Implementation of Frozen Section Services for Gynecologic Surgeries in a Single Institution in Ethiopia: Results of a Pilot 12-Month Experience and Implications for Introduction into Low- and Middle-Income Countries.

Abstract

Intraoperative frozen section provides surgeons with information that guides them to perform the most reasonable procedure. The aim of the study was to determine the accuracy of FS and share the experience of establishing FS services for implementation in similar low- and middle-income countries. This pilot study was conducted between January 2022 and December 2022, including women who underwent gynecologic surgeries, using a structured questionnaire. Data was analyzed with SPSS 23.1, and tables were employed for data presentation. The overall accuracy, sensitivity, and specificity of frozen section analysis were calculated, and the experiences of establishing frozen section services are shared. Seventy-six frozen section samples were sent for histopathology analysis. Seventy (92%) cases comprised adnexal lesions, 3 (4%) cases represented uterine lesions, and 3 (4%) cases were lymph nodes. Most (70%) of the ovarian samples were reported as benign, and 18 (26%) as malignant. One of the 3 uterine samples was reported as sarcoma, and 2 of the lymph nodes as secondary malignancy. The overall accuracy of frozen section for the detection of any benign, borderline, and malignant ovarian neoplasms was 90%. The average turnaround time was 25 min and was more than 30 min in 39% of cases. Although FS pathology helped avoid unnecessary extensive surgeries in some patients, it was inappropriately utilized in 30% of the cases, and mechanisms to address discrepant results and assuring quality were not robust. The overall accuracy of the frozen section was comparable to most international data, demonstrating its feasibility and practicality in low-resource settings. However, quality improvement mechanisms should be thoroughly considered.