Limitation of intraoperative frozen section during thyroid surgery

Estebe, Sandrine; Montenat, C.; Tremoureux, Adrien; Rousseau, Chloé; Bouilloud, F.; Jégoux, Franck

doi:10.1007/s00405-016-4398-2

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…is not progressing, so the patient's thyroid cancer will not cause a problem. As a result, microinvasive papillary cancer is not considered even to be malignant [7][8][9][10][11]. According to the results of our study, microinvasive papillary cancer was detected in 26 patients, but of them were found incidentally in goiters with no cancer suspicion preoperatively.…”

Section: Journal Of Endocrinology and Thyroid Researchmentioning

confidence: 85%

Predictive Parameters in Thyroid Cancer: The Mirror of an Endemic Country

Kocakuşak¹

2017

JETR

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It has been detected that the absence of thickening of isthmus and the solid nature of nodules, both had statistical significance in regard to predictivity of suspicious nodules. Although not statistically significant, there were differences in favour of malignancy between the groups when any of the parameters of solitary nodule, solid nature, loss of perinodular halo, hypoechoic nodule, and large nodule diameter were evaluated. In contrast to the expectancy; the number and diameter of nodules, in addition to gender were not found to be of significant predictive value in Turkey.

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Section: Journal Of Endocrinology and Thyroid Researchmentioning

confidence: 85%

Predictive Parameters in Thyroid Cancer: The Mirror of an Endemic Country

Kocakuşak¹

2017

JETR

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“…20 Another study by Estebe et al reported that an intraoperative FS has higher sensitivity and specificity compared to a preoperative fine needle aspiration cytopathology (FNAC). 21 These authors also concluded that intraoperative FS reduced the number of unjustified total thyroidectomies and the need for two-staged procedures (conservative hemithyroidectomy followed by completion thyroidectomy). 21 The absence of high-risk features of PTC, by either pre-or intra-operative biopsy, could have down-staged a number of patients in our cohort.…”

Section: Discussionmentioning

confidence: 98%

“…21 These authors also concluded that intraoperative FS reduced the number of unjustified total thyroidectomies and the need for two-staged procedures (conservative hemithyroidectomy followed by completion thyroidectomy). 21 The absence of high-risk features of PTC, by either pre-or intra-operative biopsy, could have down-staged a number of patients in our cohort. Fifteen patients who underwent total thyroidectomies without the identification of a single high-risk feature were potentially suitable for initial hemithyroidectomy.…”

Section: Discussionmentioning

confidence: 98%

Clinical Staging Variability and Surgery in Papillary Thyroid Cancers with Tumor Size 1 to 4 cm

Wood¹,

Williams²,

Ashford³

et al. 2018

World Journal of Endocrine Surgery

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Aim: Recent guidelines have attempted to de-escalate treatment pathways for low-risk papillary thyroid carcinoma (PTC) to reduce long-term morbidities associated with treatment. The literature supporting either hemithyroidectomy or total thyroidectomy for PTC between 1 and 4 cm is conflicting and dependent on the accuracy of clinical staging. We examined the variability between clinical and pathological tumor staging for PTC 1 to 4 cm. Materials and methods:This study is a single center, retrospective cohort study of all patients who underwent surgery for confirmed PTC between 1 and 4 cm, from January 2010 to August 2017. Results:The cohort included 38 patients, of which 20 patients (53%) had no high-risk features on histopathology, and 18 patients (47%) had one or more high-risk feature. Fiftyfive percent of patients had a 5mm or more variance between preoperative and postoperative sizing. Among the patients with no high-risk features, preoperative ultrasound overestimated the size (p = 0.0007) and stage (55% downgraded) when compared to postoperative histopathology reports. 80% of patients that underwent hemithyroidectomy had no high-risk features and avoided completion thyroidectomy. Conclusion:We identified a particular cohort of patients that had no high-risk features on final histopathology that had greater differences in preoperative and postoperative tumor sizes. Overestimation of size and stage of PTC has the potential for the overtreatment of these patients. This study has shown the importance of determining high-risk features and other PTC parameters, such as size and staging. We have highlighted the potential importance of preoperative or intraoperative tumor evaluation in identifying patients who could benefit from conservative surgical approaches.Clinical significance: Identification of papillary thyroid cancer patients without high-risk features either preoperatively or intraoperatively can provide surgeons with a stratified guideline to decide which patients are suitable for conservative surgery compared to total thyroidectomy.

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“…Determining exactly which patients with a history of thyroid cancer have a low risk to be used as donors for transplantation Accuracy 68%-83% sensitivity, 83%-100% specificity, 82%-94% accuracy [10][11][12] 36-86% sensitivity, 100% specificity, 88% accuracy 13,14 Complications Localized bleeding, 15 nodule infarction Operating room needed with dedicated personnel and mobilization of donor required a All cases were carried out in different centers with few with adequate documentation; therefore, we report time as described by the Italian health system schedules of charges.…”

Section: Discussionmentioning

confidence: 99%

“…Data in literature show mostly comparable diagnostic properties between the 2 procedures, with no clear advantage of one over the other. [10][11][12][13][14] Certain postbiopsy procedure complications can also have serious consequences for donor management. Total thyroidectomy has a known surgical risk of bleeding ranging from 0.1% to 14%, 16,17 which may even cause hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

Management of Thyroid Nodules in Deceased Donors With Comparison Between Fine Needle Aspiration and Intraoperative Frozen Section in the Setting of Transplantation

Eccher¹,

Girolami²,

d’Errico

et al. 2019

Prog Transpl

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Introduction: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. Methods: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. Results: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. Discussion: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.

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Limitation of intraoperative frozen section during thyroid surgery

Cited by 7 publications

References 22 publications

Predictive Parameters in Thyroid Cancer: The Mirror of an Endemic Country

Predictive Parameters in Thyroid Cancer: The Mirror of an Endemic Country

Clinical Staging Variability and Surgery in Papillary Thyroid Cancers with Tumor Size 1 to 4 cm

Management of Thyroid Nodules in Deceased Donors With Comparison Between Fine Needle Aspiration and Intraoperative Frozen Section in the Setting of Transplantation

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