Challenges in clinical, imaging, and intraoperative frozen-section diagnosis of ovarian cancer

Ovarian cancer (OC) ranks 8th among cancers in women. It is a non-visualizable, non-screenable cancer with late onset of symptoms and diagnosis, which translates into low recurrence-free and overall survival rates. The 5-year survival decreases as the OC stage increases. The World Health Organization has predicted a 47% increase in the OC incidence by 2040 to approximately 434,000 newly diagnosed cases and an annual 59 % increase in OC mortality (up to 293,000 cases). There are several difficulties in the current clinical, imaging, and intraoperative frozen-section diagnosis of OC. Patients seek medical attention when the disease has reached the advanced stage. However, specific treatment often starts late due to a long time between the first patient-physician contact and the histological verification of the diagnosis. It is vital to know the limitations and complexities of diagnostic tools, overcome them in routine practice, and use an interdisciplinary approach to the evaluation of their findings. Goal: to review the difficulties in making clinical, imaging, and intraoperative frozen-section diagnosis of OC based on Russian and worldwide literature data. Materials and methods: articles focused on the diagnostic modalities for OC that had been published in the PubMed, Cochrane Library, and eLIBRARY databases over the past 15 years were reviewed. The review outlines the limitations and difficulties in making clinical, imaging, and intraoperative frozen-section diagnosis of OC based on data from international publications and experience of gynecological oncologists and pathologists of the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine.