Introduction/Background Approximately 10–15% of ovarian epithelial cancers are borderline ovarian tumors (BOT) with an incidence of 1.8–4.8 per 100,000 women per year. These tumors are prone to both inadequate treatment and over-treatment. Surgery is the primary treatment for women with BOT. Frozen-section examination is a key element in decision-making. Frozen section diagnosis of BOT is less reliable than diagnosis of benign or malignant ovarian tumors.

Methodology This study aimed to assess the correlation between diagnoses of borderline ovarian tumors through frozen section and their concordance with permanent pathology. We conducted a comprehensive review of pathology reports at Safdarjung Hospital spanning 2018–2022, focusing on cases diagnosed with borderline ovarian tumors using frozen sections. Utilizing univariate and multivariable logistic regression models, we analyzed factors such as patient age, tumor size, histology, presence of hemosiderin-laden macrophages, bilateral or extra ovarian disease, and concurrent tubal pathology.

Results A total of 68 cases were reviewed, revealing a mean age of 43.75 years, ranging from 18 to 82 years. The mean tumor size was 15.50 ± 7 cm, with a range of 4.5 to 42 cm. Extraovarian disease was observed in 2.9%, tubal pathology in 1.5%, and bilateral disease in 17.6% of participants. Notably, 73.5% exhibited a multilocular pattern, 45.6% had papillary excrescences, 52.9% displayed solid areas, and 16.2% presented hemosiderin-laden macrophages. Frozen section findings included Borderline Epithelial Mucinous (44.1%) and Borderline Epithelial Serous (45.6%). Final histopathologic impressions comprised Benign (33.8%), Borderline (41.2%), and Malignant (25.0%).

Conclusion Our analysis demonstrated a 41.2% consistency between frozen or permanent pathology reports for borderline tumor diagnoses. Notably, the positive predictive value of borderline diagnoses through frozen section analysis was 75%. This study contributes valuable insights into the accuracy of frozen section in diagnosing borderline ovarian tumors, emphasizing the importance of meticulous evaluation in clinical settings.

Disclosures None.