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The use of frozen section analysis is of considerable importance for the diagnosis of borderline ovarian tumors (BOTs) and to plan the most appropriate surgical management. The aim of this study is to determine the accuracy of frozen section in diagnosing BOTs. Material and methods: This is a retrospective study. A computerized database was used to identify all pathology reports (frozen section analysis and/or definitive histology) with a diagnosis of BOTs performed at our institution between January 2004 and December 2015. Frozen section analysis and definitive histology reports were compared. Results: 98 BOTs were diagnosed by frozen and/or permanent section pathology in 88 women. The sensitivity of frozen section for diagnosing BOTs was 76.5%; the positive predictive value was 83.3%. The sensitivity of frozen section for diagnosing serous BOTs was significantly higher than for diagnosing mucinous BOTs. Underdiagnosis occurred in 32.7% of the tumors; it was less frequent in serous tumors than in mucinous tumors. BOTs underdiagnosed at frozen section were significantly larger than those accurately diagnosed at frozen section. In 13 women, frozen section diagnosed BOTs were upgraded to invasive ovarian carcinoma by permanent pathology; there were two relapses in these patients after a mean follow-up of 47.8 months. No recurrence was observed after a mean follow-up of 60.4 months in 19 women with BOTs underdiagnosed as benign tumors at frozen section. Discussion: the surgical management of BOTs based only on intraoperative frozen section diagnosis may result in undertreatment or overtreatment of a substantial number of patients. Under-diagnosis by frozen section is associated with conservative surgery but it does not compromise the outcome in patients with BOTs. Correspondence to: Simone Ferrero MD, PhD, Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Largo R. Benzi 10, 16132 Genoa, Italy, Tel: +01139 010 511525; Fax: +01139 010511525; E-mail: simone.ferrero@ unige.it

Accuracy of intra-operative frozen section in the diagnosis of borderline ovarian tumors and clinical impact of underdiagnosis