Current practices in performing frozen sections for thyroid and parathyroid pathology

Abstract

In this review article, current trends in thyroid and parathyroid frozen sections are discussed. In Japan and other countries, the numbers of thyroid frozen sections have been dramatically decreasing over the past decade. The decline in the number of thyroid frozen sections has been attributed to two major factors: highly diagnostic preoperative fine needle aspiration for papillary carcinomas, the most frequent type of thyroid cancers, and the acknowledgment in the literature of the disadvantageous frozen sections for follicular tumors. Several authors have argued that the frozen section of thyroid nodules should be limited only to cases that have a preoperative cytology diagnosis as "atypical" or "suspicious". In contrast, frozen sections for parathyroid glands have been increasing in numbers. This increase is thought to be largely due to the high number of parathyroidectomies for secondary hyperplasia in dialysis patients. Frozen sections are usually performed to confirm the removal of parathyroid tissue for either cyropreservation or auto-transplantation. It is concluded that thyroid and parathyroid frozen section examination is restricted to selected situations.

Clinicopathological correlates of hyperparathyroidism

“…Accurate diagnosis of parathyroid proliferations can be difficult or even impossible at the time of the intraoperative assessment 39 40 42 43 44 46 123 124. The primary role of the intraoperative pathological consultation is to confirm the presence of parathyroid tissue in the resected specimen and to exclude other tissues, such as lymph nodes or thymus, which can be mistaken for parathyroid tissue by the surgeon 35 39–46 123 125.…”

Fine-Needle Aspiration and Intraoperative Consultation in Thyroid Pathology: When and How?

“…This usually means making a choice between total thyroidectomy and lobectomy. 23 Diagnostic categories commonly used for frozen section diagnosis somewhat mirror those rendered after FNA. They include the following: The number of intraoperative consultations has been steadily declining because of the accuracy of FNA in diagnosing papillary thyroid carcinoma, and the need for extensive sampling of the tumor capsule to diagnose follicular carcinoma, something very difficult to do intraoperatively.…”

“…They include the following: The number of intraoperative consultations has been steadily declining because of the accuracy of FNA in diagnosing papillary thyroid carcinoma, and the need for extensive sampling of the tumor capsule to diagnose follicular carcinoma, something very difficult to do intraoperatively. [23][24][25] Thus, intraoperative consultation is not practical (and therefore not useful) for cases with a preoperative FNA diagnosis of follicular lesion/neoplasm, and it is not necessary in cases with a definite FNA diagnosis of papillary carcinoma. [23][24][25] It can, however, be useful in cases cytologically diagnosed as "suspicious for papillary carcinoma" and in some cases with a cytologic diagnosis of "atypia of undetermined significance."…”

“…[23][24][25] Thus, intraoperative consultation is not practical (and therefore not useful) for cases with a preoperative FNA diagnosis of follicular lesion/neoplasm, and it is not necessary in cases with a definite FNA diagnosis of papillary carcinoma. [23][24][25] It can, however, be useful in cases cytologically diagnosed as "suspicious for papillary carcinoma" and in some cases with a cytologic diagnosis of "atypia of undetermined significance." 26,27 In such instances, at the time of intraoperative consultation the pathologist has the opportunity to analyze both the growth pattern (papillary vs follicular) in the frozen section specimen, and the cytologic features of the lesion with the cytology touch or-better-scrape preparations.…”

Concurrent parathyroid carcinoma and adenoma: A rare presentation of a rarer disease entity

“…Size, color, consistency, adherence and infiltration into surrounding organs often lead to the suspicion of carcinoma. Though frozen section is useful,[14] it is often negative, as in our case, and should not bias our judgment against malignancy.…”