Influence of fine-needle aspiration biopsy and frozen section examination on the management of thyroid cancer

McHenry, Christopher R.; Rosen, Irving B.; Walfish, Paul G.; Bédard, Yvan C.

doi:10.1016/s0002-9610(05)80331-9

Cited by 52 publications

(40 citation statements)

References 6 publications

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“…Similarly, FS is unnecessary in cytologically diagnosed colloid goiters. Similar observations were also made by McHenry et al 19 The principal role of FS examination should be to determine the extent of thyroidectomy in patients with an equivocal or suspicious preoperative FNA. It should also be performed in persistent nondiagnostic FNAs in patients with a scintigraphically detected cold nodule and in detecting cervical lymph node metastasis during thyroidectomy.…”

Section: Discussionsupporting

confidence: 76%

“…Two cases of papillary carcinomas and one case of follicular adenoma were misdiagnosed as "non-neoplastic". The diagnostic limitation of FS was mainly due to inability to discern the nuclear features in papillary carcinomas and the difficulty in characterizing follicular neoplasm, 19 as previously discussed in this study. A papillary microcarcinoma was missed on both FNA and FS examination (Table 1); however, this did not alter the subsequent management, as the prognosis is generally excellent.…”

Section: Discussionmentioning

confidence: 77%

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Fine Needle Aspiration and Frozen Section Diagnosis in the Management of Thyroid Nodules

Pinto

Mathew

1995

Annals of Saudi Medicine

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Fine needle aspiration (FNA) is a valuable technique in the evaluation of thyroid nodules. A total of 182 FNAs of the thyroid performed at the Sultan Qaboos University Hospital were reevaluated and 153 were found to be adequate (84%). The cytological results of FNA were divided into neoplastic and non-neoplastic groups. Subsequent histology was obtained in 53 patients with an intraoperative frozen section (FS) in 27 patients. Papillary carcinoma was found to be the most common, accounting for 70% of the cases with histological follow-up in the neoplastic group. The utility of performing FNA in all thyroid nodules and an intraoperative frozen section only in selected cases is discussed. Ann Saudi Med 1995;15(6):614-618.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 77%

Fine Needle Aspiration and Frozen Section Diagnosis in the Management of Thyroid Nodules

Pinto

Mathew

1995

Annals of Saudi Medicine

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“…Some authors point out that FNAB is complementary to FS in planning the extent of surgery 20 . Others 6,21 suggest that FS can be restricted to cases with an FNAB diagnosis of`follicular nodule' or`indeterminate'.…”

Section: Discussionmentioning

confidence: 99%

Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules

Caraci

Aversa

Mussa

et al. 2002

British Journal of Surgery

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Background: The role of routine frozen section (FS) in the surgical management of thyroid nodules remains uncertain. This study reviewed the role of FS in the presence of an adequate ®ne-needle aspiration biopsy (FNAB).Methods: FNAB and FS were evaluated in 206 patients who had surgery for a thyroid nodule. Cytological specimens were classi®ed as benign, malignant or suspicious. The FS diagnoses were benign, malignant or deferred.Results: A cytological diagnosis was obtained in 93 nodules; the remaining 113 were classi®ed as suspicious, of which 21 were malignant on de®nitive examination. The overall accuracy of FNAB was 53 per cent. FS evaluation identi®ed 165 lesions as benign; the diagnosis was deferred until de®nitive histological evaluation in only eight. The overall accuracy, therefore, was 96 per cent. Routine use of FS was cost-effective; lowering the number of reoperations led to an estimated saving of about 40 per cent.Conclusion: These data suggest that FS remains an important tool in the surgical management of thyroid nodules and can reduce the number of patients requiring reoperation.

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“…Bugis et al reported that FNAB is complementary to FS [22], while McHenry et al suggested in their series that FS should be restricted to cases with an indeterminate result or a report with follicular pathology [16]. In our study, when FNAB was graded as benign, FS results were reported as malignant in 29 patients.…”

Section: Discussionmentioning

confidence: 46%

“…The sensitivity of intraoperative diagnosis of malignancy depends on the type of thyroid carcinoma as previously reported by Leteurtre et al [15]. Intraoperative frozen section analysis of follicular neoplasms rarely renders informative information and is still problematic due to the difficulty of differentiating follicular adenoma from carcinoma [16][17][18]. A diagnosis of follicular carcinoma is not possible on FNAB alone, and the contention that FS can discriminate follicular adenoma from carcinoma is a central point of debate.…”

Section: Discussionmentioning

confidence: 94%

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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Influence of fine-needle aspiration biopsy and frozen section examination on the management of thyroid cancer

Cited by 52 publications

References 6 publications

Fine Needle Aspiration and Frozen Section Diagnosis in the Management of Thyroid Nodules

Fine Needle Aspiration and Frozen Section Diagnosis in the Management of Thyroid Nodules

Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules

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

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