Accuracy of ultrasound, magnetic resonance imaging and intraoperative frozen section in the diagnosis of ovarian tumours: data from a London tertiary centre

Abstract

Background: Ovarian cancer has the worst prognosis among all gynaecological cancers. The pre-operative and intraoperative diagnosis of ovarian tumours is imperative to ensure the right operation is performed and to improve patients' outcomes.

Methodology: A retrospective review of cases with a confirmed histological diagnosis of ovarian cases was undertaken from January 2017 to December 2021. Comparison was undertaken between this final diagnosis and the pre-operative ultrasound, MRI and frozen section (FS) to assess diagnostic accuracy of each. In the ultrasound cases, the level of the examiner was collected. Statistical analysis was performed using Stata MP v17.0 software (USA, 2023).

Results: In total, 156 ovarian masses were examined by FS. In the histopathological examination, 123/156 of these tumours were epithelial tumours. Pre-operative US subjective impression was made in 63/156 cases and preoperative MRI subjective impression was made in 129/156 cases. For benign, borderline and malignant tumours, FS demonstrated a sensitivity of 90.8% (95%CI:81.9-96.2), 86.8% (95%CI:71.9-95.6) and 97.6% (95%CI:87.4-99.9) respectively. Ultrasound's sensitivities were 95.2% (95%CI:76.2-99.9), 20% (95%:4.33-48.1), 57.1% (95%CI:28.9-82.3) and MRI's sensitivities were 100% (95%CI:80.5-100), 31.5% (95%CI:19.5-45.6) and 63.2% (95%CI:46-78.2) respectively.

Conclusions: FS remains an accurate tool for diagnosing ovarian malignancy. However, across both imaging modalities and FS, the diagnosis of borderline ovarian tumours remains challenging.