The role of frozen section in gynecologic pathology

Abstract

Intraoperative consultation using frozen sections in gynecologic surgery aids in determining the scope of the surgery. The main indications are to evaluate the presence of malignancy, determine the primary site, histologic type, and grade of the tumor, and assess the extent of local tumor invasion and distant spread.

A thorough gross examination of submitted specimens helps identify critical features such as specimen integrity, tumor size, serosa and ovarian surface involvement, myometrial involvement, and lymph node status. Uterine endometrial carcinomas are classified based on histologic type and grade, with attention to features such as myometrial invasion, cervical stromal involvement, and gross tumor size. Correct evaluation of uterine mesenchymal tumors, ovarian epithelial tumors, sex-cord stromal tumors, and germ cell tumors is essential to guide the decision between conservative and extensive surgical staging. It is challenging but essential to distinguish primary ovarian tumors from metastatic neoplasms. Prompt and clear communication with the operating surgeon is crucial for successful consultation. Providing definitive diagnoses on frozen sections can sometimes be difficult; however, understanding the management algorithm and maintaining an open dialogue with the surgeon about differential diagnoses can help in offering the necessary information for subsequent management steps.