Cost effectiveness of intraoperative pathology in the management of indeterminate thyroid nodules

Vuong, Christopher; Watson, WayAnne; Kwon, Daniel; Mohan, Sonia S.; Perez, Mia; Lee, Steve C.; Simental, Alfred

doi:10.20945/2359-3997000000263

Cited by 7 publications

(7 citation statements)

References 20 publications

(29 reference statements)

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“…This calculation would be essential for cost-effectiveness analysis. A recent study evaluated the iFS costeffectiveness for nodules with atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), when its specificity was 100%, demonstrating that total thyroidectomy was avoided in one out of every 24 cases, resulting in savings of $80 per surgery in this population (25). In another analysis of BC V nodules that considered a surgical approach based on ATA 2015 guidelines, a small percentage of cases would have been converted to total thyroidectomy based on iFS.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative frozen section performance for thyroid cancer diagnosis

Goemann¹,

Paixão²,

Migliavacca³

et al. 2022

Archives of Endocrinology and Metabolism

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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.

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Section: Discussionmentioning

confidence: 99%

Intraoperative frozen section performance for thyroid cancer diagnosis

Goemann¹,

Paixão²,

Migliavacca³

et al. 2022

Archives of Endocrinology and Metabolism

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“…Neck dissection is recommended for cases with metastatic neck nodes, whereas prophylactic neck dissection is not advised for cases without clinical and radiological lymph node involvement ( 7 ). During operation, a rapid frozen section is considered to be beneficial in guiding management and cost-saving via reducing the need for a secondary operation ( 26 ). Our patient was treated with mass excision, followed by complementary total thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Long-term Follow-up of a Toddler with Papillary Thyroid Carcinoma: A Case Report with a Literature Review of Patients Under 5 Years of Age

Öztürk¹,

Özturan²,

Soysal³

et al. 2022

Jcrpe

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Papillary thyroid cancer (PTC) is extremely rare in children. Herein, we present a case diagnosed with PTC at 15 months of age. We conducted a literature review of the published cases with PTC under five years of age. A 1.25-year-old male patient had initially presented with a complaint of progressively enlarging cervical mass that appeared four months earlier. On physical examination, a mass located in the anterior cervical region with the largest measurements of around 3x3 cm was detected. Cervical and thyroid ultrasonography showed a 50x27 mm solid mass in the right lateral neck. Excisional biopsy revealed a follicular variant of PTC with capsular invasion. Subsequently, he underwent a complementary total thyroidectomy. He was diagnosed with intermediate-risk (T3N0M0) PTC. He developed permanent hypoparathyroidism. In the first year of the operation, he was treated with radioiodine ablation (RAI) since basal and stimulated thyroglobulin (Tg) levels tended to increase. Whole-body scintigraphy was normal in the first year of RAI ablation. On levothyroxine sodium (LT4) treatment, levels of thyroid stimulating hormone (TSH) and Tg were adequately suppressed. He is now 8.5-years-old and disease-free on LT4 replacement therapy for seven years and three months. Pediatric PTC has different biological behavior and an excellent prognosis compared to adults. The optimal treatment strategy for pediatric TC is total thyroidectomy, followed by RAI ablation. Post-operative management should include regular follow-up, TSH suppression by adequate LT4 therapy, serial Tg evaluation, and radioiodine scanning when indicated.

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“…This calculation would be essential for cost-effectiveness analysis. A recent study evaluated the iFS cost-effectiveness for nodules with atypia of undetermined signi cance or follicular lesion of undetermined signi cance (AUS/FLUS), when its speci city was 100%, demonstrating that total thyroidectomy was avoided in one out of every 24 cases, resulting in savings of $80 per surgery in this population [25]. In another analysis of BC V nodules that considered a surgical approach based on ATA 2015 guidelines, a small percentage of cases would have been converted to total thyroidectomy based on iFS.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Frozen Section Performance for Thyroid Cancer Diagnosis

Goemann¹,

Paixão²,

Migliavaca³

et al. 2021

Preprint

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Purpose: 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. 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 a reasonable option and should be specifically investigated.

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Cost effectiveness of intraoperative pathology in the management of indeterminate thyroid nodules

Cited by 7 publications

References 20 publications

Intraoperative frozen section performance for thyroid cancer diagnosis

Intraoperative frozen section performance for thyroid cancer diagnosis

Long-term Follow-up of a Toddler with Papillary Thyroid Carcinoma: A Case Report with a Literature Review of Patients Under 5 Years of Age

Intraoperative Frozen Section Performance for Thyroid Cancer Diagnosis

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