Use and Accuracy of Intraoperative Frozen Section Analysis for Ovarian Masses in Children and Adolescents.

Autor: Gil LA; 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., Lutz CM; Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio., Dillon PA; Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri., Downard CD; Division of Pediatric Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky., Ehrlich PF; Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan., Fallat ME; Division of Pediatric Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky., Fraser JD; Department of Pediatric Surgery, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri., Grabowski JE; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Helmrath MA; Division of Pediatric Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio., Hertweck SP; Department of Pediatric and Adolescent Gynecology, University of Louisville School of Medicine, Louisville, Kentucky., Hirschl RB; Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan., Kabre R; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Lal DR; Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin., Landman MP; Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Lawrence AE; Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio., Leys CM; Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Mak GZ; Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine and Biologic Sciences, Chicago, Illinois., Markel TA; Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Raiji MT; Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine and Biologic Sciences, Chicago, Illinois., Rymeski B; Division of Pediatric Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio., Saito JM; Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri., Sato TT; Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin., St Peter SD; Department of Pediatric Surgery, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri., Stafford LMC; Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Deans KJ; 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., Minneci PC; 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., Hewitt GD; Department of Obstetrics and Gynecology, Nationwide Children's Hospital, Columbus, Ohio., Aldrink JH; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: Jennifer.Aldrink@nationwidechildrens.org.
Jazyk: angličtina
Zdroj: Journal of pediatric and adolescent gynecology [J Pediatr Adolesc Gynecol] 2023 Apr; Vol. 36 (2), pp. 155-159. Date of Electronic Publication: 2022 Oct 07.
DOI: 10.1016/j.jpag.2022.10.001
Abstrakt: 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.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
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