Available online 7 October 2022

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

Prospective cohort study from 2018 to 2021

11 children's hospitals

Females age 6-21 years undergoing surgical management of an ovarian mass

Obtaining intraoperative FS pathology

Diagnostic accuracy of FS pathology

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.

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.

frozen section

pediatric ovarian mass

ovary-sparing surgery

© 2022 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.