Pg. Rose et al., ACCURACY OF FROZEN-SECTION (INTRAOPERATIVE CONSULTATION) DIAGNOSIS OFOVARIAN-TUMORS, American journal of obstetrics and gynecology, 171(3), 1994, pp. 823-826
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 conduct
ed to determine the accuracy of frozen-section diagnosis of ovarian tu
mors. STUDY DESIGN: Frozen- and permanent-section diagnoses were divid
ed into three categories (benign, borderline, and malignant). The sens
itivity, specificity acid predictive values, and 95% percent confidenc
e intervals of each frozen-section diagnosis were determined. RESULTS:
Three hundred eighty-three ovarian tumors that underwent frozen-secti
on 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 inac
curate in 7.3%. The sensitivity for malignant tumors was 92.5% tumors
(95% confidence intervals 87.7% to 97.2%), the sensitivity for borderl
ine tumors was 44.8% (95% confidence interval 26.4% to 63.2%). The spe
cificity 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 an
d 95% confidence intervals were 92.0% (88.6% to 95.4%) for benign tumo
rs, 65% (43.6% to 86.5%) for borderline tumors, and 99.1% (97.3% to 10
0.0%) for malignant tumors. Thirteen of 16 (81%) ovarian lymphomas and
tumors metastatic to the ovary were correctly identified by intraoper
ative 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 specifi
city of frozen-section diagnosis of ovarian tumors are high. Borderlin
e tumors remain difficult to accurately diagnose at frozen section bec
ause of the extensive sampling required. Frozen-section diagnoses have
important implications regarding the type and extent of surgery perfo
rmed at the initial operation.