Thyroid nodule surgery: Predictive diagnostic value of fine-needle aspiration cytology and frozen section

Prades, J.‐M.; Quérat, C.; Dumollard, Jean Marc; Richard, C.; Gavid, M.; Timoshenko, A.; Péoc’h, Michel; Martin, Claude

doi:10.1016/j.anorl.2012.12.005

Cited by 16 publications

(19 citation statements)

References 18 publications

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“…Affecting 4%–7% of the general population, palpable thyroid nodules are common. 1 The incidence of thyroid cancer has nearly tripled from 4.9 to 14.3 per 100,000 individuals over a thirty-five year period ending in 2009. 2 Such a high incidence mandates a cost-effective and efficient method for the preoperative evaluation of thyroid nodules.…”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II–VI: The Weill Cornell Medical College experience

Cohen¹,

Patel

Gromis

et al. 2015

World j. otorhinolaryngol.-head neck surg.

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ObjectiveTo evaluate the Weill Cornell Medical College (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda II–VI and to analyze the cost and pathology benefit it provides.MethodsThe surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013. A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was performed. The FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative diagnosis. The results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD).ResultsAmong 435 cases, the FNA diagnosis was Bethesda II: 149 cases, Bethesda III: 170 cases, Bethesda IV: 91 cases, Bethesda V: 19 cases, and Bethesda VI: 6 cases. There were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated carcinomas. The preoperative FNA diagnosis for these carcinomas was as follows: Bethesda II, 11/149 (7.4%), Bethesda III, 24/170 (14%), Bethesda IV, 26/91 (29%), Bethesda V, 16/19 (84%), and Bethesda VI, 6/6 (100%). IOF section contributed to the diagnosis of malignancy in 16/429 (4%) cases: 1/149 (0.7%) Bethesda II, 5/170 (3%) Bethesda III, 2/91 (1.1%) Bethesda IV, and 8/19 (42%) Bethesda V. The diagnosis of malignancy was confirmed in the 6 Bethesda VI cases by IOF section. There were no false positives on IOF section. IOF had a sensitivity and specificity of 26% and 100%, respectively.ConclusionThe role of IOF section is limited in the evaluation of thyroid nodules. IOF section is most useful for nodules with an FNA diagnosis of Bethesda V lesions. The diagnosis of follicular variant of PTC remains difficult on frozen section.

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Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II–VI: The Weill Cornell Medical College experience

Cohen¹,

Patel

Gromis

et al. 2015

World j. otorhinolaryngol.-head neck surg.

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“…One of the reason for low sensivity rate of FNAC may be due to incidental papillary micro carcinomas as pointed out by many authors [17,19] either due to inadequate sampling , or error in interpreta on [2,17]. One case was diagnosed as colloid goitre with papillary hyperplasia on FNAC as the nuclear features typical of papillary carcinoma were lacking in this par cular case.…”

Section: Discussionmentioning

confidence: 97%

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

Mushinam¹,

Padua²

2017

IJCBR

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“…The sensitivity and specificity of frozen sections for thyroid lesions or extrathyroidal extension were 58%–94% and 93%–100%, respectively. 5 , 20 – 22 Advantages of using intraoperative frozen sections were the speed of processing and the high rate of correct diagnoses, but FN diagnoses continued to exist. FN diagnoses may result in reoperation, which has a higher risk of permanent hypoparathyroidism and recurrent laryngeal nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative measurement of thyroglobulin in lymph node aspirates for the detection of metastatic papillary thyroid carcinoma

Wang

Liu

Wang

et al. 2017

OTT

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BackgroundAmong patients with papillary thyroid carcinoma (PTC), 30%–80% have cervical lymph node (LN) metastases, which are most commonly located in the central compartment. However, preoperative ultrasonography identifies malignant central compartment LNs in only 20%–30% of cases. We aimed to evaluate the diagnostic value of intraoperative thyroglobulin (Tg) measurement in fine-needle aspirates (FNA-Tg) of suspicious metastatic LNs.MethodsIn total, 75 patients (75 LNs) with PTC or suspected PTC were enrolled in this study. Suspicious metastatic LNs were isolated intraoperatively, and FNA-Tg was performed. Then, the Tg values were compared with the corresponding pathological results and preoperative ultrasonography.ResultsIn total, 37 LNs were diagnosed as malignant, and 38 were benign. According to the receiver operating characteristic (ROC) curve, the optimal cutoff value of intraoperative FNA-Tg was 147.5 ng/mL (sensitivity, 81.1%; specificity, 100%; p=0.000). The sensitivity and specificity for detecting central compartment LN metastasis were 77.78% (21/27) and 100% (36/36), respectively. The corresponding sensitivity of preoperative ultrasonography was lower than that of FNA-Tg (p=0.000). Serum Tg-antibody (Ab), thyroid-stimulating hormone (TSH) and thyroid peroxidase antibody (TPO-Ab) were not significantly associated with FNA-Tg values. There was no statistical correlation between preoperative serum Tg and intraoperative FNA-Tg (p=0.451).ConclusionIntraoperative FNA-Tg levels of suspicious metastatic cervical LNs can be useful for diagnosing metastatic PTC. Intraoperative LN-FNA-Tg may have an important role in determining which surgical procedure to perform.

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Thyroid nodule surgery: Predictive diagnostic value of fine-needle aspiration cytology and frozen section

Abstract: FNAC and frozen section have a comparable predictive diagnostic accuracy. Frozen section is requested by the surgeon not only on the basis of preoperative FNAC, especially when it is suspicious, or even indeterminate, but also in the light of the macroscopic surgical findings.

Cited by 16 publications

References 18 publications

Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II–VI: The Weill Cornell Medical College experience

Retrospective evaluation of frozen section use for thyroid nodules with a prior fine needle aspiration diagnosis of Bethesda II–VI: The Weill Cornell Medical College experience

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

Intraoperative measurement of thyroglobulin in lymph node aspirates for the detection of metastatic papillary thyroid carcinoma

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