J Cancer 2018; 9(16):2817-2824. doi:10.7150/jca.25883 This issue

Research Paper

Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors

Zhen Huang1,2,3,#, Li Li1,#, ChengCheng Li1,2, Samuel Ngaujah1,2, Shu Yao1,2, Ran Chu1,2, Lin Xie1,2, XingSheng Yang1, Xiangning Zhang1, Peishu Liu1, Jie Jiang1, Youzhong Zhang1, Baoxia Cui1, Kun Song1,4✉, Beihua Kong1,4

1. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan city, Shandong province, China.
2. School of Medicine, Shandong University, Ji'nan city, Shandong province, China.
3. Ganzhou maternity & child health hospital, Jiangxi province, China
4. Gynecology oncology key laboratory, Qilu Hospital, Shandong University, Ji'nan city, Shandong province, China.
# Zhen Huang and Li Li contribute equally to this paper.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Huang Z, Li L, Li C, Ngaujah S, Yao S, Chu R, Xie L, Yang X, Zhang X, Liu P, Jiang J, Zhang Y, Cui B, Song K, Kong B. Diagnostic accuracy of frozen section analysis of borderline ovarian tumors: a meta-analysis with emphasis on misdiagnosis factors. J Cancer 2018; 9(16):2817-2824. doi:10.7150/jca.25883. Available from https://www.jcancer.org/v09p2817.htm

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Objective: First, to evaluate the sensitivity and positive predictive value (PPV) of intra-operative frozen section (FS) diagnosis in borderline ovarian tumors (BOTs), and to explore the factors affecting the diagnostic accuracy. Second, to assess the clinical outcomes of misdiagnosed BOT patients.

Methods: We performed a retrospective study of all patients diagnosed as BOT through FS or paraffin section (PS) at Qilu Hospital between January 2005 and December 2015. Clinical and pathologic data were extracted. Univariate analysis was performed using standard two-sided statistical tests. We also performed a meta-analysis to further validate the findings.

Results: In our retrospective study, 155 patients were included. Agreement between FS and PS diagnosis was observed in 127/155 (81.9%) patients, yielding a sensitivity of 92.7% and a PPV of 87.6%. Under-diagnosis and over-diagnosis occurred in 22 cases (14.2%) and 6 cases (3.9%), respectively. In our univariate analysis of our retrospective study, tumor size (p=0.048) and surgery approach (p=0.024) were significantly associated with misdiagnosis.

The pooled analysis of 13 studies including 1,577 patients indicated that the accuracy (69.2%), sensitivity (82.5%), and PPV (81.1%) were low; also under-diagnosis (20.2%) and over-diagnosis (10.5%) were frequent. The meta-analysis results showed that mucinous histology (p < 0.0001, OR=2.03 [1.47-2.81]) and unilateral tumors (p=0.001, OR=2.39 [1.41-4.06]) were associated with the misdiagnosis of BOT. In our retrospective study, there was no statistical significance of clinical outcome such as extent of surgery (p=0.838), recurrence (p=0.586), fertility (p=0.560), death (p=0.362) between misdiagnosed and accurately diagnosed BOT patients.

Conclusions: FS analysis of BOTs has low accuracy, sensitivity, and PPV. Under-diagnosis and over-diagnosis are frequent. Meta-analysis results verify that mucinous histology and unilateral tumors are associated with misdiagnosis of FS. Nevertheless, misdiagnosed patients have a good clinical outcome despite the high frequency of misdiagnosis through FS.

Keywords: borderline ovarian tumor, frozen section, paraffin section, sensitivity, accuracy