Use and accuracy of intraoperative frozen section analysis for ovarian masses in children and adolescents.

STUDY OBJECTIVE: Describe current practice patterns and diagnostic accuracy of frozen section (FS) pathology for children and adolescents with ovarian masses.

DESIGN: Prospective cohort study from 2018 to 2021 SETTING: 11 children's hospitals PARTICIPANTS: Females age 6-21 years undergoing surgical management of an ovarian mass INTERVENTIONS: Obtaining intraoperative FS pathology MAIN OUTCOME MEASURE(S): Diagnostic accuracy of FS pathology RESULTS: Of 691 patients undergoing surgical management of an ovarian mass, FS was performed in 27 (3.9%), of which 9 (33.3%) had final malignant pathology. Amongst FS patients, 12/27 (44.4%) underwent ovary-sparing surgery (OSS) and 15/27 (55.5%) underwent oophorectomy +/- other procedures. FS results were disparate from final pathology in 7/27 (25.9%) cases. FS had a sensitivity of 44.4% and specificity of 94.4% for identifying malignancy with a c-statistic of 0.69. Malignant diagnoses missed on FS included serous borderline tumor (n=1), mucinous borderline tumor (n=2), mucinous carcinoma (n=1), and immature teratoma (n=1). FS did not guide intervention in 10/27 (37.0%) patients: 9 with benign FS underwent oophorectomy and 1 with malignant FS did not undergo oophorectomy. Of the 9 patients who underwent oophorectomy with benign FS, 5 (55.6%) had benign and 4 (44.4%) had malignant final pathology.

CONCLUSIONS: Frozen sections are infrequently utilized for pediatric and adolescent ovarian masses and may be inaccurate for predicting malignancy and guiding operative decision-making. We recommend continued assessment and refinement of guidance before any standardization of use of FS to assist with intraoperative decision-making for surgical resection and staging in children and adolescents with ovarian masses.