Prevalence of Cancer in Follicular Thyroid Nodules: Is There Still a Role for Intraoperative Frozen Section Analysis?

Abstract

The optimal surgical management of follicular thyroid nodules and the effectiveness of frozen section (FS) analysis in planning the operation are still controversial. In this study, we reviewed the prevalence of cancer in 309 consecutive patients (230 females, 79 males, aged 42 +/- 13 years) with follicular nodules at fine-needle aspiration cytology (FNAC) and the efficacy of FS evaluation in selecting cancers. On the whole, the prevalence of cancer was 20.1%; the occurrence of follicular variants of papillary cancer (14.9%) was threefold higher than follicular cancers (5.2%). The presence of atypical features at FNAC selected nodules with a significantly higher prevalence of cancer (46.7%, p = 0.01). FS analysis was performed in 142 patients and recognized only 8 of 27 (30%) cancers, one fourth of them with atypia at FNAC. In conclusion, this study confirms a 20% overall prevalence of malignancy in patients with follicular thyroid nodules. The association of cell atypia with a follicular pattern may define a subgroup of nodules more likely to be malignant. FS was seldom effective in recognizing cancer confirming the doubt on its cost effectiveness in planning the surgical approach. Protocols aimed at a better cytologic identification of follicular variants of papillary cancer should be considered.

Sonographically guided core biopsy in the assessment of thyroid nodules

“…Frozen-section analysis is poor at differentiating follicular carcinoma from benign conditions and adds little to preoperative assessment using aspiration cytology or core biopsy. 23,24 One would expect increasing use of FNAC or core biopsy to reduce the need for frozen sections, although data were insufficient to demonstrate that effect here.…”

A meta‐analysis of comparing fine‐needle aspiration and frozen section for evaluating thyroid nodules

“…Eleven publications addressed follicular lesions/neoplasms only. [3][4][5][6][7][8][9][10][11][12][13] Two publications addressed papillary carcinoma only. 14,15 Eighteen publications had separate categories for follicular and non-follicular lesions.…”

Follicular Thyroid Carcinoma: From Diagnosis to Treatment

“…Additionally, variations of encapsulated follicular lesions of the thyroid presented in diagnostic criteria and personal experience may lead to disagreement among pathologists [22]. Most studies, from randomized prospective investigations to retrospective analysis of follicular neoplasm in single or multinodular goiters, illustrated that frozen section is neither informative nor cost-effective in the diagnosis of follicular thyroid cancer [23][24][25]. The cost of frozen section varies significantly in different geographic areas.…”