Economic Impact of Frozen Section for Thyroid Nodules with “Suspicious for Malignancy” Cytology

Abstract

Objective To perform a cost analysis of the routine use of intraoperative frozen section (iFS) among patients undergoing a thyroid lobectomy with "suspicious for malignancy" (SUSP) cytology in the context of the 2015 American Thyroid Association guidelines. Study Design Case series with chart review; cost minimization analysis. Setting Academic. Subjects and Methods Records were reviewed for patients with SUSP cytology who underwent thyroid surgery between 2010 and 2015 in which iFS was utilized. The diagnostic test performance of iFS and the frequency of indicated completion/total thyroidectomies based on the 2015 guidelines were calculated. A cost minimization analysis was performed comparing lobectomy, with and without iFS, and the need for completion thyroidectomy according to costs estimated from 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results Sixty-five patients met inclusion criteria. The malignancy rate was 61.5%, 45% of which was identified intraoperatively. The specificity and positive predictive value were 100%. The negative predictive value and sensitivity were 83% and 95%, respectively. Completion/total thyroidectomy was indicated for 9% of patients; 83% of these individuals had findings on iFS that would have changed management intraoperatively. Application of the new guidelines would have resulted in a significant reduction in the frequency of conversion to a total thyroidectomy when compared with the actual management (26.1% vs 7.7%, P = .005). Performing routine iFS was the less costly scenario, resulting in a savings of $474 per case. Conclusion For patients with SUSP cytology undergoing lobectomy, routine use of iFS would result in decreased health care utilization.

Intraoperative frozen section performance for thyroid cancer diagnosis

“…In another analysis of BC V nodules that considered a surgical approach based on ATA 2015 guidelines, a small percentage of cases would have been converted to total thyroidectomy based on iFS. However, routine iFS would still be cost-effective if the method specificity were 100% (26), similarly for BC IV nodules, according to other studies (27,28). Nevertheless, most of the costeffectiveness analysis does not consider operative and postoperative costs associated with unnecessary total thyroidectomies and management of complications (hypoparathyroidism, recurrent laryngeal nerve palsy), which can occur in up to 20% of the cases (29).…”

Enhancing Parathyroid Gland Visualization Using a Near Infrared Fluorescence-Based Overlay Imaging System

“…In that aspect, NIRAF-based modalities such as OTIS can be effective in reducing the number of frozen sections and related costs required for confirming PGs in real-time. This in turn could aid both surgeons and patients by minimizing the wait-time of 20 minutes that is typically associated for frozen section analysis, which again helps in cutting expenses associated with additional anesthesia administration (48). The benefits of technology such as OTIS in hospitals/medical centers would in turn depend on the volume of surgeries done and the experience of the surgeon.…”

Developing a Clinical Prototype to Guide Surgeons for Intraoperative Label-Free Identification of Parathyroid Glands in Real Time

“…In contrast, it becomes vital to assess the costeffectiveness of modalities like the PTeye for low-volume surgeons who typically perform <25 thyroid surgeries or <15 parathyroid surgeries per year (47,(49)(50)(51). Assuming a minimal rate of 20 thyroid and 10 parathyroid surgeries per year, with an associated cost of at least one frozen section analysis (cost *145 USD/specimen) and additional 20 minutes of anesthesia administered during the procedure (cost *210 USD) (52), health care costs that could be minimized per year would amount to 10,650 USD even for a low-volume center. Higher costs would need to be factored for additional frozen sectional analysis per surgeries and health care expenses for postoperative complications (hypocalcemia following thyroid surgeries or completion surgeries after failed parathyroidectomies) that tend to be even higher with low-volume surgeons (51,53).…”