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Gynaecological oncology
Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience
Article first published online: 6 SEP 2011
DOI: 10.1111/j.1471-0528.2011.03129.x
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG
Issue
BJOG: An International Journal of Obstetrics & Gynaecology
Special Issue: Gynaecological oncology
Volume 119, Issue 2, pages 194–201, January 2012
Additional Information
How to Cite
Cross, P., Naik, R., Patel, A., Nayar, A., Hemming, J., Williamson, S., Henry, J., Edmondson, R., Godfrey, K., Galaal, K., Kucukmetin, A. and Lopes, A. (2012), Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 194–201. doi: 10.1111/j.1471-0528.2011.03129.x
Publication History
- Issue published online: 13 DEC 2011
- Article first published online: 6 SEP 2011
- Accepted 17 July 2011. Published Online 6 September 2011.
Keywords:
- Diagnostic test;
- frozen section;
- likelihood ratio;
- ovarian cancer;
- sensitivity and specificity
Please cite this paper as: Cross P, Naik R, Patel A, Nayar A, Hemming J, Williamson S, Henry J, Edmondson R, Godfrey K, Galaal K, Kucukmetin A, Lopes A. Intra-operative frozen section analysis for suspected early-stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012;119:194–201.
Objective In centres in which intra-operative frozen section (FS) analysis is not performed, ‘apparent’ early-stage ovarian cancer diagnosed after surgery on paraffin section may require further restaging laparotomy or adjuvant chemotherapy. Previous studies on FS analysis have reported high sensitivity, specificity and overall accuracy. The objective of this article is to present the largest published dataset on the accuracy of FS analysis over an 11-year period from a single institution.
Design Diagnostic test accuracy.
Setting Northern Gynaecological Oncology Centre and Department of Cellular Pathology, Gateshead, UK.
Population 1439 intra-operative FS analyses performed between January 2000 and December 2010 for suspected ovarian cancer.
Methods Prospectively collected data on FS analysis were compared with gold standard paraffin section.
Main outcome measures Sensitivity, specificity, likelihood ratios and post-test probability.
Results The overall sensitivity and specificity of FS analysis were 91.2% and 98.6%, respectively. Positive and negative likelihood ratios were 64.7% and 0.09%, respectively. The pre-test probability of an ovarian tumour being borderline or malignant was 45.8%. When FS analysis was reported to be positive, the post-test probability increased to 98% (confidence interval, 97–99%). Conversely, when FS analysis was reported to be negative, the post-test probability decreased to 7% (confidence interval, 6–9%). The majority of false test results were either borderline tumours or of mucinous differentiation.
Conclusions Intra-operative FS analysis has excellent diagnostic test accuracy and assists gynaecological oncologists to perform the appropriate surgery in 95% of cases, thereby preventing the morbidity of surgical staging in benign cases and the morbidity of restaging procedures or chemotherapy in early-stage malignant tumours.