Experience With the Use of Intraoperative Diagnosis as an Aid to Definitive Diagnosis in Malignant Lesions: A Retrospective Study From a Tertiary Cancer Institute

Background Intraoperative frozen section (IFS) helps the surgeon in surgical management by providing intraoperative diagnosis of tumors, assessment of margins and lymph nodes, and identification of metastasis. The present study aims to evaluate the indications for IFS consultation and determine its diagnostic accuracy across major anatomical sites to improve clinical management. Methodology This retrospective study included 228 IFS samples over two years (2023-2024). The histopathology findings of IFS were compared with corresponding formalin-fixed paraffin-embedded (FFPE) tissue, and the results were categorized into concordant and discordant. The causes of diagnostic differences were systematically analyzed. Diagnostic parameters, including accuracy, sensitivity, specificity, error rates, indication, tissue types, and limitations, were also evaluated. Results In the present study, the number of female patients (146, 64%) was higher than that of male patients (82, 36%), and the age range of patients was between 10 and 74 years. The maximum frozen section (FS) sample for diagnosis was obtained from the breast (59, 25.8%), followed by the ovary (45, 19.7%), head and neck (44, 19.3%), lymph nodes (31, 13.6%), omentum (13, 5.7%), gallbladder (12, 5.3%) and other anatomical sites (24, 10.5%). The most common indication for FS examination was margin assessment (107, 46.9%). In a review of nine discordance cases, misinterpretation error was found in five cases, sampling errors in three cases, and technical errors in one case. The overall diagnostic accuracy of FS was 96.1%, with a sensitivity of 90.2% and specificity of 99.3%. Conclusions The study demonstrated that FS is a useful technique for evaluating pathological entities and aiding in the surgical management of patients. It also helps identify areas requiring improvement to reduce error rates in FS.