Intraoperative consultation in gynecologic pathology

Intraoperative consultation is widely used in gynecologic surgical practice to make intraoperative diagnosis, primarily to aid the surgeon to plan the extent of surgery. This article reviews the indications, performance and interpretation, accuracy and diagnostic pitfalls in the three major areas of gynecologic malignancies where intraoperative consultations are most frequently requested: ovarian masses, endometrial carcinoma and carcinoma of the cervix. For ovarian masses intraoperative consultation is usually requested either for histologic confirmation of malignant or borderline primary ovarian tumors before proceeding with radical surgery, or to rule out malignancy at the time of surgery for presumed benign disease. The diagnosis of endometrial carcinoma is usually made preoperatively before definitive surgical treatment. Thus, intraoperative consultation is most often used to identify the subgroup of patients with features of high risk disease who have an increased risk of metastases and who will benefit from formal surgical staging. In cases of carcinoma of the cervix frozen section is most commonly used to estimate the extent of spread of known invasive carcinoma at the time of radical surgery. Despite its restrictions, frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian, endometrial and cervical tumors. The specificity of the method in experienced hands is high, the sensitivity is sufficient. The diagnosis of borderline ovarian tumors may be troublesome however, mainly due to their heterogeneity in appearance, especially in the case of large tumors of mucinous histologic type. It is important for pathologists to have a clear idea of the role and limitations of frozen section diagnosis in gynecological surgery in order to play a meaningful and optimal role in the management of the gynecologic oncology patient.