Gynecologic Pathology Intraoperative Consultation

Gynecologic specimens are frequently submitted for intraoperative consultation, primarily as a basis for making immediate treatment decisions. The extent and type of surgery often depends on the result of such examinations. Frozen section evaluation is primarily performed to confirm the presence and histologic type of malignancy, as well as to determine the adequacy of resection by examining the surgical margins. Frozen sections are accurate for clinical use during gynecologic surgery, with low false negative rate and lower false positive rate. The accuracy in general surgical practice is reported to vary from 91.5 to 97.4%, but it is lower in mesenchymal tumors, in which mitotic counts are critical, and in ovarian mucinous tumors, in which extensive sampling is often needed. In such instances, it is imperative to defer the diagnosis until additional examination is feasible. Frozen Sections in Gynecologic Pathology will consider the application, indications, contraindications and limitations of frozen sections in gynecologic specimens, as well as the causes of false-positive or false- negative frozen section results. Each organ will be considered separately, since intraoperative consultation plays a different role in each part of the genital tract. Indications on how to handle and gross different specimens will only be considered in as much as it relates to frozen section and gross consultation carried within the frozen section laboratory. Frozen Sections in Gynecologic Pathology will be highly valuable to practicing surgical pathologists, both community and academic, and to pathology residents and fellows. The perspectives provided will also be valuable to gynecology oncology surgeons and their trainees who may appreciate this for their practice and for their boards.