Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis

Background. Frozen section diagnosis is a diagnostic procedure for the assessment of the adnexal mass during surgery. The purpose of the present study was to perform a systematic review of the literature on the accuracy of frozen section diagnosis in the assessment of the adnexal mass. Methods. We performed a computerized Medline and EMBASE search to identify all registered articles published between January 1966 and June 2003, comparing frozen section diagnosis of ovarian pathology to the final histopathological diagnosis. For each study, we calculated the prevalence of malignant and borderline tumors, and the sensitivity and specificity of the frozen section diagnosis using the final histopathological diagnosis as reference. We performed the calculations in two ways. In the first analysis, tumors that were found to be borderline were considered as malignant in the 2 x 2 table. In the second analysis, tumors that were found to be borderline were considered as benign in the 2 x 2 table. Results. Eighteen studies were included for analysis. When the diagnosis borderline was classified as malignant, the sensitivity of frozen section diagnosis varied between 65% and 97%, and the specificity between 97% and 100%. When the diagnosis borderline was considered to be benign, the sensitivity varied between 71% and 100%, for a specificity varying between 98.3% and 100%. Conclusion. The accuracy of frozen section diagnosis for the assessment of the ovarian mass is good, with acceptable sensitivities for almost perfect specificities. Future studies on patient preferences for the different outcomes as well as economic analysis are needed for definite position of this diagnostic technique. (C) 2004 Elsevier Inc. All rights reserved.