Are blood parameters assessed before taking frozen sections useful in gynecological oncology?

A novel index in the prediction of gynecological malignancy



Frozen section, Gynecological oncology, Complete blood count, Lymphocyte, Neutrophil


Background/Aim: Inflammatory processes are often implicated in oncology, and inflammatory markers and indices have been much studied in this context. In gynecological surgery, frozen sections have proven valuable in decision-making. Here we aim to identify laboratory parameters that correlate with frozen section results and thus develop new indices in neoplastic decision-making.

Methods: In this retrospective cross-sectional study at Bursa Yüksek İhtisas Training and Research Hospital, we evaluated 139 patients diagnosed with adnexal mass and endometrial intraepithelial neoplasia. We divided the patients whose frozen sections were reported as malignant, borderline, or benign into three groups and compared the pre-operative complete blood parameters.

Results: The mean age of our patients was 57.3 (11.5) years, and frozen section reports were benign in 33 (23.7%), borderline in 43 (30.9%), and malignant in 63 (45.3%) patients. The mean corpuscular volume and mean platelet volume values ​​were different, and this difference was significant between borderline and malignant groups in post-hoc analyses (P = 0.04 and P = 0.03, respectively). While the percentage of lymphocytes was lower in malignant groups, the percentage of neutrophils was higher (P = 0.01 and P = 0.03, respectively). According to post-hoc analysis, the percentage of neutrophils differs between benign and malignant groups (P = 0.05). The difference in lymphocyte percentage was significant between benign-borderline and benign-malignant groups (P = 0.02, P = 0.05; respectively). The blood neutrophil/lymphocyte ratio was higher in the malignant groups compared to the other two groups (P = 0.02). We used the Multi Linear Regression Analysis method to analyze the factors that play a role in predicting the frozen outcome as malignant. Accordingly, the model with the best performance used lymphocyte percentage, neutrophil/lymphocyte ratio, and Ca-125 parameters (P = 0.03).

Conclusion: This study indicates that inflammatory markers may give a clue about the character of the neoplastic mass before oncology surgery. Thus, we can make new contributions to the surgical and clinical approach in the literature by developing new malignancy indices.


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Olawaiye AB, Zhao C. Clinical view of gynecologic intraoperative frozen section diagnosis. Gynecology and Obstetrics Clinical Medicine. 2022;2:6–8. doi: 10.1016/j.gocm.2022.02.002. DOI:

Wang K-G, Chen T-C, Wang T-Y, Yang Y-C, Su T-H. Accuracy of Frozen Section Diagnosis in Gynecology. Gynecologic Oncology. 1998;70:105–10. doi: 10.1006/gyno.1998.5057. DOI:

El-Bahrawy M, Ganesan R. Frozen section in gynaecology: uses and limitations. Archives of Gynecology and Obstetrics. 2014;289:1165–70. doi:10.1007/s00404-013-3135-y. DOI:

Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer. New England Journal of Medicine. 2010;363:943–53. doi:10.1056/NEJMoa0908806. DOI:

Santoro A, Piermattei A, Inzani F, Angelico G, Valente M, Arciuolo D, et al. Frozen section accurately allows pathological characterization of endometrial cancer in patients with a pre-operative ambiguous or inconclusive diagnoses: our experience. BMC Cancer. 2019;19:1096. doi:10.1186/s12885-019-6318-5. DOI:

Park KJ, Soslow RA, Sonoda Y, Barakat RR, Abu-Rustum NR. Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: Pathologic pitfalls and the application of an objective scoring system. Gynecologic Oncology. 2008;110:316–23. doi: 10.1016/j.ygyno.2008.05.029. DOI:

Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists. 2008;27:353–65. DOI:

Ganesan R, Brown LJR, Kehoe S, McCluggage WG, El-Bahrawy MA. The role of frozen sections in gynaecological oncology: survey of practice in the United Kingdom. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013;166:204–8. DOI:

Valentin L, Ameye L, Savelli L, Fruscio R, Leone FPG, Czekierdowski A, et al. Adnexal masses difficult to classify as benign or malignant using subjective assessment of gray‐scale and Doppler ultrasound findings: logistic regression models do not help. Ultrasound in Obstetrics & Gynecology. 2011;38:456–65. DOI:

Van Calster B, Timmerman D, Valentin L, McIndoe A, Ghaem-Maghami S, Testa AC, et al. Triaging women with ovarian masses for surgery: observational diagnostic study to compare RCOG guidelines with an International Ovarian Tumour Analysis (IOTA) group protocol. BJOG. 2012;119:662–71. DOI:

Tingulstad S, Hagen B, Skjeldestad FE, Onsrud M, Kiserud T, Halvorsen T, et al. Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre‐operative diagnosis of pelvic masses. BJOG. 1996;103:826–31. DOI:

Morotti M, Menada MV, Moioli M, Sala P, Maffeo I, Abete L, et al. Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with pre-operative diagnosis of atypical endometrial hyperplasia. Gynecologic oncology. 2012;125:536–40. DOI:

Salman MC, Usubutun A, Dogan NU, Yuce K. The accuracy of frozen section analysis at hysterectomy in patients with atypical endometrial hyperplasia. Clinical and Experimental Obstetrics & Gynecology. 2009;36:31–4.

