Intraoperative frozen section performance for thyroid cancer diagnosis

Abstract

Objective: A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Subjects and methods: To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard. Results: In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy. Conclusion: Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated.

Significance of LINC02082 and LOC105369812 in differentiating papillary thyroid cancer from benign nodules

“…The risk of malignancy increases when the nature of the nodules seen on ultrasound is TI-RADS category 4A and above. [15] Fine-needle aspiration biopsy under ultrasound localization can improve the diagnostic concordance rate of malignant nodes, [16] which is influenced by sampling quality, sampling site, and other factors. Some patients have multiple nodes simultaneously, including PTC and BN; therefore, it is highly likely that they will be missed during the diagnosis.…”

Intraoperative Assessment of High-Risk Thyroid Nodules Based on Electrical Impedance Measurements: A Feasibility Study

“…TN-IMS scored all these Bethesda IV nodules as positive or high-risk for malignancy which were in accordance with permanent pathology. Therefore, TN-IMS can be very advantageous in diagnosing follicular neoplasms due to the low sensitivity of frozen-section pathology in these nodules [ 30 ]. There were also four Hurthle cell lesions in the cohort study.…”