The utility of intra‐operative frozen section for the evaluation of microscopic extrathyroidal extension in papillary thyroid carcinoma

Hong, Jong-Chul; Seo, Ji Won; Jang, Ahreum; Suh, Sung Hwan; Pak, Min Gyoung; Han, Shuai; Park, Y.J.; Lee, D.K.; Park, H.S.; Kang, Myung Koo

doi:10.1111/coa.12843

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…Of 300 thyroid cancer patients, positive sentinel lymph nodes were identified in 43 cases, and FS failed to predict lymph node involvement in 10 cases (sensitivity and specificity of 89.6% and 100%, respectively). Similar finding was also reported by Hong et al 22 and the present study findings as well suggest the high reliability of FS biopsy in lymph node status assessment.…”

Section: Discussionsupporting

confidence: 93%

Fine‐needle aspiration biopsy versus frozen section examination in assessing cervical lymph node metastasis in primary clinically positive neck papillary thyroid carcinoma

Fang

Dai

et al. 2022

Diagnostic Cytopathology

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Background Both fine‐needle aspiration biopsy (FNAB) and frozen section (FS) examination are reliable methods for assessing cervical lymph node (level II–V) metastasis (LNM) in papillary thyroid carcinoma (PTC). Our goal was to compare the diagnostic accuracy of FNAB and FS in clinically positive neck (cN+) PTC patients. Methods Altogether, 264 lymph node samples from 220 patients were prospectively enrolled. Samples were assessed by FNAB cytology (FNAB‐C), thyroglobulin (Tg) FNAB needle wash testing (FNAB‐Tg), and FS simultaneously. Diagnostic performance of the different methods were analyzed by the Chi‐square test. Results The sensitivity and specificity of FNAB‐C alone in predicting LNM was 87.4% and 85.7%, respectively. Combined with FNAB‐Tg, the sensitivity and specificity of FNAB‐C increased to 98.9% and 81.6%, respectively. The sensitivity and specificity of FS in predicting LNM was 92.4% and 81.1%, respectively. FNAB‐C and FNAB‐Tg had better sensitivity than FS when applied to solid lymph nodes, and comparable sensitivity when applied to cystic and cystic‐solid lymph nodes. Conclusion The utilization of FNAB‐Tg significantly improved the diagnostic ability of FNAB‐C. FS can be replaced by preoperative FNAB combined with FNAB‐Tg without compromising diagnostic accuracy.

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Section: Discussionsupporting

confidence: 93%

Fine‐needle aspiration biopsy versus frozen section examination in assessing cervical lymph node metastasis in primary clinically positive neck papillary thyroid carcinoma

Fang

Dai

et al. 2022

Diagnostic Cytopathology

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“…18,19 However, a recent study by Hong et al, demonstrated that an intraoperative frozen biopsy can be useful in determining whether the PTC has a microscopic extra-thyroid extension (high-risk feature) and therefore affects the extent of the surgery. 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).…”

Section: Discussionmentioning

confidence: 99%

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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“…In particular, microscopic extrathyroidal extension can only be detected by pathological microscopic examination. [ 34 ] The number of studies on the effectiveness of FS in extrathyroidal extension is limited in the literature. First of all, Park et al [ 35 ] studied the effectiveness of FS in evaluating extrathyroidal extension in papillary thyroid cancer.…”

Section: B Frozen Section Examination In Assessment Of Extrathyroidal...mentioning

confidence: 99%

“…In another study, where microscopic extrathyroidal extension was 27.5% in papillary thyroid cancer, it was reported that intraoperative FS could detect microscopic extrathyroidal extension with 100% sensitivity and specificity in all cases. [ 34 ] Both studies reported that intraoperative FS can be used to detect extrathyroidal extension in papillary thyroid cancer, and FS can assist the surgeon in determining the extent of thyroid surgery and central dissection. FS examination can be used to evaluate extrathyroidal spread, especially if the treatment plan will change in patients with papillary thyroid cancer.…”

Section: B Frozen Section Examination In Assessment Of Extrathyroidal...mentioning

confidence: 99%

The Role of Frozen Section Examination in Thyroid Surgery

Uludag

2023

Sisli Etfal

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In endocrine pathology, frozen section (FS) examination is most commonly used for the intraoperative evaluation of thyroid and parathyroid tumors, as well as cervical lymph nodes. In the past, frozen section was considered a fundamental tool in thyroid surgery. However, with advancements in preoperative ultrasound and fine-needle aspiration biopsy (FNAB), there have been increasing queries about its routine use due to the improved preoperative diagnosis. Nowadays, while the use of FS during thyroidectomy has decreased, it is still used as an additional method for different purposes intraoperatively. FS may not always provide definitive results. If FS will alter the surgical plan or extent, it should be applied. Routine FS is not recommended for evaluating thyroid nodules. But in addition to FNAB, if FS results may change the operation plan or extent, they can be utilized. FS should not be applied for thyroid lesions smaller than 1 cm, and the entire lesion should not be frozen for FS. For the assessment of thyroid nodules, the use of FS is recommended based on the Bethesda categories of FNAB. In Bethesda I category nodules, FS may contribute to distinguishing between malignant and benign lesions and guide surgical treatment. In Bethesda II nodules, where the malignancy rate is low, the performance of FNAB and FS can be compared, but it's not recommended due to the lack of a significant contribution to the surgical strategy. The sensitivity of FS in Bethesda III and IV nodules is low; its contribution to the diagnosis is limited, and it does not provide an apparent benefit to treatment; therefore, it is not recommended. In Bethesda V nodules, FS can effectively confirm the malignancy diagnosis, contribute to the surgical strategy, and reduce the possibility of completion thyroidectomy, and accordingly, it is recommended for use. Nonetheless, in Bethesda V nodules with a benign FS report, the malignancy rate remains high, so it should not be used to rule out malignancy. In Bethesda VI nodules, the performance of FS is lower or comparable to FNAB and does not significantly contribute to the treatment strategy; hence, it is not recommended. Particularly in patients with papillary thyroid cancer, intraoperative FS can be effective in detecting extrathyroidal extension and can assist the surgeon in determining the extent of thyroid surgery and central neck dissection. FS has high sensitivity and specificity in evaluating the lymphatic status of the central region intraoperatively and can be used to determine the extent of central compartment node dissection. During thyroidectomy, FS examination can be used in recognizing parathyroid tissue and distinguishing it from fatty tissue, thymus, thyroid, lymph nodes, especially in differentiating metastatic lymph nodes.

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The utility of intra‐operative frozen section for the evaluation of microscopic extrathyroidal extension in papillary thyroid carcinoma

Abstract: Intra-operative frozen biopsy can be a useful method for identifying the microscopic ETE. During the surgery, it can also help the surgeon to decide the optimal extent of surgery and the need for central compartment neck dissection in PTC patients.

Cited by 6 publications

References 32 publications

Fine‐needle aspiration biopsy versus frozen section examination in assessing cervical lymph node metastasis in primary clinically positive neck papillary thyroid carcinoma

Fine‐needle aspiration biopsy versus frozen section examination in assessing cervical lymph node metastasis in primary clinically positive neck papillary thyroid carcinoma

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

The Role of Frozen Section Examination in Thyroid Surgery

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