Introduction Frozen section examination (FSE) of pelvic lymph nodes in early stage cervical cancer is designed to avoid the morbidity of dual therapy. It is however timely and expensive.

Method All patients undergoing surgery for early stage cervical cancer between 2010–2019 in a UK tertiary centre were identified (n=180). All patients had pre-operative MRI scans performed and all patients underwent planned intra-operative FSE. Nodes retrieved by FSE were examined by expert pathologists. Patient MRI and histology findings were analysed to suggest an optimal approach to employing FSE.

Results 4913 lymph nodes in total were retrieved. 22/180 patients had positive nodes on FSE. 18 of these had intermediate/high grade tumours; and 13 had no suspicious lymph nodes identified on pre-operative MRI. The sensitivity of MRI to detect positive nodes was 40% (95% CI 20% to 63%); specificity 83% (95% CI 76% to 88%); NPV 91% (95% CI 88% to 94%); and PPV 25% (95% CI 16% to 39%).

Conclusions Pre-operative MRI did not reliably predict the presence of lymph node involvement in women with intermediate/high grade cervical cancer. Perhaps FSE could be targeted to this group, employing this timely and expensive technique in those at greatest risk having nodal disease.