Objective: The aim
of this work is to compare between intraoperative frozen section and scrape
smear cytology in the diagnosis of ovarian neoplasm. Method: This study was
performed between March 2011 and March 2012, on 50 patients presented with
ovarian mass. Gross examination of the tumor removed was done by inspection and
palpation. The specimen was then cut with a sharp knife into two halves. The
area was scraped with a sharp scalpel or the end of a glass slide, depending
upon the type of tissue. A semifluid drop thus obtained was spread over a glass
slide. One to four slides per case were taken from different representative
areas. The slides were labelled and immediately put into 95% ethyl alcohol and
stained with hematoxylin-eosin. The specimens were then fixed in formalin.
Paraffin blocks of the sections were processed in the routine way and sections
were stained with hematoxylin and eosin (H and E). Assessment of the overall
accuracy of the intraoperative diagnosis was classified as concordant or discordant.
Results: The sensitivity, specificity, positive predictive value, negative
predictive value and accuracy of scraping technique in the diagnosis of benign
ovarian masses were 100%, 95.2%, 96.7%, 100% and 98% respectively. The
sensitivity, specificity, positive predictive value, negative predictive value
and accuracy of scraping technique in the diagnosis of border line ovarian
masses were 100%, 93.4%, 25%, 100% and 94% respectively. The sensitivity,
specificity, positive predictive value, negative predictive value and accuracy
of scraping technique in the diagnosis of malignant ovarian masses were 80%,
100%, 100%, 88.2% and 92% respectively. The sensitivity, specificity, positive
predictive value, negative predictive value and accuracy of frozen section in
the diagnosis of benign ovarian masses were
100%, 100%, 100%, 100% and 100% respectively. The sensitivity, specificity,
positive predictive value, negative predictive value and accuracy of
frozen section in the diagnosis of borderline ovarian masses were 100%, 95.9%,
33.3%, 100% and 96% respectively. The sensitivity, specificity, positive
predictive value, negative predictive value and accuracy of frozen section in
the diagnosis of malignant ovarian masses were 90%, 100%, 100%, 93.8% and 96%
respectively. Conclusion: Frozen section is more accurate than smear
preparations in the intraoperative assessment of ovarian tumors in this study.
However, the cytology preparations were helpful in supporting the histological
diagnoses, and in some cases, provided additional useful information. Thus,
cytology has a complementary role to frozen section in the intraoperative
assessment of ovarian lesions. At the centers where the facilities of frozen
section are not available, intraoperative scrape cytology is a useful tool for
intraoperative diagnosis of tumor.