Diagnostic Accuracy of Frozen Section and Its Influence on Intraoperative Management of Indeterminate Epithelial Ovarian Tumors

  • Nyengidiki T. Kennedy
  • Ajit SebastianEmail author
  • Dhanya S. Thomas
  • Anitha Thomas
  • Mayank Gupta
  • Ramani Manoj Kumar
  • Abraham Peedicayil
Original Article


The objective of this study is to determine the diagnostic accuracy of frozen section in detecting epithelial ovarian tumor histological types and its effect on management. A retrospective review was done of all patients who had an intraoperative frozen section for an indeterminate ovarian tumor over a six-year period. The reference standard was final histology. The validity indices for frozen section in diagnosing benign, borderline, and malignant lesions were determined. One hundred thirty-five intraoperative frozen section–diagnosed epithelial ovarian tumors were reviewed. The mean age was 44.9 ± 14.2 years, the median parity was 2, and 57% (77/135) of patients were post-menopausal. The commonest histological subtype was mucinous 48.1% (65/135) on frozen section and 46.7% (63/135) on final histology. The overall concordance rate of frozen section to final histology was 81.5% (ƙ = 0.719, p = 0.0001). The accuracy, sensitivity, specificity, and positive predictive value of frozen section to diagnose benign lesions were 86.7%, 85.7%, 97.2%, and 79.2% respectively. In borderline tumors, the diagnostic test characteristics were 88.1%, 81.2%, 90.3%, and 72.2%. For malignant lesions, these values were 88.1%, 77.8%, 95.1%, and 91.3% respectively. The odds ratios for frozen section being correct were 40.9 (95% CI 14.8–113.5) for benign lesions, 40.3 (95% CI 13.4–121.3) for borderline tumors, and 67.4 (95% CI 20.5–222.0) for malignancy. Over-treatment or under-treatment occurred in 19.3% of patients. Intraoperative frozen section is useful in situations where the nature of the ovarian tumor is uncertain. However, borderline ovarian tumors are more likely to be over-diagnosed. About a fifth of patients received inappropriate treatments based on the frozen section report.


Diagnostic test Ovarian neoplasm Frozen section India 



Dr. Rachel G Chandy for encouragement and logistic support.


Nyengidiki T Kennedy: Conceptualization, methodology, analysis, data curation, original draft

Ajit Sebastian: Conceptualization, validation, data curation, writing and review, visualization

Dhanya S Thomas: Software, writing and review

Anitha Thomas: Software, writing and review

Mayank Gupta: Software, writing and review

Ramani M Kumar: Methodology, validation, writing and review

Abraham Peedicayil: Conceptualization, methodology, original draft, review and editing, supervision

Compliance with Ethical Standards

Permission for the study was obtained from the Institutional Review board (IRB).

Conflict of Interest

The authors declare that they have no conflict of interest.




