Diagnostic Accuracy of Intraoperative Frozen Section Examination of Pelvic Lymph Nodes in Cervical Carcinoma: A Cross-Sectional Study in Eastern India

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Background Cervical cancer continues to be a major cause of cancer-related incidence and mortality in women, especially within low- and middle-income countries where available screening tests and preventive healthcare services are suboptimal. Intraoperative frozen section examination (IFSE) enables real-time evaluation of suspicious pelvic lymph nodes and helps guide surgical management. The present study was undertaken to evaluate the diagnostic accuracy and reliability of IFSE of pelvic lymph nodes in patients with cervical carcinoma using final histopathology as the reference standard. Methods Our hospital-based cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics and Gynecology at Rajendra Institute of Medical Sciences, Ranchi, India, over a period of 18 months. A total of 80 patients with histopathologically confirmed cervical carcinoma undergoing pelvic lymph node dissection were included. Suspicious lymph nodes were submitted for frozen section examination and compared with final paraffin-embedded histopathology. Diagnostic indices, including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy, were calculated. Results The mean age was 47.89 ± 13.95 years, with the highest proportion of patients in the 51-60-year age group. Frozen section examination demonstrated metastatic positivity in 37 (46.3%) patients, whereas final histopathological examination identified nodal metastasis in 60 (75%) cases. IFSE demonstrated sensitivity of 60%, specificity of 95%, positive predictive value of 97.3%, negative predictive value of 44.2%, and overall diagnostic accuracy of 68.8%. Frozen section positivity showed a significant association with human papillomavirus (HPV) infection, smoking history, parity, and advancing age. Conclusion Frozen section analysis was found to have high specificity and positive predictive value, thus being highly reliable for the diagnosis of nodal metastasis during surgery and for intraoperative decision-making. Frozen section analysis of pelvic lymph nodes can be considered as a useful adjunctive tool in the surgical management of cervical carcinoma, especially in low-resource settings.

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