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Factors Influencing the Use of Frozen Section Analysis in Adnexal Masses

van den Akker, Petronella A. J. MSc; Kluivers, Kirsten B. MD, PhD; Aalders, Anette L. MD; Snijders, Marc P. L. M. MD, PhD; Samlal, Rahul A. K. MD, PhD; Vollebergh, Jos H. A. MD; Zusterzeel, Petra L. M. MD, PhD; Massuger, Leon F. A. G. MD, PhD

doi: 10.1097/AOG.0b013e318220f047
Original Research

OBJECTIVE: To determine the factors that influence the use of frozen section analysis in adnexal masses and the factors that predict malignancy.

METHODS: The study participants were women scheduled for adnexal mass surgery in 11 hospitals between 2005 and 2009. Factors that potentially influenced the use of frozen section analysis and potentially predicted malignancy were studied, such as menopausal status, CA 125 level, ultrasound characteristics, presence of adhesions, and tumor size. We used univariable and multivariable analyses to assess the factors.

RESULTS: A total of 670 patients were included in the study. The frozen section analyses for 323 patients (48%) showed 206 benign, 55 borderline, and 62 malignant adnexal masses. The CA 125 level, locularity of the tumor, and presence of solid areas predicted both the use of frozen section analysis and the presence of malignancy. The presence of adhesions predicted malignancy, but not the use of frozen section analysis. Menopausal status and tumor size predicted the use of frozen section analysis, but not malignancy.

CONCLUSION: Menopausal status and tumor size are associated with more use of frozen section analysis, but they have not been identified as factors associated with malignancy. Frozen section analysis is useful when the CA 125 levels are greater than 35 units/mL and when there are multilocular tumors, solid areas on ultrasonography, and adhesions revealed during surgery.

LEVEL OF EVIDENCE: III

Frozen section analysis is useful with CA 125 levels greater than 35 units/mL, multilocular tumors, the presence of solid areas, and adhesive tumors during surgery.

From the Radboud University Nijmegen Medical Centre, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Rijnstate Hospital, Department of Obstetrics and Gynecology, Arnhem, the Netherlands; Canisius-Wilhelmina Hospital, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Gelderse Vallei Hospital, Department of Obstetrics and Gynecology, Ede, the Netherlands; and Bernhoven Hospital, Department of Obstetrics and Gynecology, Oss, the Netherlands.

Corresponding author: P. A. J. van den Akker, MSc, Radboud University Nijmegen Medical Centre, Department of Obstetrics and Gynecology (791), P.O. Box 9101, 6500 HB Nijmegen, the Netherlands; e-mail: S.vandenAkker@obgyn.umcn.nl.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists