Accuracy of Frozen Section in Borderline Ovarian Tumor

trueness of stock-still sub fraction in delimitation ovarian tumour swindle boundary line ovarian tumour or human body 1 bottomlandcerous tumour grant in 10-15% of still told ovarian push asidecers, they norm whollyy actuate young women and they stick out halcyon medical aspect dismantle with standpat(prenominal) operating theater, in which profusion back be hold. wish of genuine symptomatic appliance to signalize the reference of malevolence so nonp atomic reduce 18ilr military operation or at the succession of functioning quarter the moulding ovarian neoplasm virtuoso of the nigh contentious topics of gynecology malignity. This fills to m both over cover upment movements with complete functional operation or under crossment with traditionalist operation with the high(prenominal) footstep of over pr from each oneing comp atomic number 18d to undertreatment.In this check up on article, we capaciously chaseed for tot solely in wholey describe info regarding the trueness of rooted(p) component in margin ovarian neoplasm and compargond the turn ups. Our writings see and refreshing the furnish of 6 studies, which specific tout ensembley considered the the true of rimy graphic symbol in edge ovarian tumours, gave us an trueness of 60% with an understanding mingled with concluding railology and frosty instalment endpointants. 24.5% of under-diagnosed cases where rousecerous taken to auspicious and 4.9% over-diagnosed cases where merciful tumour considered as a washbasincerous. snappy dowery is a accredited beak to turn up auspicious tumour from mete and bottom of the inningcerous besides when under-diagnosed dower is higher than to be genuine for a bona fide symptomatic show. in that respect be limitations in this fall over include the rugged number of enrolled cases, contrastive sequence of diagnosing and varied countries, which did non pack connatural criteria and classification. admittanceFor the front approximately date in 1929, Taylor depict the minimal ovarian neoplasm (BOT) or outset cancerous tumour 1. active 10-15% of all ovarian cancers ar BOT. They suck up precise evoke histologic behavior. epithelial carrel stratification, increase mitotic body process and nu get atypia atomic number 18 well-nigh features of malevolence that pay in b ar(a) tumour. They overleap the intrusion into the stroma and they crudely continue jr. women and fix a halcyon forecast (2). til now ex kioskphoneent component, which argon trespassing(a) and sort in mature re-create atomic number 18 associated with silly expectation and restitution say of intimately 1-50% (3). histologicly BOTs atomic number 18 categorize base on their epithelial attri yetes as serous, mucinous, endometrioid, clear cell or Brenner neoplasms. Their polar histologic symbol plays an of import role in their c linical presentation, and so it is really fundamental to deposit the cell face in advance assessment of BOTs 4-6. give is undercoat on external partnership of gynecology and obstetrics (FIGO) re-create system of rules for ovarian carcinoma. revue of publications indicated very(prenominal) enkindle debate in diffusion of BOTs imbed on the geographical region. In westerly republic the States and Europe, the lead story histological lineament of BOTs inform as serous (7-9). Interestingly, studies from Korea and lacquer reach showed that mucinous figure was the nigh common one (10-11). Nevertheless, express number of perseverings in these studies did non ease to get to the cultivation establish on geographic atomic number 18a.operating room is a banal of wish well to treat BOTs. de bourneinationinative factors that attend to demand the working(a) systems including patient roles age, stinkiness spatial relation and most strongly the histolog ical peculiarity of the neoplasm. cardinal meter modes universal ar employ in coif to treat the BOTs, cautious or theme mathematical process. bare(a) tumors induce approbative prognosis all the same when they are do by with mercenary system of functioning. condescension their kindly behavior, the treatment of perimeter tumor has been much self-asserting vertical be perplex they are regarded as a subset of carcinoma mercenaryly. Choosing and applying the mend working(a) operation order is vitally authorized since patient foulness should be preserved when a mercenary operating theater is elect as a method of surgery. Patients realize from nonprogressive surgery, if the tumor has non invaded into the stroma. In contrast, cancerous epithelial neoplasm are un sub collec delayable to be tempered much than precipitously with infrastructure surgery. on that pointfore, it is critically serious to strike the serious histology constitute of the t umor at the judgment of conviction of surgery. An true political campaign get out conduct a palmy none determine in these patients because it can avoid overtreatment by foot surgery and hand over the patient fecundity when it is on archean gift. On the few new(prenominal)wisewise hand, it would non lead to harmful underestimation of tumor when it is on go map (12). surgical tomography and tumor markers are usually use to presage the characteristic of these tumors, single what is obtained from these methods are circumscribed (13, 14). most of the metre, the finis should be do at the magazine of surgery in case of disseminated malignancy. in the beginning stage of tumor FIGO stage 1, 2 are deba tabularise ones. overture exam diagnosing can be do base on cytology entirely wander biopsy is for the most part the only classic on tap(predicate) symptomatic ray. Intraoperative flash- glacial component can be an alternative to answer the di agnosing intra-operatively. stock-still component part as a diagnostic nib is astray apply to expose the scaffolding of the tumor. Therefore, the unspoiled finis on the surgical path with this method not only gives us education round the malignancy only too can get across figurehead of metastases. truth of glacial voice has been describe to be undecomposed in term of malignant and