  1. 1.
    Makhija P, Singh N (2014) Surface epithelial Tumours of the ovary. In: Farghaly SA (ed) Advances in diagnosis and management of ovarian cancer. Springer, Boston, pp 59–86CrossRefGoogle Scholar
  2. 2.
    Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (2003) Pathology and classification of ovarian tumors. Cancer 97:2631–2642CrossRefGoogle Scholar
  3. 3.
    Ilker A, Aykut B, Muge H, Ibrahim HM, Ulku OB, Sener G et al (2011) Accuracy of intra-operative frozen section in the diagnosis of ovarian tumours. J Pak Med Assoc 61:856–858Google Scholar
  4. 4.
    Hashmi AA, Naz S, Edhi MM, Faridi N, Hussain SD, Mumtaz S, Khan M (2016) Accuracy of intraoperative frozen section for the evaluation of ovarian neoplasms: an institutional experience. World J Surg Oncol 14:91CrossRefGoogle Scholar
  5. 5.
    Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Mangioni C (2001) Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol 19:2658–2664CrossRefGoogle Scholar
  6. 6.
    Wakahara F, Kikkawa F, Nawa A, Tamakoshi K, Ino K, Maeda O, Kawai M, Mizutani S (2001) Diagnostic efficacy of tumor markers, sonography, and intraoperative frozen section for ovarian tumors. Gynecol Obstet Investig 52:147–152CrossRefGoogle Scholar
  7. 7.
    Supriya P, Shobha G, Anupama H (2016) Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms in comparison with histopathology in deciding the extent of surgery. A comparative study. J Dental Med Sci 15:10–12Google Scholar
  8. 8.
    Ureyen I, Turan T, Cirik DA, Tasci T, Boran N, Bulbul D, Tulunay G (2014) Frozen section in borderline ovarian tumours ; is it reliable? Eur J Obstet Gynaecol Reprod Biol 181:115–118CrossRefGoogle Scholar
  9. 9.
    Takemoto S, Ushijima K, Kawano R, Fukui A, Terada A, Fujimoto T, Imaishi H, Kamura T (2014) Validity of intraoperative diagnosis at laparoscopic surgery for ovarian tumours. J Minim Invasive Gynecol 21:576–579CrossRefGoogle Scholar
  10. 10.
    Scully RE, Young RH, Clement PR (1998) Tumours of the ovary, maldeveloped gonads, fallopian tube and broad ligament. In: Atlas of tumour pathology. 3rd series, fascicle 23. Armed Forces Institute of Pathology, Washington DC, pp 51–79Google Scholar
  11. 11.
    Maheshwari A, Gupta S, Kane S, Kulkarni Y, Goyal BK, Tongaonkar HB (2006) Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms: experience at a tertiary oncology center. World J Surg Oncol 4:12CrossRefGoogle Scholar
  12. 12.
    Morton R, Anderson L, Carter J, Pather S, Saidi SA (2017) Intraoperative frozen section of ovarian tumors. A 6-year review of performance and potential pitfalls in an Australian tertiary referral center. Int J Gynecol Cancer 27:17–21CrossRefGoogle Scholar
  13. 13.
    Stewart CJ, Brennan BA, Hammond IG, Leung YC, McCartney AJ (2006) Intraoperative assessment of ovarian tumours: a 5-year review with assessment of discrepant diagnostic cases. Int J Gynecol Pathol 25:216–222Google Scholar
  14. 14.
    Ratnavelu ND, Brown AP, Mallet S et al (2016) Intraoperative frozen section analysis for the diagnosis of early ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev 3:CD10360Google Scholar
  15. 15.
    Subbian A, Devi UK, Bafna UD (2013) Accuracy rate of frozen section studies in ovarian cancers: a regional cancer institute experience. Indian J Cancer 50:302–305CrossRefGoogle Scholar
  16. 16.
    Jung EJ, Eom HM, Byun JM, Kim YN, Lee KB, Sung MS, Kim KT, Jeong DH (2017) Different features of the histopathological subtypes of ovarian tumors in pre- and postmenopausal women. Menopause 24:1028–1032CrossRefGoogle Scholar
  17. 17.
    Fang S, Shoughhen C, Yifei G, Xujing D, Chen Q (2017) The prevalence of malignant and borderline ovarian cancers in pre- and post -menopausal Chinese. Oncotarget 8:80589–80594Google Scholar
  18. 18.
    Fatemeli N, Vahid S, Behnaz J, Seyed SJ, Alireza G (2017) Diagnostic accuracy of intraoperative frozen section and causes of error in ovarian epithelial tumours: an institutional experience. Middle East J Cancer 8:155–160Google Scholar
  19. 19.
    Yarandi F, Eftekhar Z, Izandi-Mood N, Schojaei H (2008) Accuracy of intraoperative frozen section in the diagnosis of ovarian tumours. Aust NZ J Obstet Gynaecol 48:438–441CrossRefGoogle Scholar
  20. 20.
    Kim JH, Kim TJ, Park YG, Lee SH, Lee CW, Song MJ, Lee KH, Hur SY, Bae SN, Park JS (2009) Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary. J Gynecol Oncol 20:176–180CrossRefGoogle Scholar
  21. 21.
    Pongsuvareeyakul T, Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Siriaunkgul S (2012) Accuracy of frozen-section diagnosis of ovarian mucinous tumors. Int J Gynecol Cancer 22:400–406CrossRefGoogle Scholar
  22. 22.
    Song T, Choi CH, Kim HJ, Kim MK, Kim TJ, Lee JW, Bae DS, Kim BG (2011) Accuracy of frozen section diagnosis of borderline ovarian tumors. Gynecol Oncol 122:127–131CrossRefGoogle Scholar
  23. 23.
    Nigrisoli E, Gardini G (1994) Quality control of intraoperative diagnosis: annual review of 1490 frozen sections. Pathologica 86:191–195Google Scholar
  24. 24.
    Scurry JP, Sumithran E (1989) An assessment of the value of frozen section in gynecologic surgery. Pathology 21:159–163CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  • Nyengidiki T. Kennedy
    • 1
  • Ajit Sebastian
    • 2
    Email author
  • Dhanya S. Thomas
    • 2
  • Anitha Thomas
    • 2
  • Mayank Gupta
    • 3
  • Ramani Manoj Kumar
    • 3
  • Abraham Peedicayil
    • 2
  1. 1.Department of Obstetrics & GynaecologyUniversity of Port Harcourt Teaching HospitalPort HarcourtNigeria
  2. 2.Department of Gynecologic OncologyChristian Medical College & HospitalVelloreIndia
  3. 3.Department of PathologyChristian Medical College & HospitalVelloreIndia

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