Role of intraoperative frozen section in the management of thyroid nodules

Wong, Zarina; Muthu, Carl; Craik, J. E.; Carter, Jim; Harman, C. Richard

doi:10.1111/j.1445-1433.2004.03266.x

Cited by 22 publications

(15 citation statements)

References 12 publications

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“…One study reported a decrease in the number of reoperations as a result of routine FS analysis, which led to an estimated saving of 40% [5]. Since the costs of both FS analysis and operative intervention differ greatly between countries [5,10,26], we believe that this issue needs individualization for each country. There is limited information available regarding the clinical and cost results of FS in thyroid cancer in Turkey.…”

Section: Discussionmentioning

confidence: 96%

“…Although there are many reports concerning FS in thyroid surgery, the role of intraoperative FS in thyroidectomy is still a subject of controversy. On one hand there is strong evidence that FS diagnosis is accurate for processing a high volume of surgical pathology cases and may avoid surgical overand under-treatments and the need for a second operation [5,9,11,12], while on the other hand it is believed that the role of FS is becoming increasingly limited and has no substantial benefit in patient outcome [4,10,13]. One of the main goals of intraoperative FS is to identify which patient has malignancy, to avoid the increased costs and operative risks associated with a completion surgery [13].…”

Section: Discussionmentioning

confidence: 99%

“…The extent of surgery still remains controversial [3]. While developments and controversies in thyroid surgery are ongoing, the benefit of frozen section (FS) has been a matter of debate between experts [1,[4][5][6][7][8][9][10].…”

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confidence: 99%

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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: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

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“…The value of the intra-operative frozen section (FS) remains controversial while its potential to help the surgeon decide between hemithyroidectomy or total thyroidectomy. The method can potentially avoid a second surgery to remove the contralateral lobe should the surgical specimen reveal malignancy in the histopathology included in paraffin and, alternatively, it can avoid an unnecessary total thyroidectomy which will cause the patient to have to replace levothyroxine forever and increase the chance of the patient developing hypoparathyroidism and damage to the recurrent laryngeal nerve 3 .…”

Section: Introductionmentioning

confidence: 99%

O papel da biópsia intraoperatória de congelação para os nódulos tireoidianos

Almeida

Netto

Rocha

et al. 2009

Rev. Bras. Otorrinolaringol.

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The role of intraoperative frozen sections (FS) during thyroidectomy is controversial. Aim: to evaluate the role of FS for thyroid nodules management. Patients and methods: All patients who had thyroid surgery for nodular disease and previous USG-guided FNAB in 2006 were prospectively analyzed. They underwent intraoperative FS evaluation, and the biopsy material was classified as benign, malignant or follicular neoplasm. FNAB, FS and paraffin sections were compared. Results: Under the FS, 54% of the nodules were benign, 30% were follicular neoplasms, and 16% were malignant. All cases considered benign and malignant under the FS evaluation were confirmed through the histological "paraffin" analysis. Since it is not considered a definitive indication for total thyroidectomy, if the follicular neoplasms were classified as "benign" under the FS, their sensitivity, specificity, positive and negative predictive values and global diagnostic accuracy were 69%, 100%, 100%, 91,5% e 77%, respectively. Among the 42 cases classified as "follicular neoplasm" under the FNAB, in 1 case the FS conclusion was for papillary carcinoma, in 3 cases as benign (all confirmed through the "paraffin"); and 38 cases continued as "follicular pattern", being 29 follicular adenomas and 9 carcinomas through the "paraffin". Conclusion: The FS is only indicated when the FNAB reports "follicular neoplasm".

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“…In case of malignancy total thyroidectomy should be the option of surgical choice in order to protect patient from the risk of a second intervention which might possess increased morbidity and complication rates. On the other hand, according to the accurate diagnosis of a benign thyroid disease the impact of FS could alter operative management from aggressive to conservative surgery [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Frozen section and fine needle aspiration biopsy in thyroid surgery — needles and sections

et al. 2007

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Role of intraoperative frozen section in the management of thyroid nodules

Abstract: The present review found little benefit in performing intraoperative frozen section in this setting. As a diagnostic test the cost of frozen section (NZ $200 for each frozen section) needs to be weighed against its low clinical benefit.

Cited by 22 publications

References 12 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?

O papel da biópsia intraoperatória de congelação para os nódulos tireoidianos

Frozen section and fine needle aspiration biopsy in thyroid surgery — needles and sections

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