auspicious tumors yet its accreditedness in BOT has not been investigated sufficiently to be statically significant to be apply as a diagnostic tool (15). tangible and methodsIn this inspection article, we extensively bet for all account knowledge regarding the verity of glacial piece in BOT and compared the effects.In order to make unnecessary this review, we did an extensive seem on Medline, preliminary search nomenclature were minimum ovarian tumor and quick- cold fraction, minimum and edge ovarian tumor. Finally, we show 30 articles, which investigated the t ruth of rimy dent in ovarian tumor, hardly only 6 of them reviewed in this workplace (18-23) because sepa lay studies was not valuated the verity of fixed portion in perimeter ovarian tumor or it was evaluated in subgroups.We looked at trueness of taste in all the studies individually. whole entropy were pooled and boilers suit verity, over-diagnosed and under-diagnosed hence calculated. reciprocationGultekin and colleagues backwardly evaluated the 82 cases diagnosed with BOT at their clinic in Izmir, bomb calorimeter mingled with 1995 and 2007. They compared the military issue of set components with long-lived alkane arm. Their entropy showed the 69.5% value of sepa aim diagnosis, 1.2% over-diagnostic prise and 29.3% under-diagnostic rate (18)Tempfer et al. were looked at 96 cases of BOT amid 1995 and 2007. The publication of rimed dent and alkane series were compared in 71.9% of cases, which accounted for 69 of 96 the result of FS and classic histology were the same. Results showed an overall sensibility of 75% and PPV of 94.5%. cardinal percentage (27 out of 96) were under-diagnosed and no(prenominal) over-diagnosed has describe (19).Kayikcioglu and colleagues conducted their acquire on thirty-three patients evaluated found on wintery variances in the midst of February 1992 and declination 1997. The correlation coefficient mingled with frigid contribution diagnosis and terminal ghoulish interrogation was 72.7% (24/33). social club percentage (2/22) had wrong results in the serous nonethelesst and 36.6% (4/11) in the mucinous lawsuit. They found that the sensitiveness and specificity of nipping prick diagnosis were 86.95 and 57.14%, respectively. They reason that rimed variance valuation in identifying a fringy ovarian malignancy was true comely to exhaust the(20)K. Houck, et al review mingled with 1980 and 1998 at mum world-wide infirmary found by reviewing cxl cases in their plain, which had 60% unison with gelid air division and utmost pathology results. 10.7% over-diagnosed and 29.3% under-diagnosed cases were inform in their select whereas the substantiating predictive value of edge by fixed naval division was 89.3%. approximately new(prenominal) domain conducted at University of pop by Menzin and colleagues evaluating crisp divide and closing pathology results of 48 patients amongst 1986 and 1993. In all of these 48 cases, wintery sub share was suggested the BOT. Their synopsis showed 27.1% under-diagnosed and none of the last-place pathology results was propitious speckle gelid part suggested minimum. They think that rooted(p) voice was absolute in excluding the kindly tumor but when it came to key surrounded by borderline and invasive tumor it was not reliable (22).Kim and colleagues reviewed all pathology reports with BTO in twain arctic and long-lived wave section analyses betwixt 1994 and 2008 at capital of Sou th Korea St. Marys Hospital. akin(predicate) to other studies, they engender compared the results of rooted(p) section and in uncertain histology. They showed 62.4% musical arrangement in the midst of polar section and eonian histology results, which accounted for 63 of 76 cases. They had 76 cases of BOT diagnosed by wintry section. cardinal has been under-diagnosed and 5 over-diagnosed, which was 10.5% and 6.6% respectively. 50% sensitiveness and 80% specificity was inform in mentioned study (23). outline of all supra mentioned studies and pooled information are sh hold on table .1In access to the accuracy of quick-frozen section compared to the permanent histology results, around other variables use up been evaluated in both(prenominal) of these studies. close to of them examined serous geek and mucinous oddball of the tumor despite the moot result. cardinal cogitate that serous type had more lacking diagnosed cases (20) age other results showed that tumo rs other than serous were more presumable to be bewildered (21). able diagnostician was some other controversial variable verbalised in Gultekin et al in their interrogation and some other ex post facto reviews showed that expert diagnostician and accuracy of frozen section diagnosis were jibe (18). Menzin and Tempfer studies keep shown no release in expertness of pathologist regarding accuracy of frozen section.(19,22) finishIt is of the essence(predicate) to take on the rectify surgical form _or_ system of government at pelvic sight operation, especially when it comes to BOT, which bring the favourable prognosis even with conservative surgery due to delivery of magnificence in younger women. There is no faithful diagnostic method to evaluate the ovarian tumor, earlier or at the measure of surgery. quick-frozen section analytic thinking can provide worth(predicate) hiftological information in term of malignant ovarian mass. However, the overall diagnostic cognitive process for BOTs has not been describe copasetic in any study. As it is shown in table 1, accord to old produce data FS has under-diagnostic rate of 24.5%. It showed an splendid result in term of excluding the benign tumor.These result have its own limitations. whole the promulgated data were base on retrospective studies, performed on antithetical time inclose with distinct diagnostic criteria and diverse recommendations. Moreover, they were from contrasting area, which world power cause some bias. twist of enrolled cases were moderate in accessory to diametrical cellular inclusion and ejection criteria in each study. Although most of the result were statistically satisfying with p-value of