1. Assist. Prof. Dr. Neslihan BAYRAMOĞLU TEPE
IS INTRAOPERATIVE FROZEN EXAMINATION RELIABLE IN THE MANAGEMENT OF OVARİAN TUMORS?
SINGLE CENTER 10 YEARS EXPERIENCE
Assist. Prof. Dr. Neslihan BAYRAMOĞLU TEPE
Gaziantep University, Faculty of Medicine Department of Obstetrics and Gynecology
25th European Congress of Obstetrics and Gynaecology, 15th Congress of Turkish Society of Obstetrics and Gynaecology Congress, 2017 May, Antalya

2. Definition
Ovarian cancer is the second most common cancer and it has the highest mortality among gynecological cancers
Management of ovarian neoplasms varies according to histological subtypes
It is important for the surgeon to identify the category of neoplasm in preoperative period
Frozen examination is an intraoperative diagnostic procedure that allows classification of the tumor as benign, borderline and malignant, thus guiding the extent of surgical procedure

3. Purpose
Patients with ovarian masses requiring intraoperative frozen examination
Not only epithelial ovarian tumors (ET), but also sex-cord stromal (SCST)and germ cell (GCT)ovarian tumors
Sensitivity, specificity, negative and positive predictive value of frozen in all subgroups

4. According to our knowledge, our study is the first study to reveal the sensitivity, specificity, PPV and NPV of frozen in all subgroups of ovarian tumors !

5. January 2006 to December 2015 585 patients
Materials & Methods
Patients who underwent explorative laparotomy due to ovarian mass and required intraoperative frozen examination at Gaziantep University, Faculty of Medicine, Department of Obstetrics and Gynecology
Retrospective
January 2006 to December patients

6. Solid-cystic characteristics Presence of ascites
Materials & Methods
Age of patients
Size of tumors
Laterality of tumors
Solid-cystic characteristics
Presence of ascites
Result of inraoperative frozen section (IFS)
Result of permanent paraffin section (PPS)

7. Results of intraoperatif frozen section (IFS) were classified as;
Materials & Methods
Results of intraoperatif frozen section (IFS) were classified as;
Benign
Malign
Borderline
Deferred
Results of permanent paraffin section (PPS) were divided into 3 main groups as ;
Benign
Malign
Borderline
These 3 main groups were subdivided into ;
Epithelial
Sex cord stromal (SCST)
Germ cell tumors
Non-neoplastic lesions
Mesenchymal tumors
Hematological tumors
Metastatic tumors

8. IFS (n:585) PPS (n:555) Results
Table 1. The Distribution of Ovarian Masses at IFS and PPS Results
IFS (n:585)
PPS (n:555)
Malign
Benign
Borderline
Deferred
n=114
n=390
n=51
n=30
n=126
n=381
n=48
19.5%
66.7%
8.7%
5.1%
22.7%
68.6%
8.6%

9. PPS Discordance % IFS Results Epithelial Germ Cell SCST
Table 2.Concordance and Discordance of Patients According to the Results of IFS and PPS
PPS
Discordance %
Concordance (n)
Diskordance (n)
Total
(n)
IFS
Epithelial
Malign 82 1 83
6.8%
Benign
220 12
232
Borderline 37 49
Germ Cell 2 3 5
7.8% 57 58
SCST 9
5.3% 44 47

10. Results
Table 3. Sensitivity, Specivity, PPV and NPV of Epithelial, Borderline, Sex-cord Stromal and Germ-cell Ovarian Tumors
Epithelial
Borderline
SKST
Germ Cell
Sensitivity
97.62%
77.08%
75.00%
66.67%
Specivity
100%
96.20%
95.00%
PPV
75.51%
40.00%
NPV
99.10%
96.51%
93.62%
98.28%

11. Results
The highest sensitivity was detected in the epithelial tumor group (97.62%)
The lowest sensitivity was detected in the germ cell ovarian tumors (66.67%)
Sensitivity in borderline ovarian tumors was similar to literature (77.08%)

12. Conclusions
Despite the limitations, frozen is an effective and reliable method for intraoperative management of ovarian tumors
Frozen may have limitations; especially in large, mucinous and tumors with teratoma histology

13. To increase the reliability of the frozen;
Conclusions
To increase the reliability of the frozen;
Increased number of cross sections
Appropriate sectioning of tumors thought to be non-epithelial
Assessed by an experienced gynecopathologist

14. Thank You…