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Rodolfo Wild A.

Bio: Rodolfo Wild A. is an academic researcher from Pontifical Catholic University of Chile. The author has contributed to research in topics: Obstetrics and gynaecology & Ovarian carcinoma. The author has an hindex of 2, co-authored 3 publications receiving 21 citations.

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TL;DR: Evaluated the accuracy of frozen-sections in ovarian carcinoma considering the influence of tumor diameter and weight and found diagnostic correlation was higher in epithelial ovarian tumors with diameter 10 cm or weight >700 g.
Abstract: Background: Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary a high level of accuracy. Aim: To evaluate the accuracy of frozen-sections in ovarian carcinoma considering the influence of tumor diameter and weight. Patients and methods: Retrospective study of frozen-sections performed in patients with ovarian tumors who underwent surgery. Frozen- and permanent- sections were divided into three categories (benign, borderline and malignant) and stratified by diameter ( 20 cm) and weight ( 1400 g). The diagnostic correlation, sensitivity, specificity, predictive values and accuracy of each frozen-section diagnosis were determined. Results: Eight hundred forty two ovarian tumors that underwent frozen-sections between January 1988 and October 1998 were studied. Final diagnosis was 86,7% benign, 2,7% low malignant potential (LMP) and 10,6% malignant. The diagnosis correlation between frozen- and permanent-sections was 98,2%. Misdiagnosis was in epithelial ovarian tumors, particularly in LMP tumors. Sensitivity, specificity, positive- and negative- predictive values and accuracy of the four hundred eighty nine epithelial tumor were 92,6%, 99,2%, 96,7%, 98,2% and 97,9%, respectively. Diagnostic correlation was higher in epithelial ovarian tumors with diameter 10 cm or weight >700 g (particularly in LMP tumors) is difficult because of the extensive sampling required. Frozen-sections diagnoses are important to determine the type and extent of surgery performed at the initial operation.

13 citations

Journal ArticleDOI
TL;DR: Los hallazgos encontrados sugieren that el tumor ovarico en the postmenopausia no debe ser una indicacion perentoria de cirugia abierta, y dada la frecuencia de tumores benignos, en casos bien seleccionados (por tamano, caracteristicas ecograficas y marcadores) and contando with biopsia contemporanea es pos
Abstract: Se presenta una serie de 234 pacientes postmenopausicas mayores de 50 anos con diagnostico de tumor ovarico operadas en nuestro centro. Aproximadamente 60% de los casos fueron hallazgo del examen, ecografia o de la cirugia. Las pacientes fueron mayoritariamente abordadas por laparotomia (89%). Solo en 25 casos se realizo laparoscopia no registrandose casos de tumor maligno. En un 23% de los casos el diagnostico histologico fue el de cancer de ovario. En aquellos casos en que se realizo biopsia contemporanea (72,6%) hubo excelente concordancia (98,8%) con el diagnostico reportado en la biopsia definitiva. La tasa de complicaciones observada fue menor al 10% (con menos de un 5% de complicaciones graves). De interes resulta el que no se observaron tumores malignos en lesiones ovaricas con diametro ultrasonografico menor de 3 cm. Los hallazgos encontrados sugieren que el tumor ovarico en la postmenopausia no debe ser una indicacion perentoria de cirugia abierta. El seguimiento ecografico es factible en lesiones pequenas (menores de 3 a 5 cm), particularmente si las caracteristicas ecograficas sugieren benignidad y el CA-125 es negativo. Dada la frecuencia de tumores benignos, en casos bien seleccionados (por tamano, caracteristicas ecograficas y marcadores) y contando con biopsia contemporanea es posible realizar un abordaje por laparoscopia. En centros especializados la edad avanzada (> 70 anos) no debiese ser una contraindicacion a la cirugia

7 citations

Journal ArticleDOI
TL;DR: This document shows an analysis of Obstetrics and Gynecology educational programs of prestigious foreign universities and of Pontificia Universidad Catolica de Chile.
Abstract: SUMMARY Permanent progress in Obstetrics and Gynecology make necessary the continuous updating and restructuring of programs, with periodical and objective evaluation of the resident in his different formative phases. Dedication must be exclusive, remunerated, supervised and activity according to developed countries standards, not lower than 80 hours weekly. This document shows an analysis of Obstetrics and Gynecology educational programs of prestigious foreign universities and of Pontificia Universidad Catolica de Chile.

