Clinical value of intraoperative frozen section in the surgical management of ovarian tumors: diagnostic accuracy and correlation with final histopathology.

Abstract

Objectives: Intraoperative frozen section (FS) analysis is widely used during surgery for ovarian tumors to guide the extent of the operative procedure. It plays a particularly significant role in young women, in whom fertility-sparing surgery is considered. Despite its high clinical utility, FS has technical limitations that may result in discrepancies compared with final histopathological diagnosis. To assess the concordance between intraoperative frozen section diagnosis and final histopathological examination of ovarian tumors, and to evaluate the diagnostic accuracy, sensitivity, specificity, and predictive values of FS.

Material and methods: The analysis included finally 100 women aged 11-78 years from among 114 who were hospitalized and underwent surgery for ovarian tumors conducted at a tertiary Gynecology and Obstetrics Clinical Hospital from January to June 2025. Frozen section diagnoses were compared with final histopathological results. Concordance rates, patterns of diagnostic discrepancies, and diagnostic performance parameters (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were calculated using final histopathology as the reference standard.

Results: Overall concordance between frozen section and final histopathology was 85%. Diagnostic discrepancies were observed in 15% of cases, with only 2% considered clinically significant. Frozen section showed excellent diagnostic performance for benign tumors (sensitivity 100%, specificity 94.1%) and malignant tumors (specificity and PPV 100%). The lowest diagnostic accuracy was observed for borderline tumors, which accounted for most clinically relevant discrepancies. The most frequent source of discordance involved hemorrhagic cysts, which were ultimately diagnosed as endometriotic cysts on final histopathology.

Conclusions: Intraoperative frozen section analysis is a reliable and safe diagnostic tool that effectively supports surgical decision-making in ovarian tumors. Its high diagnostic accuracy and predictive values confirm its clinical value, particularly in tailoring the extent of surgery. Special caution is warranted in the interpretation of borderline tumors, for which final histopathological examination remains essential.