Frozen section in laparoscopic management of macroscopically suspicious ovarian masses

To study the usefulness of and applications for frozen section in the laparoscopic management of adnexal masses.

Historical prospective study (Canadian Task Force classification II-3).

Large tertiary care hospital with university affiliation.

One hundred forty-one women undergoing laparoscopy for a suspicious adnexal mass.

Adnexal masses suspicious on ultrasound were managed by laparoscopy. After laparoscopic diagnosis, frozen sections were used to confirm a diagnosis of malignancy. Treatment was performed by laparoscopy whenever feasible.

The results of frozen section were compared with the results of permanent sections, and the consequences of the intraoperative diagnosis on the surgical management were evaluated. The frozen section diagnosis was correct in 125 of the 141 patients (88.7%). In one patient, the result was false negative. Specifically, frozen section diagnosis was correct in 96.8% of cases when a cyst or biopsy was sent for pathologic examination and in 86.4% when the whole adnexa was sent. It was correct in 93% of the cases involving tumors smaller than 100 mm and in 74% of larger tumors. It was correct in 92.3% of the women younger than 50 years and in 81.6% of women older than age 50. Intraoperative pathologic diagnosis was correct in 95.5% of benign tumors, 77.8% of low-malignancy tumors, and 75% of cancer cases.

Frozen section is a useful examination for surgical management decision making; however, the limitations and the difficulties should be taken into account.