Krithiga and Priya: Correlation between histopathology and frozen study of ovarian carcinoma


Introduction

The frozen section procedure is a pathological laboratory procedure to perform fast microscopic analysis of a specimen.1 The technical name for this procedure is cryosection. Using this procedure

The accuracy of frozen section diagnosis concluded that for tumors that were clearly either benign or malignant the accuracy of the frozen section was good which was later confirmed by regular biopsy. On the contrary, where the frozen section diagnosis was a borderline tumor, the diagnosis was less accurate.2

The frozen section is used to guide intraoperative or perioperative patient management as it provides rapid diagnosis. Thus it is used to provide a more efficient management to the patient.3

Ovarian cancer is one of the most common cancer in women, especially women aged over 60 years.

Ovarian cancer mostly goes undetected until it has spread within the pelvis and abdomen. At the late stage, ovarian cancer is more difficult to treat but if it is detected in early stages, in which the disease is confined to the ovary, is more likely to be treated successfully.4

The type of ovarian cancer is determined from the type of cell from where the cancer has begun.

WHO has classified ovarian tumours into 4 categories:

Epithelial tumours — it is the most commonest type of ovarian tumours

  1. Germ cell tumours — it comprises 10-20% of ovarian tumours

  2. Sex cord -stromal tumours — it comprises about 5% of ovarian tumours

  3. Others

The cryostat is the instrument to freeze the tissue and additionally to chop the frozen tissue for microscopic section. The freezing of the tissue sample converts the water to ice.5 Within the tissue there is a firm ice which acts as embedding media to cut the tissue.6

Periodic review of the correlation between the frozen section diagnosis and final diagnosis is useful to identify the potential causes of errors and thus measures can be implemented to help prevent similar occurrences.7 Proper guidelines will definitely help to reduce such occurrences. So strict guidelines should be followed to prevent these errors.

Methods and materials

The study was carried out in the Frozen Section and Histopathology Division of Department of Pathology, Saveetha medical college and hospitals, Chennai from July 2017 to July 2018. A total of 30 cases were taken.

Fresh tissue was sent to the frozen section room and the specimens were dissected and inspected.8 Optimal cooling temperature compound is used to cut out blocks on the cryostat. After which it is stained by hematoxylin-eosin staining. Immediately the frozen section diagnoses are informed to the concerned authorities.9

The non-frozen tissues were then sent to the histopathological lab where it is fixed in 10% for malin solution and processed for routine paraffin section followed by hematoxylin-eosin staining on the next day and further reporting was done.10

The impression of frozen histology and histopathology was compared and the accuracy and specificity of the frozen section reporting was determined in comparison to the routine histopathology reporting.11

A total of 30 cases were taken and the histopathological and frozen section diagnosis were compared.

Figure 1

A pathological specimen of ovarian carcinoma

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Figure 2

Histology of ovarian carcinoma

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Figure 3

Histopathology of ovarian carcinoma

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Figure 4

Intraoperative frozen section diagnosis

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Correlation between the frozen diagnosis and histopathological diagnosis of ovarian carcinoma

