Usefulness of intraoperative frozen section for diagnosing acute invasive fungal rhinosinusitis: A systematic review and meta-analysis
Int Forum Allergy Rhinol. 2021 Mar 26. doi: 10.1002/alr.22797. Online ahead of print.
BACKGROUND: The accuracy of diagnoses of acute invasive fungal rhinosinusitis (AIFRS) based on frozen sections has been questioned.
METHODS: PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, SCOPUS, and Google Scholar were used for data sources. True-positive, true-negative, false-positive, and false-negative data were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) Tool.
RESULTS: Nine prospective and retrospective studies were included. The diagnostic odds ratio of intraoperative frozen section in AIFRS was 124.4717 (95% confidence interval [CI], 75.5168-205.1623). The area under the summary receiver operating characteristic curve was 0.906. The sensitivity, specificity, and positive predictive value were 0.8337 (95% CI, 0.7962-0.8655), 0.9858 (95% CI, 0.9330-0.9971), and 0.9822 (95% CI, 0.8905-0.9973), respectively. The correlation between sensitivity and the false-positive rate was 0.437, indicating a lack of heterogeneity. In subgroup analysis, the “per patient” subgroup tended to show higher diagnostic accuracy than the “per specimen” subgroup. Regarding fungal species, the frozen biopsy of aspergillus showed higher sensitivity than that of mucor (0.8103 vs. 0.7544).
CONCLUSION: Positive frozen sections are reliable and facilitate early intervention in AIFRS. Collecting multiple specimens during surgery will decrease the rate of false-negative results.