title: Borderline ovarian tumors and diagnostic dilemma of intraoperative diagnosis: could preoperative He4 assay and ROMA score assessment increase the frozen section accuracy? A multicenter case-control study.
abstract: The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P<0.05), and overdiagnosis in 11.6% versus 0% (P<0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.
authors.affiliation: Department of Woman and Child Health, University of Padua, 35128 Padua, Italy ; Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Department of Surgical Sciences, University of Parma, 43100 Parma, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Berretta
authors.affiliation: Department of Woman and Child Health, University of Padua, 35128 Padua, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.affiliation: Department of Medical Diagnostic and Special Therapy, University of Padua, 35128 Padua, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Guido
authors.affiliation: Gynaecologic and Obstetric Units, Vicenza General Hospital, 36100 Vicenza, Italy.
authors.forename: Giuliano Carlo
authors.initials: GC
authors.lastname: Zanni
authors.affiliation: Gynaecologic and Obstetric Units, Vicenza General Hospital, 36100 Vicenza, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Franceschetti
authors.affiliation: Department of Obstetrics and Gynaecology, University of Verona, 37100 Verona, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Quaranta
authors.affiliation: Department of Laboratory Medicine, University of Padua, 35128 Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.affiliation: Department of Woman and Child Health, University of Padua, 35128 Padua, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
authors.affiliation: Department of Surgical Sciences, University of Parma, 43100 Parma, Italy.
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005629:Frozen Sections; D006801:Humans; D010535:Laparoscopy; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D057234:Preoperative Period; D011506:Proteins / Q000378:metabolism*; D012307:Risk Factors; D014463:Ultrasonography; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human