Thyroid surgery: Does frozen section have a role? If yes, in which cases?

Lanitis, Sophocles; Sourtse, G.; Kouloura, Andriana; Ganis, V.

doi:10.1007/s13126-015-0175-8

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…Ultrasound-guided FNA is the method most frequently used to evaluate thyroid nodules with high accuracy, and is less invasive than surgery 9 . However, whether the use of intraoperative FS of thyroid nodules with previous conclusive FNA diagnosis is necessary remains controversial 14 , 15 . Richards et al .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative frozen section can be reduced in thyroid nodules classified as Bethesda categories V and VI

Huang

Luo

Chen

et al. 2017

Sci Rep

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Intraoperative frozen section (FS) can be reduced during thyroid lobectomy according to the results of fine needle aspiration (FNA). We evaluated the role of intraoperative FS in thyroid nodules with different diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology by FNA. This retrospective study included 1,235 nodules collected via thyroidectomy with both preoperative FNA and intraoperative FS at the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2011 to January 2014. FNA cytological diagnosis was classified into six categories, based on the Bethesda system. The diagnostic findings of FNA cytology and FS histology were compared with the final histological results. 189 nodules were benign. The remainder were malignant. FS diagnosis was more accurate than FNA diagnosis for nodules classified as Bethesda Categories II, III, and IV (P < 0.05). However, the accuracy of FNA diagnosis in nodules assigned Bethesda Categories V and VI was significantly higher than that of FS (P < 0.05). FS appears be beneficial for thyroid nodules classified as Bethesda categories I through IV. FS may not be necessary in nodules diagnosed as Bethesda Categories V and VI.The incidence of thyroid nodules has increased in recent years 1 , with an estimated prevalence of 1-5% for palpable nodules and up to 50% for nonpalpable nodules 2 . This increase in incidence is due to identification through the use of ultrasound examinations and the emphasis on early detection of cancer over the past three decades 3 . Autopsy studies have showed that 50% of the U.S. population has thyroid nodules 4 . The reported incidence of thyroid cancer in all thyroid nodules is approximately 5% 5 .Ultrasound-guided fine needle aspiration 6 is the most useful and reliable method for the evaluation of thyroid nodules 7 . It was used worldwide because of its safety, simplicity, and cost-effectiveness 8,9 . Cytological results are classified according to the Bethesda System for Reporting Thyroid Cytopathology 6 , which has been applied in our institution since 2011. These cytological diagnoses are determined, as follows: 1) Bethesda I, nondiagnostic or unsatisfactory, 2) Bethesda II, benign, 3) Bethesda III, atypical of indeterminate significance or follicular lesion of indeterminate significance, 4) Bethesda IV, follicular neoplasm or suspicious for a follicular neoplasm, 5) Bethesda V, suspicious for malignancy, and 6) Bethesda VI, malignant.FNA diagnoses may not be definitive. This creates a dilemma with regard to follow-up and/or treatment, especially regarding the need for surgery. Frozen section (FS) has been used extensively to help guide intraoperative management of patients with thyroid nodules. However, FS is usually insufficient to determine true capsular or vascular invasion, and deferral to a final pathologic diagnosis is often necessary in the setting of follicular lesions 10 . The use of intraoperative FS has long been debated, secondary to concerns about increased costs and operative time, ...

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Section: Discussionmentioning

confidence: 99%

Intraoperative frozen section can be reduced in thyroid nodules classified as Bethesda categories V and VI

Huang

Luo

Chen

et al. 2017

Sci Rep

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“…FS can be utilized if the frozen results, in addition to FNAB, are expected to alter the surgical plan or the extent of the operation. [ 12 ] In cases of multinodular goiter, unless there are suspicious features in the macroscopic appearance of a nodule, frozen section should not be performed. For lesions smaller than 1 cm, frozen section should be avoided.…”

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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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Thyroid surgery: Does frozen section have a role? If yes, in which cases?

Cited by 2 publications

References 10 publications

Intraoperative frozen section can be reduced in thyroid nodules classified as Bethesda categories V and VI

Intraoperative frozen section can be reduced in thyroid nodules classified as Bethesda categories V and VI

The Role of Frozen Section Examination in Thyroid Surgery

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