Introduction/Background Frozen section diagnoses of borderline ovarian tumors (BOTs) are not always straightforward (ambiguous), and sometimes the pathologist may tend towards a diagnosis of invasive carcinoma. It must be decided whether or not additional lymph node sampling (LNS) should be performed to prevent a second procedure in the event of a carcinoma as a definite postoperative diagnosis. The aims of the present study were (i) to compare (un)ambiguous BOT frozen section diagnoses (FSDs) and their definite diagnoses, (ii) to evaluate how often a LNS was performed in these cases and (iii) to discuss managerial implications.
Methodology All patients who underwent ovarian surgery with perioperative frozen section analysis in the participating hospitals between January 2007 and July 2018 were identified and included in case of a BOT FSD (whether or not tending towards invasive carcinoma) and a definite diagnosis of a BOT or carcinoma.
Results Of 106 patients with a serous BOT FSD, 92 were unambiguous, of whom two patients were diagnosed with a carcinoma (figure 1). Five of 92 patients underwent LNS (one carcinoma) and 87 patients did not (one carcinoma). Of the remaining 14 patients with an ambiguous serous BOT FSDs, 5 were diagnosed with a carcinoma (35.7%). Two of 14 underwent LNS (two carcinomas) and 12 did not (3 carcinomas). The results with respect to (un)ambiguous mucinous BOT FSDs (n=88) are shown in figure 1 as well.
Conclusion The chance of a carcinoma in case of ambiguous serous BOT FSD is 35.7%. Implementation of LNS in case of an ambiguous serous BOT FSD should be discussed with the patient individually. LNS in case of unambiguous BOT FSDs can be omitted, as well as in case of mucinous ambiguous BOT FSDs, since LNS in case of mucinous ovarian carcinomas is not performed frequently because of a low incidence of lymph node metastases.
Disclosure L.F.S. Kooreman received grant support from Novartis and Roche, intented for financing research into breast cancer.
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