Bridging the Frozen Section Gap: Diagnostic Utility of Intraoperative Cytology in Ovarian Tumours From a Rural Tertiary Care Centre in South India

BACKGROUND: Ovarian neoplasms are a significant cause of morbidity among women, particularly in resource-limited rural settings where access to advanced diagnostic facilities is often restricted. Intraoperative cytology provides a rapid and cost-effective diagnostic adjunct that may facilitate timely surgical decision-making. AIM: To evaluate the diagnostic utility of minimally invasive techniques of cytology in ovarian tumours in a rural tertiary care centre. MATERIALS AND METHODS: This study has been conducted by the Departments of Pathology, Obstetrics and Gynecology, by analysing cytological samples obtained from ovarian cysts/tumours retrospectively between June 2023 and December 2025. This includes specimen of ovarian mass/cysts submitted for touch/imprint, scrape and crush smears, along with fine-needle aspiration cytology (FNAC) for intra-operative cytological (IOC) assessment. FNA aspirates from ovarian masses obtained intra-operatively were centrifuged at 3500 rpm for 2-3 min and sediment smears were examined. Cytological diagnoses obtained intra-operatively were compared with histopathological findings, which served as the gold standard. Data were analysed for age distribution, concordance between cytology and histology, and diagnostic performance parameters including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: A total of 79 cases have been included in the study, and nine cases were excluded due to lack of relevant data for histopathological correlation. The age of patients ranged between 14 and 77 years, with a peak incidence in the 41-50-year age group (31.4%). Cytology showed concordance with histopathology in 61 out of 70 cases (87.1%), while 9 cases (12.9%) were discordant. For detection of malignancy, cytology demonstrated a sensitivity of 80%, specificity of 100%, PPV of 100% and NPV of 98.1%, with an overall diagnostic accuracy of 98.3%. No false-positive cases were identified, while one false-negative case was noted. The kappa coefficient was 0.88 with diagnostic accuracy being 98.3%. CONCLUSION: Cytology is a rapid, reliable and highly specific diagnostic tool for ovarian tumours, particularly valuable in rural tertiary care settings where access to advanced diagnostics may be limited. Its high specificity and PPV make it especially useful for differentiating between benign and malignant complex ovarian cysts and aiding early clinical decision-making.