Concordance of intraoperative cytology with frozen section and final pathology for ovarian neoplasms

Introduction

Intraoperative frozen section analysis (IOFS) is a widely used method for evaluating ovarian masses and guiding surgical decisions. However, IOFS is not always accessible in low-resource settings. Recent research suggests that intraoperative cytology (IOC) may offer a quicker, less equipment-dependent alternative. This study aims to compare IOC and IOFS in women with ovarian neoplasms. The pathologists interpreting IOC were blinded to IOFS findings.

Methods

The study included 15 women aged 18 or older undergoing surgery for ovarian mass removal. Patients with biopsy-confirmed malignancies or known recurrences were excluded. After tumor removal, both IOFS and IOC were performed. IOFS involved using a Cryostat for sectioning and H&E staining. IOC used touch/imprint, scrape, and crush techniques. Independent pathologists analyzed the smears, and paraffin-embedded tissue histopathology was the diagnostic gold standard.

Results

IOC results were consistent with final pathology in 10 of 15 cases, while IOFS matched in 12 cases. IOC had 4 indeterminate and 1 borderline diagnosis, compared to 1 indeterminate, 1 benign, and 1 borderline diagnosis with IOFS. Three discrepancies between IOC and IOFS were identified, with IOC providing indeterminate results where IOFS ranged from benign to malignant. Indeterminate cases led to malignancy management strategies, including intraoperative staging.

Conclusion

This pilot study indicates that intraoperative cytology is a practical and effective method for rapid ovarian neoplasm evaluation. Further research with larger cohorts is needed to assess its comparative performance with frozen section analysis and optimize its methodology. IOC may offer a viable option for intraoperative surgical guidance.