2 citations


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Journal ArticleDOI
TL;DR: The accuracy of frozen section diagnosis for the assessment of the ovarian mass is good, with acceptable sensitivities for almost perfect specificities, and future studies on patient preferences for the different outcomes as well as economic analysis are needed.

111 citations

Journal ArticleDOI
TL;DR: Intraoperative frozen section diagnosis of BTO has a low sensitivity and PPV and overdiagnosis and underdiagnosis are frequent, and surgical management based on intraoperativerozen section diagnosis should be used with caution.

111 citations

Journal ArticleDOI
TL;DR: It is concluded that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.
Abstract: A quantitative systematic review was performed to estimate the diagnostic accuracy of frozen sections in ovarian tumors. Studies that compared frozen sections and paraffin sections within subjects for diagnosis of ovarian tumors were included. Fourteen primary studies were analyzed, which included 3 659 women. For benign ovarian vs borderline/malignant tumor cases, the occurrence of a positive frozen-section result for benignity (pooled likelihood ratio [LR], 8.7; 95% confidence interval [CI], 7.3-10.4) and posttest probability for benign diagnosis was 95% (95% CI, 94-96%). A positive frozen-section result for malignant vs benign diagnosis (pooled LR, 303; 95% CI, 101-605) increased the probability of ovarian cancer to 98% (95% CI, 97-99%). In borderline vs benign ovarian tumor cases, a positive frozen-section result (pooled LR, 69; 95% CI, 45-106) increased the probability of borderline tumors to 79% (95% CI, 71-85%). In borderline vs malignant ovarian tumor cases, a positive frozen-section result (pooled LR, 18; 95% CI, 13-26) increased the probability of borderline tumors to 51% (95% CI, 42-60%). We conclude that diagnostic accuracy rates for frozen-section analysis is high for malignant and benign ovarian tumors, but the accuracy rates in borderline tumors remain relatively low.

