cytology, Ovarian

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	DiSaia, P.J. and Creasman, W.T. (2008) The Adnexal Mass and Early Ovarian Cancer. 7th Edition, Clinical Gynecologic Oncology, Mosby, Chapter 10, 283-312.
[2]	Stewart, C.J., Brennan, B.A., Hammond, I.G., Leung, Y.C. and McCartney, A.J. (2006) Intraoperative Assessment of Ovarian Tumors: A 5-Year Review with Assessment of Discrepant Diagnostic Cases. International Journal of Gynecological Pathology, 25, 216-222.
[3]	Khunamornpong, S. and Siriaunkgul, S. (2003) Scrape Cytology of the Ovaries: Potential Role in Intraoperative Consultation of Ovarian Lesions. Diagnostic Cytopathology, 28, 250-257. http://dx.doi.org/10.1002/dc.10273
[4]	Alvarez Santín, C., Sica, A., Melesi, S., Feijó, A., Garrido, G. and Rodríguez Alvarez, C. (2011) Contribution of Intra-operative Cytology to the Diagnosis of Ovarian Lesions. Acta Cytologica, 55, 85-91. http://dx.doi.org/10.1159/000320859
[5]	Stewart, C.J., Brennan, B.A., Koay, E., Naran, A. and Ruba, S. (2010) Value of Cytology in the Intraoperative Assessment of Ovarian Tumors: A Review of 402 Cases and Comparison with Frozen Section Diagnosis. Cancer Cytopathology, 118, 127-136. http://dx.doi.org/10.1002/cncy.20073
[6]	Kolte, S.S. and Satarkar, R.N. (2010) Role of Scrape Cytology in the Intraoperative Diagnosis of Tumor. Journal of Cytology, 27, 86-90. http://dx.doi.org/10.4103/0970-9371.71871
[7]	Deb, P., Malik, A. and Sinha, K.K. (2011) Intraoperative Scrape Cytology: Adult Granulosa Cell Tumor of Ovary. Journal of Cytology, 28, 207-209. http://dx.doi.org/10.4103/0970-9371.86350
[8]	Kar, T., Kar, A. and Mohapatra, P.C. (2005) Intra-Operative Cytology of Ovarian Tumors. The Journal of Obstetrics and Gynecology of India, 55, 345-349.
[9]	Ilvan, S., Ramazanoglu, R., Ulker Akyildiz, E., et al. (2005) The Accuracy of Frozen Section (Intraoperative Consultation) in the Diagnosis of Ovarian Masses. Gynecologic Oncology, 97, 395-399. http://dx.doi.org/10.1016/j.ygyno.2005.01.037
[10]	Geomini, P., Bremer, G., Kruitwagen, R., et al. (2005) Diagnostic Accuracy of Frozen Section Diagnosis of the Adnexal Mass: A Meta-Analysis. Gynecologic Oncology, 96, 1-9. http://dx.doi.org/10.1016/j.ygyno.2004.09.042
[11]	Heatley, M.K. (2012) A Systematic Review of Papers Examining the Use of Intraoperative Frozen Section in Predicting the Final Diagnosis of Ovarian Lesions. International Journal of Gynecological Pathology, 31, 111-115. http://dx.doi.org/10.1097/PGP.0b013e318226043b
[12]	Ilker, A., Aykut, B., Muge, H., Ibrahim, H.M., Ulku, O.B., Sener, G., et al. (2011) Accuracy of Intra-Operative Frozen Section in the Diagnosis of Ovarian Tumors. Journal Pakistan Medical Association, 61, 856-858.
[13]	Wootipoom, V., Dechsukhum, C., Hanprasertpong, J., et al. (2006) Accuracy of Intra-Operative Frozen Section in Diagnosis of Ovarian Tumors. Journal of the Medical Association of Thailand, 89, 577-582.
[14]	Stewart, C.J., Brennan, B.A., Koay, E., Naran, A. and Ruba, S. (2010) Value of Cytology in the Intraoperative Assessment of Ovarian Tumors: A Review of 402 Cases and Comparison with Frozen Section Diagnosis. Cancer Cytopathology, 118, 127-136. http://dx.doi.org/10.1002/cncy.20073
[15]	Tempfer, C.B., Polterauer, S., Bentz, E.K., Reinthaller, A. and Hefler, L.A. (2007) Accuracy of Intra-Operative Frozen Section Analysis in Borderline Tumors of the Ovary: A Retrospective Analysis of 96 Cases and Review of the Literature. Gynecologic Oncology, 107, 248-252. http://dx.doi.org/10.1016/j.ygyno.2007.06.008
[16]	Brun, J.L., Cortez, A., Rouzier, R., et al. (2008) Factors Influencing the Use and Accuracy of Frozen Section Diagnosis of Epithelial Ovarian Tumors. American Journal of Obstetrics and Gynecology, 199, 244. http://dx.doi.org/10.1016/j.ajog.2008.04.002
[17]	Coffey, D., Kaplan, A.L. and Ramzy, I. (2005) Intraoperative Consultation in Gynecologic Pathology. Archives of Pathology and Laboratory Medicine, 129, 1544-1557.
[18]	Rao, S., Sadiya, N., Joseph, L.D. and Rajendiran, S. (2009) Role of Scrape Cytology in Ovarian Neoplasms. Journal of Cytology, 26, 26-29. http://dx.doi.org/10.4103/0970-9371.54864
[19]	Gal, R. (1988) Scrape Cytology Assessment of Margins of Lumpectomy Specimens in Breast Cancer. Acta Cytologica, 32, 838-839.
[20]	Mair, S., Lash, R.H., Suskin, D. and Mendelsohn, G. (1991) Intraoperative Surgical Specimen Evaluation: Frozen Section Analysis, Cytologic Examination, or Both? American Journal of Clinical Pathology, 96, 8-14.
[21]	Shidham, V.B., Dravid, N.V., Grover, S. and Kher, A.V. (1984) Role of Scrape Cytology in Rapid Intraoperative Diagnosis: Value and Limitations. Acta Cytologica, 28, 477-482.
[22]	Esteban, J.M., Zaloudek, C. and Silverberg, S.G. (1987) Intraoperative Diagnosis of Breast Lesion: Comparison of Cytologic with Frozen Section Technics. American Journal of Clinical Pathology, 88, 681-688.