Table 1
S. No Hospital number Age Frozen histology Histopathology
1 1608150092 55 benign ovarian tumor fibroma of ovary
2 1608270035 53 malignant mucinous adenocarcinima of ovary mucinous adenocarcinoma of ovary
3 1609080023 39 benign mucinous cystadenoma with he morrhage benign cystic teratoma
4 1610060073 48 bilateral high grade serous carcinima of both ovaries bilateral high grade serous carcinoma of both ovaries
5 1611100010 17 boderline mucinous tumor boderline mucinous tumor
6 1408153236 47 fibrothecoma of both ovaries ovarian fibrothecoma
7 1701241013 50 mucinous neoplasm mucinous boderline tumor
8 1701040104 65 sertoli leydig cell tumor serous highgrade ca rcinoma
9 1608180045 17 benign serous cystadenofibroma benign serous cystadenofibroma
10 161100126 55 benign serous cystadenofibroma benign serous cystadenofibroma
11 1702090068 37 benign cystic teratoma benign cystic teratoma
12 1702160036 43 benign cyst probably serous cystadenoma benign serous cystadenoma
13 1702240120 29 mixed germ cell tumor of ovary mixed malignant germ cell tumor
14 1703150078 60 mucinous cystadenoma of ovary mucinous cystadenoma
15 1703130006 63 benign mucinous cyst benign mucious cystadenoma of right ovary
16 1703170010 52 benign serous cystofibroma serous boderline tumor
17 170325014 53 benign cystic teratoma benign cystic teratoma
18 1704070185 64 benign serous cystadenofibroma benign serous cystadenofibroma
19 1703160043 49 benign mucinous cystadenoma of ovary benign mucious cystadenoma
20 1704270119 70 benign serous cystadenoma ovary benign serous cystadenoma of ovary
21 1705080235 44 serotic leydig cell tumor right ovary lipid cell tumor
22 1706271109 46 granulosa cell tumor adult granulosa cell tumor of right ovary
23 1710091009 23 benign mucinous cystadenoma benign mucinous cystadenoma of ovary
24 1803280018 21 benign papillary serous cystadenofibroma benign serous cystadenofibroma of ovary
25 1804140042 60 benign mucinous cyst benign mucinous cystadenofibroma
26 1805310297 45 benign fibrothicoma ovary benign ovarian fibroma of left ovary
27 1807120042 50 atypical proliferative mucinous tumor boderline mucinous tumor
28 1810030254 28 benign mucinous cystadenoma of ovary benign mucinous cystadenoma of ovary
29 1809060530 37 benign serous cystadenoma of ovary benign serous cystadenoma of ovary
30 1811220032 50 serous carcinima of ovary highgrade serous ca rcinoma of ovary

Discussion

The histopathological section diagnosis of all 30 ovarian specimens revealed 66.66% benign tumours and 33.34%malignant tumours. The final frozen section revealed 60% benign tumours and 40% malignant tumours.

The overall accuracy rate of frozen section analysis is 93.33%. However there is a failure rate of 6.67%. The 6.67% negative results could have occurred due to any sampling errors.

These findings are in concordance with that of Chandramouleeswari K. et al12 and.3 Shrestha S. et al.2 They have reported the accuracy rates as 92% and 94.6%respectively. But the study of Junn-Liang et al13 and Farah- Klibi F. et al.14 Showed slightly higher accuracy ratesof 97.7% and 97.5% respectively. These showed a relative decrease in the negative results.

In one case, benign ovarian tumor reported on frozen section turned out to be fibroma of ovary on conventional paraffin section.15

In another case, it was reported as benign serous cystofibroma on frozen section but it turned out to be serous borderline tumor on paraffin section.

Sometimes these kind of negative results can also be observed.5 The negative diagnosis was due to the error by the pathologist which may have resulted due to the method of freezing, type of procedure, type of lesion etc.

Appropriate measures and strict guidelines would help to reduce the failure rates.

Conclusion

Intaoperative frozen section diagnosis appears to be an accurate technique for the histopathological diagnosis of ovarian tumours.

The results can be used to guide the surgery. Frozen diagnosis can provide rapid, reliable, cost effective information necessary for optimum patient care.16

Evaluation of the frozen section diagnosis and histopathological diagnosis should be carried out regularly for more efficient management of ovarian tumors.

The diagnostic accuracy of frozen section as an important source of information in surgical procedure is important not only in the management of surgical patients but also as a measure of quality control in surgical pathology.17

To reduce error rates and to improve frozen section diagnosis, continues monitoring in the pathology department should be done. This should be done on a regular basis to attain better results.18

This correlation between the histopathological diagnosis and frozen section diagnosis is definitely very useful to identify the tumours.

Source of Funding

None.

Conflict of Interest

None.

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