Role of frozen section in the surgical management of indeterminate thyroid nodules

Najah, H.; Trésallet, Christophe

doi:10.21037/gs.2019.04.07

Cited by 28 publications

(23 citation statements)

References 31 publications

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“…In fact, FSs jeopardize the detection of capsular invasion because of the fragmentation of the specimen during the process. 33 At our institution, FSs were never performed to augment the diagnosis of cases of Bethesda III on FNAC.…”

Section: Discussionmentioning

confidence: 99%

Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

Pasha

Dhanani

Mughal

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is one of the six diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology. The prevalence of malignancy among Bethesda category III cytology is variable, ranging from 5% to 37% in the literature. Objective To determine the rate of malignancy in thyroid nodules reported as Bethesda category III. Methods A total of 495 patients underwent surgical intervention for thyroid nodules from January 2015 to December 2017. The present study included 81 cases reported as Bethesda category III, and their medical records were reviewed. Results Out of 495 fine-needle aspiration cytology samples, 81 (16.4%) samples were labeled as AUS/FLUS. Among these 81 patients, the mean age was 43.0 years (± 13.9), with only 11 (14%) patients older than 55 years of age. Most of our patients were female (n = 69; 85.2%), and the rest were male. The rate of malignancy based on the final histology was of 33.3% (n = 27). The majority were 17 cases (21%) of papillary carcinoma, followed by follicular carcinoma (n = 6) (7.4%). Conclusion The risk of malignancy can be higher than it is commonly believed, and guidelines should be based on the data from the institutions themselves for a better assessment of the outcomes.

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Section: Discussionmentioning

confidence: 99%

Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

Pasha

Dhanani

Mughal

et al. 2020

Int Arch Otorhinolaryngol

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“…Furthermore, OCT does not reach the levels of preoperative diagnostic accuracy of USG for thyroid fine needle aspiration. However, due to the low invasiveness and the ability of imaging tissue volume without slicing, it can be used as an aid in intraoperative diagnostics in an organ such as the thyroid in which histological frozen section investigations are not always recommended [39,40]. Moreover, a technique similar to OCT for imaging a small tissue volume without the need to perform slicing can be useful in the pathology examination routine or even for the physiologic studies [1,2] of tissue without any direct clinical implementation.…”

Section: Clinical Implementationmentioning

confidence: 99%

Optical coherence tomography for thyroid pathology: 3D analysis of tissue microstructure

Tampu¹,

Maintz²,

Koller³

et al. 2020

Biomed. Opt. Express

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To investigate the potential of optical coherence tomography (OCT) to distinguish between normal and pathologic thyroid tissue, 3D OCT images were acquired on ex vivo thyroid samples from adult subjects (n=22) diagnosed with a variety of pathologies. The follicular structure was analyzed in terms of count, size, density and sphericity. Results showed that OCT images highly agreed with the corresponding histopatology and the calculated parameters were representative of the follicular structure variation. The analysis of OCT volumes provides quantitative information that could make automatic classification possible. Thus, OCT can be beneficial for intraoperative surgical guidance or in the pathology assessment routine.

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“…Historically, intraoperative frozen biopsy has been utilized to guide the surgical treatment strategy of thyroid nodule [ 10 ]. If the frozen biopsy diagnosis is benign, surgical treatment could be sufficient with a hemi-thyroidectomy, while a total thyroidectomy should be done in case of a malignant tumor [ 10 ]. The role of frozen biopsy has been controversy since the emergence of FNA as the main preoperative diagnostic tool of thyroid nodules [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…If the frozen biopsy diagnosis is benign, surgical treatment could be sufficient with a hemi-thyroidectomy, while a total thyroidectomy should be done in case of a malignant tumor [ 10 ]. The role of frozen biopsy has been controversy since the emergence of FNA as the main preoperative diagnostic tool of thyroid nodules [ 10 ]. However, as mentioned above, there are lesions that cannot be determined by cytology alone and diagnosed as AUS.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic pitfall of thyroid fine-needle aspiration induced fibrosis: follicular adenoma mimicking medullary thyroid carcinoma in frozen section

et al. 2021

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Background Fine-needle aspiration (FNA) is a frequently utilized method for the diagnosis of thyroid nodules. Although the technique has clear advantages, the injury caused by the aspiration needle can induce various histological alterations. Herein, we report a case of follicular adenoma showing histological alterations possibly caused by FNA biopsy. Furthermore, the histological appearance of the lesion mimicked those of medullary thyroid carcinoma, particularly in the frozen section. Case presentation Ultrasonography of a thyroid nodule in a 39-year-old man revealed a mass (2.2 cm in diameter) in the right thyroid lobe. FNA was performed three times on the mass, and the results of the cytology were atypia of undetermined significance. Thereafter, the patient underwent right hemithyroidectomy. The histological findings of the operative frozen section analysis indicated medullary thyroid carcinoma. However, after evaluation and immunohistochemical staining of the permanent section, the mass was diagnosed as follicular adenoma with extensive fibrosis. Conclusion The histological alterations observed in the follicular adenoma are believed to have been caused by injury during the repeated FNA procedures.

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Role of frozen section in the surgical management of indeterminate thyroid nodules

Cited by 28 publications

References 31 publications

Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

Optical coherence tomography for thyroid pathology: 3D analysis of tissue microstructure

Diagnostic pitfall of thyroid fine-needle aspiration induced fibrosis: follicular adenoma mimicking medullary thyroid carcinoma in frozen section

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