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BioMed Research International
Volume 2014, Article ID 803598, 10 pages
Research Article

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

1Department of Woman and Child Health, University of Padua, 35128 Padua, Italy
2Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy
3Department of Surgical Sciences, University of Parma, 43100 Parma, Italy
4Department of Medical Diagnostic and Special Therapy, University of Padua, 35128 Padua, Italy
5Gynaecologic and Obstetric Units, Vicenza General Hospital, 36100 Vicenza, Italy
6Department of Obstetrics and Gynaecology, University of Verona, 37100 Verona, Italy
7Department of Laboratory Medicine, University of Padua, 35128 Padua, Italy

Received 25 February 2014; Revised 11 August 2014; Accepted 3 September 2014; Published 5 November 2014

Academic Editor: David G. Mutch

Copyright © 2014 Salvatore Gizzo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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% (: n.s.), underdiagnosis in 25.6% versus 41.4% (), and overdiagnosis in 11.6% versus 0% (). 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.