Moodley M, Bramdev A. Frozen section: Its role in gynaecological oncology. Journal of Obstetrics and Gynaecology. 2005;25:629–34. DOI:

Villaruel A, Damian K. The Diagnostic Accuracy of Hematologic Parameters, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio, in Malignant and Benign Epithelial Neoplasms of the Ovary in Philippine General Hospital Service Patients. PJP. 2021;6 2 SE-Original Articles:22–9. doi: 10.21141/PJP.2021.12. DOI:

Gao M, Gao Y. Value of pre-operative neutrophil–lymphocyte ratio and human epididymis protein 4 in predicting lymph node metastasis in endometrial cancer patients. Journal of Obstetrics and Gynaecology Research. 2021;47:515–20. doi: 10.1111/jog.14542. DOI:

Matsubara S, Mabuchi S, Takeda Y, Kawahara N, Kobayashi H. Prognostic value of pre-treatment systemic immune-inflammation index in patients with endometrial cancer. PLOS ONE. 2021;16:e0248871. doi: 10.1371/journal.pone.0248871. DOI:

Leng J, Wu F, Zhang L. Prognostic Significance of Pretreatment Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, or Monocyte-to-Lymphocyte Ratio in Endometrial Neoplasms: A Systematic Review and Meta-analysis. Frontiers in Oncology. 2022;12:734948. DOI:

Petric A, Živadinović R, Mitić D, Stanojević M, Živadinović A, Kostić I. Hematological and biochemical markers in determining the diagnosis and stage prediction of endometrial cancer. Ginekologia Polska. 2022;0. doi: 10.5603/GP.a2022.0038. DOI:

Ekici H, Malatyalioglu E, Kokcu A, Kurtoglu E, Tosun M, Celik H. Do Leukocyte and Platelet Counts Have Benefit for Preoperative Evaluation of Endometrial Cancer? Asian Pacific Journal of Cancer Prevention. 2015;16:5305–10. DOI:

Matsuo K, Hom MS, Moeini A, Machida H, Takeshima N, Roman LD, et al. Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer. Gynecologic Oncology. 2015;138:332–8. DOI:

Metindir J, Bilir Dilek G. Pre-operative hemoglobin and platelet count and poor prognostic factors in patients with endometrial carcinoma. Journal of Cancer Research and Clinical Oncology. 2009;135:125–9. DOI:

Heng S, Benjapibal M. Pre-operative thrombocytosis and poor prognostic factors in endometrial cancer. Asian Pacific Journal of Cancer Prevention. 2014;15:10231–6. DOI:

Haruma T, Nakamura K, Nishida T, Ogawa C, Kusumoto T, Seki N, et al. Pre-treatment neutrophil to lymphocyte ratio is a predictor of prognosis in endometrial cancer. Anticancer Research. 2015;35:337–43.

Cummings M, Merone L, Keeble C, Burland L, Grzelinski M, Sutton K, et al. Pre-operative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. British Journal of Cancer. 2015;113:311–20. DOI:

Karaşin SS, Akselim B. The relationship of pre-operative laboratory parameters with endometrial cancer and prognostic factors. J Surg Med. 2021;5:344–8. DOI:

Zhao Z, Zhao X, Lu J, Xue J, Liu P, Mao H. Prognostic roles of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in ovarian cancer: a meta-analysis of retrospective studies. Archives of Gynecology and Obstetrics. 2018;297:849–57. doi: 10.1007/s00404-018-4678-8. DOI:

Sanna E, Tanca L, Cherchi C, Gramignano G, Oppi S, Chiai MG, et al. Decrease in Neutrophil-to-Lymphocyte Ratio during Neoadjuvant Chemotherapy as a Predictive and Prognostic Marker in Advanced Ovarian Cancer. Diagnostics. 2021;11. DOI:

Williams KA, Labidi-Galy SI, Terry KL, Vitonis AF, Welch WR, Goodman A, et al. Prognostic significance and predictors of the neutrophil-to-lymphocyte ratio in ovarian cancer. Gynecologic Oncology. 2014;132:542–50. doi: 10.1016/j.ygyno.2014.01.026. DOI:

Grivennikov SI, Greten FR, Karin M. Immunity, Inflammation, and Cancer. Cell. 2010;140:883–99. doi: 10.1016/j.cell.2010.01.025. DOI:

Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30:1073–81. DOI:

Viganó A, Bruera E, Jhangri GS, Newman SC, Fields AL, Suarez-Almazor ME. Clinical survival predictors in patients with advanced cancer. Archives of Internal Medicine. 2000;160:861–8. DOI:






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Karaşin SS, Toksoy Karaşin Z. Are blood parameters assessed before taking frozen sections useful in gynecological oncology? A novel index in the prediction of gynecological malignancy. J Surg Med [Internet]. 2022 Aug. 31 [cited 2022 Sep. 28];6(8):751-5. Available from: