The value of frozen section in intraoperative surgical management of thyroid follicular carcinoma

Došen, Danijel; Turić, Marko; Smalcelj, Josip; Janušić, Renato; Grgić, Marko; Šeparović, Viktor

doi:10.1002/hed.10251

Cited by 22 publications

(14 citation statements)

References 17 publications

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“…However, the study evaluated only nine cases of well‐differentiated thyroid cancer with high cost of frozen section. Most studies reported a relatively high (44.3%) percentage of false‐negative results in the diagnosis of follicular thyroid carcinoma by frozen section 14. In contrast, there were very few false‐positive results.…”

Section: Discussionmentioning

confidence: 99%

Thyroid follicular neoplasm: Analysis by fine needle aspiration cytology, frozen section, and histopathology

Liu¹,

Liou²,

Chao³

et al. 2009

Diagnostic Cytopathology

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We performed a retrospective analysis of follicular neoplasm data obtained from frozen section examinations of thyroid nodules. A total of 5,660 patients underwent preoperative neck ultrasonography and fine-needle aspiration cytology (FNAC), surgical treatment, and follow-up at a medical institute. Patients with papillary thyroid microcarcinoma were excluded from this study. In 971 cases, frozen section examination was performed during the surgical treatment of follicular neoplasm that was diagnosed via FNAC. Thyroid malignancies were histologically confirmed in 25.1% of cases (244/971). Among the patients with papillary thyroid carcinoma, 45 were diagnosed with the follicular variant of papillary thyroid carcinomas (27.4%). The diagnostic sensitivity of frozen section for the nonfollicular variant of papillary thyroid carcinoma was better than that for the follicular variant of papillary thyroid carcinoma (89.1% versus 78.9%; P = 0.1023). For 12 cases the diagnosis was atypical follicular adenomas. The diagnostic accuracy of frozen section in cases of follicular neoplasm was 76.9% with a sensitivity of 84.8% and a specificity of 98.9%. In conclusion, our analysis revealed high rates of accuracy when using frozen tissue sections for early diagnosis and treatment of follicular neoplasm; thus, an early decision to extent of surgery prevents a risky follow-up surgery.

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Section: Discussionmentioning

confidence: 99%

Thyroid follicular neoplasm: Analysis by fine needle aspiration cytology, frozen section, and histopathology

Liu¹,

Liou²,

Chao³

et al. 2009

Diagnostic Cytopathology

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“…For some cases of minimally invasive or so-called atypical adenoma the problem of accurate diagnosis still remains. The values of frozen sections in intra-operative surgical management of thyroid follicular carcinoma have been confirmed by most surgeons [17]. With multiple frozen sections, typically 5 to 12 depending on the size of the tumor, the diagnostic accuracy of frozen section is roughly 98% [18,19].…”

Section: Frozen Section For Follicular Thyroid Carcinomamentioning

confidence: 99%

“…A cost-effective analysis for diagnosis of follicular thyroid carcinoma should be conducted in different countries, and if the cost is not higher than a secondary operation, improved technical support and an increased number of slides will increase accuracy of frozen section diagnosis [17]. Frozen section procedures during thyroid surgery, using quick-freezing microtome with a modified toluidine blue staining or standard H&E staining, have been evaluated [17]. There are still problems in interobserver and intraobserver reproducibility in histopatholical diagnoses of follicular thyroid cancer [26].…”

Section: Frozen Section For Follicular Thyroid Carcinomamentioning

confidence: 99%

Follicular Thyroid Carcinoma: From Diagnosis to Treatment

Lin

Chao

2006

Endocr J

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Abstract. Unusual presentations with bone, lung or soft tissue metastases in initial diagnosis of follicular thyroid carcinoma have been reported occasionally. This implies how difficult it is to diagnosis this type of cancer at the preoperative or intra-operative stage of treatment. Fine needle aspiration cytology has been shown to be an ineffective method for diagnosing vascular or capsule invasion of follicular thyroid cancer. Multiple frozen sections, usually 5 to 12 depending on the size of the tumor, can achieve a diagnostic accuracy of 98%. Clinical application of various gene expressions in thyroid follicular tumors by needle aspiration using in situ hybridization requires further investigation. Although radioactive iodide ( 131 I) has been used as the standard treatment for follicular thyroid carcinoma with distant metastases, the effectiveness of 131 I treatment for follicular thyroid carcinoma depends on the differentiation of cancer cells. The possibility of 131 I for thyroid remnant ablation replacing a secondary operation for follicular thyroid carcinoma has been debated. Recent studies applied more expressions of sodium iodide symporters to attain the effect of 131 I treatment and slow the proliferation of thyroid cancer cell which, in turn, slows the progression of follicular carcinoma. Consensus for the surgical procedures for the specific prognostic risks for follicular thyroid carcinoma is needed. Dedifferentiated, anti-angiogenic, or gene therapies for follicular thyroid cancer with distant metastases or anaplastic transformation comprise the principal directions in future research for this cancer.

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“…[9] Thus, diagnosis of a solitary encapsulated nodule with follicular histologic pattern is sometimes problematic for pathologists. [5,10] One of the most challenging tasks in pathologic evaluation of thyroid follicular pattern lesion is distinction between FTC and FTA as a common benign thyroid nodule. [4] Diagnosis of carcinoma is based on the presence of capsular, vascular or extra thyroid tissue invasion or nodal or distant metastasis.…”

Section: Introductionmentioning

confidence: 99%

“…[4] Diagnosis of carcinoma is based on the presence of capsular, vascular or extra thyroid tissue invasion or nodal or distant metastasis. [5,8,[10][11][12] Different tools such as IHC and molecular profiling have been used to differentiate between benign and malignant follicular neoplasms or differentiating malignant tumor subtypes, [4,9,13] including some angiogenesis factors. [9] Thyroid is rich in vascular network [14] and shows increased vascularity in both non neoplastic and malignant conditions.…”

Section: Introductionmentioning

confidence: 99%

Expression of PSMA in Thyroid follicular neoplasms: Utility for differentiating between benign from malignant lesions

Saffar

kiany

Tavangar

et al. 2017

APALM

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Background: Prostate-Specific Membrane Antigen (PSMA) has been known as a tumor associated neovasculature marker in some solid malignant tumors. Targeting of PSMA by cytotoxic-conjugated antibody can represent powerful tool for vascular targeted therapy. In thyroid, it appears that angiogenesis factors are involved in neoplastic growth and aggressiveness of tumors.This study was conducted to evaluate the expression of PSMA as an angiogenesis factor in neovasculature of thyroid follicular neoplasms by immunohistochemistry to determine its usefulness for distinguishing between adenoma and carcinoma.Methods: Paraffin Blocks of formalin fixed samples representing 48 cases of Follicular Thyroid Adenoma (FTA) and 15 cases of Follicular Thyroid Carcinoma (FTC) were evaluated.Results: Among 15 cases of FTC, 11 cases revealed both capsular and vascular invasion. In one case only capsular and in two cases only vascular invasions were observed. One case also revealed suspicious vascular invasion with further bone metastasis.The intensity of PSMA staining in vascular structures of carcinomas were significantly higher in comparison with thyroid follicular adenomas (p=0.028). However, we observed no significant difference in the extent of PSMA expression in adenoma and carcinoma groups (p=0.239).Thyroid follicular cells were negative for PSMA in adenoma, carcinoma and in non-neoplastic area. Conclusion:According to our findings, significant higher intensity of PSMA expression in FTC could be useful in differentiating between FTA and FTC. However, more importantly, expression in neovasculature of differentiated thyroid tumors can represent a potential utility for PSMA-targeted radionuclide therapy in advanced differentiated thyroid cancers.

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The value of frozen section in intraoperative surgical management of thyroid follicular carcinoma

Cited by 22 publications

References 17 publications

Thyroid follicular neoplasm: Analysis by fine needle aspiration cytology, frozen section, and histopathology

Thyroid follicular neoplasm: Analysis by fine needle aspiration cytology, frozen section, and histopathology

Follicular Thyroid Carcinoma: From Diagnosis to Treatment

Expression of PSMA in Thyroid follicular neoplasms: Utility for differentiating between benign from malignant lesions

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