Does frozen section have a role in the intraoperative management of thyroid nodules?

Cheng, Ming; Morgan, Joanna L; Serpell, Jonathan W.

doi:10.1046/j.1445-2197.2002.02474.x

Cited by 24 publications

(16 citation statements)

References 20 publications

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“…We designated the sensitivity of FS analysis as 58%. This rate was similar to those of some other studies in the literature [1,6,13,14]. The inability to diagnose papillary microcarcinoma, follicular variant of papillary carcinoma and follicular carcinoma intraoperatively with FS was the major factor accounting for the low sensitivity of FS.…”

Section: Discussionsupporting

confidence: 89%

The Ongoing Debate In Thyroid Surgery: Should Frozen Section Analysis Be Omitted?

et al. 2007

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Abstract. Controversies concerning the role of frozen section (FS) have been a matter of debate. The aim of this study was to identify the role of FS analysis in intraoperative decision making and analyze the effect of the cost in detecting thyroid malignancies in Turkey. Out of 214 consecutive patients who had been operated on for thyroid cancer between January 1996 and August 2004, 178 patients were evaluated retrospectively. All 178 patients were subjected to FS. Intraoperative FS correctly identified the pathology as malignant in 58.4% of patients. A true-positive FS result changed the surgical strategy in 30 (27.6%) cases False negative FS lesions were defined histologically as papillary microcarcinoma in 54%, follicular variant of papillary cancer in 18% and follicular cancer in 8% of cases. The sensitivities of FNAB and intraoperative FS in thyroid cancer patients were 22.5% and 58.4%, respectively. False negative FS results increased the cost for each informative FS from €25 to €42.7. Despite limitations, results of this study reject the idea that the role of FS is becoming limited. We recommend routine frozen section in the operative assessment of thyroid nodules. Omitting FS may be suggested only in cases with a FNAB revealing malignancy.

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Section: Discussionsupporting

confidence: 89%

The Ongoing Debate In Thyroid Surgery: Should Frozen Section Analysis Be Omitted?

et al. 2007

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“…Others disagree on the basis that increased costs from additional operating time and pathologists needed to read the specimens are not justified by a significant benefit in patient outcomes (42). Frozen section analysis often complements the fine needle aspiration cytology in cases with cytologic atypia or suspicious appearance, and is most useful at making a diagnosis of papillary thyroid carcinoma (43). Its efficacy and therefore use will vary between institutions, surgeons, and pathologists.…”

Section: Frozen Section Analysismentioning

confidence: 99%

Evaluation of a Thyroid Nodule

Bomeli

LeBeau

Ferris

2010

Otolaryngologic Clinics of North America

158

134

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The thyroid specialist frequently evaluates thyroid nodules because they may represent malignancy. Nodules are typically found on physical exam or incidentally when other imaging studies are performed. Malignant or symptomatic nodules that compress nearby structures warrant surgical excision. Yet, the majority of thyroid nodules are asymptomatic and benign, so the thyroid surgeon must rely on diagnostic studies to determine when surgery is indicated. Ultrasound is the preferred imaging modality for thyroid nodules, and the ultrasound guided fine needle aspiration biopsy (FNAB) is the preferred method of tissue sampling. Nodules one centimeter or larger, or nodules with suspicious sonographic appearance warrant cytologic analysis to better quantify the risk of malignancy. Molecular biomarkers are a powerful adjunct to cytology, as detecting malignancy pre-operatively allows total thyroidectomy in a single operation without the need for frozen section or a second operation for completion thyroidectomy if malignancy is found during the initial thyroid lobectomy.

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“…This is usually done in the first or second week following the initial surgery. An FNAB result of "suspicious for malignancy," particularly if it is papillary, allows the use of an intraoperative frozen section diagnosis for decision making [53,54]. If the pathologist is confident of a diagnosis of papillary carcinoma on frozen section, the patient should proceed to a total thyroidectomy and possibly ipsilateral level VI lymph node dissection.…”

Section: Indeterminatementioning

confidence: 99%

Management of the Solitary Thyroid Nodule

2008

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After completing this course, the reader will be able to:1. Describe the investigations used for a solitary thyroid nodule.2. Explain the importance of thyroid ultrasound and fine-needle aspiration biopsy results.3. Discuss how thyroid nodules are managed surgically.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThyroid nodules are common, with up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Increasing numbers of nodules are being detected serendipitously because of the rising use of imaging to investigate unrelated conditions. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. This begins with a thorough history, including previous exposure to radiation and any family history of thyroid cancer or other endocrine diseases. Clinical examination of the neck should focus on the thyroid nodule and the gland itself, but also the presence of any cervical lymphadenopathy. Biochemical assessment of the thyroid needs to be followed by thyroid ultrasound, which may demonstrate features that are associated with a higher chance of the nodule being malignant. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule. It provides highly accurate cytologic information about the nodule from which a definitive management plan can be formulated. The challenge remains in the management of nodules that fall under the "indeterminate" category. These may be subject to more surgical intervention than is required because histological examination is the only way in which a malignancy can be excluded. Surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates. The Oncologist 2008;13:105-112

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Does frozen section have a role in the intraoperative management of thyroid nodules?

Cited by 24 publications

References 20 publications

The Ongoing Debate In Thyroid Surgery: Should Frozen Section Analysis Be Omitted?

The Ongoing Debate In Thyroid Surgery: Should Frozen Section Analysis Be Omitted?

Evaluation of a Thyroid Nodule

Management of the Solitary Thyroid Nodule

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