The accuracy of intraoperative frozen sections in the diagnosis of ovarian tumors.

OBJECTIVE: To determine whether frozen section evaluation of ovarian tumors can be used to establish a histopathologic diagnosis and guide the surgeon to perform the appropriate surgical procedure. MATERIAL AND METHOD: Between January 2002 and December 2006, 376 ovarian specimens were submitted for frozen section examination and received for permanent section evaluation. The accuracy, sensitivity, specificity, and positive and negative predictive values of the frozen sections were studied. RESULTS: The overall accuracy was 87.8% while the inaccuracy was 12.2%. The sensitivity for malignant tumors was 79.6%, the sensitivity for borderline tumors was 61.8%, and the sensitivity for benign tumors was 98.2%. The specificity for the benign tumors was 88.6%, 93.8% for borderline tumors, and 97.1% for malignancy The positive predictive value was 92.2% for benign tumors, 63% for borderline tumors, and 91.1% for malignant tumors. CONCLUSION: The present study confirms that frozen section diagnosis is a reliable method for the surgical management of patients with ovarian masses.

Screening of cervical neoplasia by using pap smear with speculoscopy compared with pap smear alone.

OBJECTIVE: The objective was to compare the sensitivity and specificity of Pap smear plus speculoscopy with Pap smear alone. MATERIAL AND METHOD: The study was conducted in the Gynecology Clinic, Rajavithi hospital, Thailand between February 1st and July 31st 2003. Women who made a request for cervical screening underwent a Pap smear, speculoscopy and colposcopy. Colposcopically directed biopsies were obtained from women who had a positive colposcopy. Analytical methods were applied. RESULTS: Of 257 women recruited to the study, Pap smear plus speculoscopy could increase sensitivity from 6.67% with Pap smear alone and to 33.33% when Pap smear plus speculoscopy is used. The false negative rate was reduced from 93.33% with Pap alone and to 66.67% with Pap smear plus speculoscopy. In using Pap smear alone compared with combination of two tests, the specificity decreased from 97.52% to 77.68% and false positive rate increased from 2.48% to 22.31%, respectively. CONCLUSION: Adding speculoscopy to the Pap smear is able to significantly increase the sensitivity of the cervical screening. It also reduces the 'false negative" result. However, as expected, the specificity slightly decreases, due to the false positive from speculoscopy itself. One solution is to defer colposcopy for 6 months and to perform colposcopy only if either Pap smear or speculoscopy is positive.