Using Intra-Operative Frozen Section (IFS) in Gynaecological Oncology

Gynecologic malignancies where intra-operative frozen section (IFS) is frequently requested are ovarian masses, endometrial carcinoma, carcinoma of the cervix and Paget's disease of vulva.The accuracy of intra-operative frozen section with ovarian masses is fairly high and enables guidance to the type and extent of surgery performed in centres where IFS is available and the expertise is adequate. The accuracy is high for obviously benign and malignant masses but frequent problems may arise with borderline tumors, mucinous tumors and granulosa cell tumors. The sensitivity of malignant tumors has been reported to be varying from 87-99% and for borderline tumors 30-98% being more sensitive for serous and less sensitive for mucinous tumors.The role of intra-operative consultations in endometrial carcinoma can identify subgroups of patients with features of high risk disease who will benefit from formal surgical staging with pelvic and para-aortic lymphadenectomy is currently contentious.Frozen section cannot be offered for endometrial tissue specimens at dilatation and curettage since the sensitivity and specificity are low.Accuracy of frozen section for lymph node metastasis in patients undergoing radical hysterectomy for carcinoma of the cervix is fairly high. Frozen section diagnosis of pelvic node metastasis is a highly specific procedure which can alter intra-operative management of early-stage cervical cancer.Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia is a good option. Immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia can identify frank invasion and permit adequate treatment in a single procedure. In early microinvasive disease, frozen section examination cannot detect the area of invasion very accurately but reliably detects clear resection margins.