Intraoperative pathologic examination with frozen section (FS) was performed on 504 specimens of thyroid tissue obtained from 457 patients over a period of 9 years. After examination of permanent sections (PS) a malignant neoplasm was diagnosed in 57 specimens (11.3%); 50 (87%) of these were primary thyroid carcinoma, four (8%) metastatic carcinoma, and three (5%) malignant lymphoma. The FS diagnosis was "benign" in 448 (88.9%), "malignant" in (30) 5.9%, and "deferred" in 26 (5.2%). The sensitivity of FS diagnosis of malignancy was 53% and the specificity and positive predictive value 100%. The negative predictive value was 97.8% and overall accuracy 97.9%. The PS disclosed a malignant neoplasm in 62% of specimens in which FS diagnosis was "deferred." Sixty-eight percent of papillary carcinomas, 87% of undifferentiated carcinomas, and a single case of medullary carcinoma were diagnosed with FS examination. A FS diagnosis of malignancy was not made in any of the ten specimens containing follicular carcinoma; in all ten the neoplasms were well-differentiated and eight were encapsulated and minimally invasive. The inability to diagnose follicular carcinoma intraoperatively with FS is the most significant factor accounting for the relatively low sensitivity of FS diagnosis of malignant thyroid neoplasms.
One hundred fifty-nine patients, 80 years of age or older, with cancer of the head and neck were reviewed. Patients tolerated head and neck resection well and an absolute survival of 36 months for all treated patients and 41 months for all surgically treated patients suggests the efforts are worthwhile. Treatment offered the elimination of uncontrolled cancer in 68% of the patients. Prompt and adequate treatment reduces time, effort, cost, and the actual suffering of the patients. There is little justification for therapeutic nihilism even in the elderly patient.
Aneurysmal bone cysts are rare lesions, particularly in the craniofacial bones. After a comprehensive review of the English literature, the fifty fifth case occurring in the craniofacial area, and the twentieth in the mandible is reported. Cryosurgery is recommended as the treatment of choice in the head and neck area because of the low recurrence rate, the excellent cosmetic and functional results, and the lack of untoward sequelae in the long‐term.
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