94 citations

Journal ArticleDOI
TL;DR: To assess the diagnostic test accuracy of frozen section (index test) to diagnose histopathological ovarian cancer in women with suspicious pelvic masses as verified by paraffin section (reference standard), a test threshold was used for frozen section results as invasive cancer and negative test results as borderline and benign tumours.
Abstract: Background Women with suspected early-stage ovarian cancer need surgical staging which involves taking samples from areas within the abdominal cavity and retroperitoneal lymph nodes in order to inform further treatment. One potential strategy is to surgically stage all women with suspicious ovarian masses, without any histological information during surgery. This avoids incomplete staging, but puts more women at risk of potential surgical over-treatment. A second strategy is to perform a two-stage procedure to remove the pelvic mass and subject it to paraffin sectioning, which involves formal tissue fixing with formalin and paraffin embedding, prior to ultrathin sectioning and multiple site sampling of the tumour. Surgeons may then base further surgical staging on this histology, reducing the rate of over-treatment, but conferring additional surgical and anaesthetic morbidity. A third strategy is to perform a rapid histological analysis on the ovarian mass during surgery, known as 'frozen section'. Tissues are snap frozen to allow fine tissue sections to be cut and basic histochemical staining to be performed. Surgeons can perform or avoid the full surgical staging procedure depending on the results. However, this is a relatively crude test compared to paraffin sections, which take many hours to perform. With frozen section there is therefore a risk of misdiagnosing malignancy and understaging women subsequently found to have a presumed early-stage malignancy (false negative), or overstaging women without a malignancy (false positive). Therefore it is important to evaluate the accuracy and usefulness of adding frozen section to the clinical decision-making process. Objectives To assess the diagnostic test accuracy of frozen section (index test) to diagnose histopathological ovarian cancer in women with suspicious pelvic masses as verified by paraffin section (reference standard). Search methods We searched MEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015) and relevant Cochrane registers. Selection criteria Studies that used frozen section for intraoperative diagnosis of ovarian masses suspicious of malignancy, provided there was sufficient data to construct 2 x 2 tables. We excluded articles without an available English translation. Data collection and analysis Authors independently assessed the methodological quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) domains: patient selection, index test, reference standard, flow and timing. Data extraction converted 3 x 3 tables of per patient results presented in articles into 2 x 2 tables, for two index test thresholds. Main results All studies were retrospective, and the majority reported consecutive sampling of cases. Sensitivity and specificity results were available from 38 studies involving 11,181 participants (3200 with invasive cancer, 1055 with borderline tumours and 6926 with benign tumours, determined by paraffin section as the reference standard). The median prevalence of malignancy was 29% (interquartile range (IQR) 23% to 36%, range 11% to 63%). We assessed test performance using two thresholds for the frozen section test. Firstly, we used a test threshold for frozen sections, defining positive test results as invasive cancer and negative test results as borderline and benign tumours. The average sensitivity was 90.0% (95% confidence interval (CI) 87.6% to 92.0%; with most studies typically reporting range of 71% to 100%), and average specificity was 99.5% (95% CI 99.2% to 99.7%; range 96% to 100%). Similarly, we analysed sensitivity and specificity using a second threshold for frozen section, where both invasive cancer and borderline tumours were considered test positive and benign cases were classified as negative. Average sensitivity was 96.5% (95% CI 95.5% to 97.3%; typical range 83% to 100%), and average specificity was 89.5% (95% CI 86.6% to 91.9%; typical range 58% to 99%). Results were available from the same 38 studies, including the subset of 3953 participants with a frozen section result of either borderline or invasive cancer, based on final diagnosis of malignancy. Studies with small numbers of disease-negative cases (borderline cases) had more variation in estimates of specificity. Average sensitivity was 94.0% (95% CI 92.0% to 95.5%; range 73% to 100%), and average specificity was 95.8% (95% CI 92.4% to 97.8%; typical range 81% to 100%). Our additional analyses showed that, if the frozen section showed a benign or invasive cancer, the final diagnosis would remain the same in, on average, 94% and 99% of cases, respectively. In cases where the frozen section diagnosis was a borderline tumour, on average 21% of the final diagnoses would turn out to be invasive cancer. In three studies, the same pathologist interpreted the index and reference standard tests, potentially causing bias. No studies reported blinding pathologists to index test results when reporting paraffin sections. In heterogeneity analyses, there were no statistically significant differences between studies with pathologists of different levels of expertise. Authors' conclusions In a hypothetical population of 1000 patients (290 with cancer and 80 with a borderline tumour), if a frozen section positive test result for invasive cancer alone was used to diagnose cancer, on average 261 women would have a correct diagnosis of a cancer, and 706 women would be correctly diagnosed without a cancer. However, 4 women would be incorrectly diagnosed with a cancer (false positive), and 29 with a cancer would be missed (false negative). If a frozen section result of either an invasive cancer or a borderline tumour was used as a positive test to diagnose cancer, on average 280 women would be correctly diagnosed with a cancer and 635 would be correctly diagnosed without. However, 75 women would be incorrectly diagnosed with a cancer and 10 women with a cancer would be missed. The largest discordance is within the reporting of frozen section borderline tumours. Investigation into factors leading to discordance within centres and standardisation of criteria for reporting borderline tumours may help improve accuracy. Some centres may choose to perform surgical staging in women with frozen section diagnosis of a borderline ovarian tumour to reduce the number of false positives. In their interpretation of this review, readers should evaluate results from studies most typical of their population of patients.

84 citations

Journal ArticleDOI
Mert Göl1, A. Baloglu1, S. Yigit1, M. Dogan1, Ç. Aydin1, U. Yensel1 
TL;DR: Frozen section evaluation in identifying a malignant or benign ovarian tumor is accurate enough for the correct diagnosis, and accuracy rates for borderline ovarian tumors are low, which is similar with the previous studies.
Abstract: A retrospective study of 222 ovarian biopsy results between January 1, 2000 and August 31, 2002 was examined to determine the accuracy of frozen section diagnosis. In addition we reviewed all previous studies that examined the accuracy rates of frozen section diagnosis in ovarian tumors. Histopathologic examination results of frozen section biopsies were concordant with paraffin diagnosis in 92% of all cases. The sensitivity rates for benign, malignant, and borderline ovarian tumors were 98%, 88.7%, and 61%, respectively. There were five (2.2%) false-positive (overdiagnosed), and 13 (5.4%) false-negative (underdiagnosed) patients in frozen section examination. Frozen section examination of mucinous tumors showed higher underdiagnosis rates (20%). Review of previous studies showed no significant variation in accuracy rates of frozen section diagnosis for benign and malignant ovarian tumors, in relation with time. We found low accuracy rates for borderline ovarian tumors which was similar with the previous studies. Hovewer, there were consistent and relatively higher sensitivity rates for borderline ovarian tumors in the recent studies. As a result, we conclude that frozen section evaluation in identifying a malignant or benign ovarian tumor is accurate enough for the correct diagnosis. Since accuracy rates for borderline ovarian tumors are low, we should have more improvement in the correct diagnosis.

55 citations