Objective: To analyze the performance of intraoperative cytological diagnosis and its contribution to enhance the diagnostic concordance of intraoperative procedures with definitive histological diagnosis in ovarian lesions. Descriptions of cytologic features of some ovarian lesions as seen in imprint and smear specimens are documented. Advantages and limitations of cytological specimens are underscored. Study Design: We performed a retrospective review of intraoperative consultations of ovarian neoplastic and non-neoplastic lesions of 337 cases identified from the pathologic records of our laboratory. All cases evaluated had intraoperative cytological imprint or smear specimens. The intraoperative diagnosis transmitted to the surgeon was the combined result of a thorough macroscopic study of the surgical specimens, frozen section analysis of tissue samples obtained from the most representative areas, evaluation of smear and imprint cytological specimens, and cyto-histological correlation. The intraoperative diagnosis was compared with the final histological diagnosis. Blinded review of cytological slides in discrepant cases was carried out. Results: Final histological diagnosis showed 268 benign lesions, 49 malignant tumors and 20 borderline epithelial tumors. Diagnostic accuracy was 97%, sensitivity 93%, specificity 98%, positive predictive value 91% and negative predictive value 98%. After the cytological review of the discrepant cases, accuracy increased to 98.5%, specificity to 100%, and positive predictive value to 100%. The sensitivity and negative predictive values did not change, remaining 93 and 98%, respectively. The proportion of false positives dropped from 7 (2.1%) to 0, and the proportion of false negatives from 9 (2.7%) to 5 (1.5%). The new values showed significant differences for specificity (p = 0.0401), positive predictive value (p = 0.0479) and for the proportion of false positives (p = 0.0226). Cytologic evaluation contributed with wider sampling of tumors and excellent cyto-morphological details. Conclusion: Adding cytological evaluation of imprint and smear specimens and cyto-histologic correlation to the traditional gross examination and frozen sections results in better correlation of the intraoperative consultation with the definitive histological diagnosis. In this series cytology was more accurate than frozen sections in some cases. Cytological evaluation of imprints and smears should be considered an important complementary tool in the setting of intraoperative consultation.

Stewart Colin JR, Brennan BA, Hammond IG, Leung YC, McCartney AJ: Intraoperative assessment of ovarian tumors: a 5-year review with assessment of discrepant diagnostic cases. Int J Gynecol Pathol 2006;25:216–222.
Nagai Y, Tanaka N, Horiuchi F, Ohki S, Seki K, Sekiya S: Diagnostic accuracy of intraoperative cytology in ovarian epithelial tumors. Int J Gynaecol Obstet 2001;72:159–164.
Baker P, Oliva E: A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008;27:353–365.
Geomini P, Bremer G, Kruitwagen R, Mol BWJ: Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis. Gynecol Oncol 2005;96:1–9.
Pinto PB, Andrade L, Derchain S: Accuracy of intraoperative frozen section diagnosis of ovarian tumors. Gynecol Oncol 2001;81:230–232.
Gol M, Baloglu A, Dogan Y, Aydin C, Yenseri U: Accuracy of frozen section diagnosis in ovarian tumors: is there a change in the course of time? Int J Gynecol Cancer 2003;13:593–597.
Saglam EA, Usubutun A, Ayhan A, Küçükali T: Mistakes prevent mistakes: experience for intraoperative consultation with frozen section. Gynecol Reprod Biol 2006;125:266–268.
Acs G: Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol 2002;19:237–254.
Ilvan S, Ramazanoglu R, Akyldiz UE, Calay Z, Bese T, Oruc N: The accuracy of frozen section (intraoperative consultation) in the diagnosis of ovarian masses. Gynecol Oncol 2005;97:395–399.
Tangjitgamol S, Jesadapatrakul S, Manusirivithaya S, Sheanakul C: Accuracy of frozen section in diagnosis of ovarian mass. Int J Gynecol Cancer 2004;14:212–219.
Ittee S: Imprint cytologic examination as an adjunct to frozen section. J Med Assoc Thai 1993;76:458–464.
Shidham V, Galindo L, Edmonds P, George V: Intraoperative scrape cytology: comparison with frozen sections, using receiver operating characteristic (ROC) curve. Diagn Cytopathol 2000;23:134–139.
Scucchi FL, Di Stefano D, Cosentino L, Vecchione A: Value of cytology as an adjuntive intraoperative diagnostic method: an audit of 2,250 consecutive cases. Acta Cytol 1997;41:1489–1496.
Souka S, Kamel M, Rocca M, El-Assi M, Hebeishy N, Sheir SH: The combined use of cytological imprint and frozen section in the intraoperative diagnosis of ovarian tumors. Int J Gynecol Obstet 1990;31:43–46.
Khunamornpong S, Siriaunkgul S: Scrape cytology of the ovaries: potential role in intraoperative consultation of ovarian lesions. Diagn Cytopathol 2003;28:250–257.
Michael C, Lawrence WD, Bedrossian WM: Intraoperative consultation in ovarian lesions: a comparison between cytology and frozen section. Diagn Cytopathology 1996;15:387–394.
Tempfer CB, Polterauer S, Bentz EK, Reinthaller A, Hefler LA: Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynecol Oncol 2007;107:248–252.
Wang KG, Chen TC, Wang TY, Yang YC, Su TH: Accuracy of frozen section diagnosis in gynecology. Gynecol Oncol 1998;70:105–110.
Houck K, Nikrui N, Duska L, Chang Y, Fuller A, Bell D, Goodman A: Borderline tumors of the ovary: correlation of frozen and permanent histopathologic diagnosis. Obstet Gynecol 200;95:839–843.
Saglam EA: Mistakes prevent mistakes: experience for intraoperative consultation with frozen section (Lett.). Gynecol Reprod Biol 2006;125:266–268.
Boriboonhirunsarn D, Serboon A: Accuracy of frozen section in the diagnosis of malignant ovaran tumor. J Obstet Gynaecol Res 2004;30:394–399.
Stewart Colin Jr: Cytologic identification of Reinke crystalloids in ovarian Leydig cell tumor. Ach Pathol Lab Med 2006;130:765–766.
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