Intraoperative Frozen-Section Analysis for Thyroid Nodules

Abstract

To determine accuracy and intertest agreement of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen-section analysis (FS) findings in thyroid surgery, and to assess the influence of intraoperative FS findings on decision making and the utility of FS in thyroid surgery. Design: Retrospective analysis. The results of preoperative FNAC, intraoperative FS, and final histopathological analyses were taken from the histopathology reports. We calculated intertest agreement using the statistic. Patients: Two-hundred fifteen patients who underwent primary thyroid surgery. All patients were treated by the same surgeon (S.J.W.). Results: The sensitivity and specificity of FNAC were 57.4% and 91.7%, respectively. The sensitivity and specificity of FS were 32.4% and 96.5%, respectively. The intertest agreement was poor (=0.17). In case of malignant FNAC findings, the FS result did not influence treatment decisions; in case of a malignant FS result on the background of a benign, indeterminate, or nondiagnostic FNAC finding, the FS result influenced treatment decisions in 88% of cases. Conclusions: Intraoperative FS did not give additional information in cases where a malignant neoplasm was predicted by the FNAC finding. In this setting, it led to conflicting results and did not contribute to correct decision making.

Accuracy and Diagnostic Utility of Frozen Section in Thyroid Lesions: A Comparative Study

“…9 cases which were suspicious for malignancy, FS was able to diagnose four cases of malignancy. Malignancy rate in suspicious category is 16-54 % [24] and according to guidelines of the Papanicoloau society of cytology for prac ce of thyroid FNAC, this should be around 15% [4]. In the present series, the malignancy rate in this category is 7.3% which is lower than reported.…”

“…The tradi onal approach for the evalua on of pa ents with thyroid pathology includes detailed clinical history, physical examina on, thyroid func on tests, ultrasonography and computed tomography [3,4]. But none of these tests conclusively dis nguish benign from malignant lesions, and in malignant lesions when to operate or to what extent.…”

Diagnosis and Treatment of Anaplastic Thyroid Carcinoma

“…Frozen section should be considered unnecessary because it does not affect the intraoperative decision making [35]. The sensitivity of frozen section ranges widely from 32.4% to 93% [23,[36][37][38][39]. Frozen sections distort and collapse the blood vessels of the thyroid gland, increaseing the difficulty in detecting angioinvasion which is an important feature in differentiating between follicular adenomas and carcinomas [40].…”

Current practices in performing frozen sections for thyroid and parathyroid pathology

“…Incidence of frozen sections on thyroid glands Several recent studies have reported a decrease in the number of frozen section diagnosis for thyroid lesions [3][4][5]9]. To some degree, the number and type of thyroid frozen sections are likely to depend on the experience of the surgical team, the case volume, and on the prevalent types of surgeries being performed.…”

“…Frozen section examinations in endocrine pathology have been most commonly used for intraoperative assessment of thyroid and parathyroid tumors and cervical lymph node metastases. In recent years, however, the number of frozen sections in thyroid surgery has been steadily decreasing worldwide [3][4][5]. This decline has been attributed to two major factors: the high diagnostic accuracy of fine needle aspiration (FNA) cytology for papillary thyroid carcinoma (PTC) and the low sensitivity of frozen section diagnosis for follicular lesions of the thyroid.…”