Utility of Intraoperative Frozen Sections during Thyroid Surgery

IntroductionIt is not uncommon for patients with indeterminate thyroid nodules to undergo diagnostic hemithyroidectomy. When the final pathology determines that the nodule is in fact malignant, patients require counseling as to the whether a completion thyroidectomy is necessary.ObjectivesDetermine the incidence of well differentiated thyroid cancer (WDTC) in the contralateral thyroid lobe in patients undergoing completion thyroidectomy.Identify features of the malignant tumor in the initial resection that increase the likelihood of malignancy in the contralateral lobe.MethodsRetrospective chart review of 97 patients who underwent hemithyroidectomy and completion thyroidectomy in a university’s teaching hospital network between 2006 and 2012. Pathology reports from both surgeries as well as patient and thyroid nodule characteristics were reviewed.ResultsOf the 97 patients, 47 (48 %) had a malignancy in the contralateral lobe. In the contralateral lobe, 42/47 (89 %) of malignancies were papillary microcarcinomas (PMC) and 15/42 (36 %) of the PMC were multifocal. Multifocal malignancies in the initial specimen had a 60 % rate of contralateral malignancy and were found to be a predictor of bilateral disease (p = 0.04) with OR = 2.74 (95 % CI: 1.11–6.79; p = 0.003) in WDTC and OR = 3.59 (95 % CI:1.35 9.48; p = 0.01) in papillary cancer specifically. There was no statistical significant correlation established for the following variables: presence of positive cervical nodes, extrathyroidal extension, positive resection margins, size and angio-lymphatic invasion. Moreover, there was no statistical correlation between any of the variants of papillary thyroid cancer and bilateral disease, even though most aggressive subtypes were found to be bilateral.ConclusionIn this study, the rate of malignancy in the contralateral lobe was 48 %. Multifocality and presence of an aggressive subtype of papillary thyroid cancer in the initial specimen were found to be more important variables to consider in decision-making regarding completion thyroidectomy than size of the initial tumor alone.

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“…This is in line with multiple series in the literature that prove that frozen sections were of little clinical usefulness [18–20]. …”

Section: Discussionsupporting

confidence: 86%

Completion thyroidectomy: predicting bilateral disease

Ibrahim

Forest

Hier

et al. 2015

J of Otolaryngol - Head & Neck Surg

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“…Routine intra-operative frozen section biopsy might not be recommended to determine the extent of thyroid surgery. 28,29 32 as seemed to be the case in one patient in the present study who had a positive BRAF result.…”

Section: Resultssupporting

confidence: 76%

“…Routine intra‐operative frozen section biopsy might not be recommended to determine the extent of thyroid surgery . In our series of intra‐operative frozen biopsies ( N =42).…”

Section: Discussionmentioning

confidence: 93%

False‐positive cytopathology results for papillary thyroid carcinoma: A trap for thyroid surgeons

Ahn

Park

et al. 2017

Clinical Otolaryngology

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“…Previous studies have reported no clinical usefulness of FS with previous FNA biopsies showing SFM. 26 Additionally, some institutions perform thyroid procedures based on prognostic factors and intraoperative findings regardless of previous FNA results. 20 The diagnosis of SFM is a relatively infrequent diagnosis among the 6 Bethesda categories (,5% of total FNA cases).…”

Section: Discussionmentioning

confidence: 99%

Fine-Needle Aspiration Versus Frozen Section in the Evaluation of Malignant Thyroid Nodules in Patients With the Diagnosis of Suspicious for Malignancy or Malignancy by Fine-Needle Aspiration

Woo²,

Zhao³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Cytopathology recommends against the use of intraoperative frozen section (FS) during lobectomy of a thyroid nodule with a fine-needle aspiration (FNA) diagnosis of malignant. Bethesda recommendations for FS in the FNA category of suspicious for malignancy (SFM) is less welldefined. In some institutions in China, FS examination is performed during lobectomy even for FNA-proven malignant cases.Objective.-To compare the efficacy of FNA versus FS in the evaluation of malignant thyroid lesions.Design.-A 3-year retrospective analysis from a single institution was performed on cases with an FNA diagnosis of SFM or malignant with subsequent FS examination during thyroidectomy. The results of FNA and FS findings were compared to the final thyroidectomy pathology.Results. Conclusions.-Frozen section should not be performed for the malignant FNA category because FS evaluation may result in 10% falsely negative findings. Performing FS for SFM may be better justified; however, more than half of FS cases read as benign in this category had malignant final pathology. Therefore, caution should be taken for FS results even in the SFM group.

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Utility of Intraoperative Frozen Sections during Thyroid Surgery

Cited by 36 publications

References 13 publications

Completion thyroidectomy: predicting bilateral disease

Completion thyroidectomy: predicting bilateral disease

False‐positive cytopathology results for papillary thyroid carcinoma: A trap for thyroid surgeons

Fine-Needle Aspiration Versus Frozen Section in the Evaluation of Malignant Thyroid Nodules in Patients With the Diagnosis of Suspicious for Malignancy or Malignancy by Fine-Needle Aspiration

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