Accuracy of frozen-section (intraoperative consultation) diagnosis of ovarian tumors

• Published in: American journal of obstetrics and gynecology Vol. 171; no. 3; pp. 823 - 826
• Main Authors: Rose, Peter G., Rubin, Ronald B., Nelson, Beth E., Hunter, Richard E., Reale, Frank R.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-09-1994; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Child, Preschool; Female; Female genital diseases; frozen section; Frozen Sections; Gynecology. Andrology. Obstetrics; Humans; Infant; Intraoperative Care; Medical sciences; Middle Aged; Ovarian Neoplasms - pathology; Ovarian tumors; pathology; Predictive Value of Tests; Referral and Consultation; Retrospective Studies; Sensitivity and Specificity; Tumors; frozen section; pathology; Ovarian tumors; Ovarian diseases; Ovary; Histopathology; Tumor; Diagnosis; Performance; Female genital diseases
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(94)90105-8

Objective: Frozen-section evaluation of ovarian tumors can be used to establish a histopathologic diagnosis and guide the surgeon to perform the appropriate surgical procedure. A retrospective study was conducted to determine the accuracy of frozen-section diagnosis of ovarian tumors.
Study Design: Frozen- and permanent-section diagnoses were divided into three categories (benign, borderline, and malignant). The sensitivity, specificity and predictive values, and 95% percent confidence intervals of each frozen-section diagnosis were determined.
Results: Three hundred eighty-three ovarian tumors that underwent frozen-section evaluation between June 1983 and June 1993 were studied. The final histopathologic diagnosis was 61.1 % benign, 7.6% borderline, and 31.3% malignant. Frozen section was accurate in 92.7% of all cases and inaccurate in 7.3%. The sensitivity for malignant tumors was 92.5% tumors (95% confidence intervals 87.7% to 97.2%), the sensitivity for borderline tumors was 44.8% (95% confidence interval 26.4% to 63.2%). The specificity for benign tumors was 92.0% (95% confidence interval 88.6% to 95.4%) but increased to 97.9% (95% confidence interval 96.1 % to 99.7%) if borderline tumors were excluded. The positive predictive value and 95% confidence intervals were 92.0% (88.6% to 95.4%) for benign tumors, 65% (43.6% to 86.5%) for borderline tumors, and 99.1% (97.3% to 100.0%) for malignant tumors. Thirteen of 16 (81 %) ovarian lymphomas and tumors metastatic to the ovary were correctly identified by intraoperative frozen section. The sensitivity for borderline serous tumors was 64.3% and for borderline mucinous tumors 30.8% (p = 0.48).
Conclusion: With the exception of borderline tumors, the sensitivity and specificity of frozen-section diagnosis of ovarian tumors are high. Borderline tumors remain difficult to accurately diagnose at frozen section because of the extensive sampling required. Frozen-section diagnoses have important implications regarding the type and extent of surgery performed at the initial operation.