Role of Intraoperative Frozen Section in the Diagnosis of Ovarian Neoplasms- A Retrospective Study in an Oncology Centre

Abstract

Introduction: Ovarian malignancy is the sixth most common cancer in women and the seventh most common cause of cancer death. Intraoperative frozen section evaluation plays a critical role in guiding the type and extent of surgery. The overall accuracy of the intraoperative frozen section diagnosis for ovarian tumours was reported to be ranging from 85 to 95%. Aim: To determine frozen section accuracy in the diagnosis of ovarian neoplasms. Materials and Methods: The present study was a retrospective study taken up in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, from January 2011 to December 2018 during which all the ovarian masses which were sent for frozen section and later for regular Histopathological Examination (HPE) were included in the study. All the slides of these cases were reviewed by two senior pathologists in a double blind study. The frozen section and the permanent section reports of each patient were compared. The overall accuracy, sensitivity, specificity, positive and negative predictive values of the frozen section diagnoses were studied for benign, borderline and malignant cases by using 2 × 2 tables. The final histopathological diagnosis was considered as gold standard. Results: The study included 289 cases and the overall accuracy of frozen section was 87.89%. Thirty five cases were incorrectly diagnosed, of which 24 cases were under diagnosed and 11 were over diagnosed. With respect to malignant potential, the sensitivity for malignant tumours was 81.4% with specificity of 96.8%. For benign tumours, the sensitivity and specificity were 93% and 91.4%, respectively. Borderline tumours had the lowest sensitivity of 68.7% with specificity of 91.8%. Conclusion: Gross examination is to be done carefully for tumour tissue selection for frozen section diagnosis intraoperatively. The results help to decide the type and extent of surgical management.