Use and accuracy of intraoperative frozen section analysis for ovarian masses in children and adolescents
Authors
Lindsay A. Gil, Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Carley M. Lutz, Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Patrick A. Dillon, Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Cynthia D. Downard, Division of Pediatric Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
Peter F. Ehrlich, Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.
Mary E. Fallat, Division of Pediatric Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
Jason D. Fraser, Department of Pediatric Surgery, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
Julia E. Grabowski, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Michael A. Helmrath, Division of Pediatric Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
S Paige Hertweck, Department of Pediatric and Adolescent Gynecology, University of Louisville School of Medicine, Louisville, Kentucky.
Ronald B. Hirschl, Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.
Rashmi Kabre, Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Dave R. Lal, Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Matthew P. Landman, Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Amy E. Lawrence, Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Charles M. Leys, Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Grace Z. Mak, Advocate Aurora Health
Troy A. Markel, Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Manish T. Raiji, Advocate Aurora HealthFollow
Beth Rymeski, Division of Pediatric Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Jacqueline M. Saito, Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Thomas T. Sato, Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Shawn D. St Peter, Department of Pediatric Surgery, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
Linda M. Stafford, Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Katherine J. DeansFollow
Recommended Citation
Gil LA, Lutz CM, Dillon PA, et al. Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents. J Pediatr Adolesc Gynecol. 2023;36(2):155-159. doi:10.1016/j.jpag.2022.10.001
Abstract
Study objective:Describe the current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses DESIGN: Prospective cohort study from 2018 to 2021 SETTING: Eleven children's hospitals PARTICIPANTS: Females age 6-21 years undergoing surgical management of an ovarian mass INTERVENTIONS: Obtaining intraoperative FS pathology MAIN OUTCOME MEASURE: Diagnostic accuracy of FS pathology RESULTS: Of 691 patients who underwent surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had a final malignant pathology. Among FS patients, 12 of 27 (44.4%) underwent ovary-sparing surgery, and 15 of 27 (55.5%) underwent oophorectomy with or without other procedures. FS results were disparate from final pathology in 7 of 27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy, with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n = 1), mucinous borderline tumor (n = 2), mucinous carcinoma (n = 1), and immature teratoma (n = 1). FS did not guide intervention in 10 of 27 (37.0%) patients: 9 with benign FS underwent oophorectomy, and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology.
Conclusions:FSs are infrequently utilized for pediatric and adolescent ovarian masses and could be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.
