Intraoperative Frozen-Section Analysis for Thyroid Nodules: A Step Toward Clarity or Confusion? | Endocrinology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Cady  BRossi  R An expanded view of risk-group definition in differentiated thyroid carcinoma.  Surgery 1988;104 (6) 947- 953PubMedGoogle Scholar
Kupferman  MEMandel  SJDiDonato  LWolf  PWeber  RS Safety of completion thyroidectomy following unilateral lobectomy for well-differentiated thyroid cancer.  Laryngoscope 2002;112 (7, pt 1) 1209- 1212PubMedGoogle ScholarCrossref
Caraci  PAversa  SMussa  APancani  GOndolo  CConticello  S Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules.  Br J Surg 2002;89 (6) 797- 801PubMedGoogle ScholarCrossref
Chang  HYLin  JDChen  JF  et al.  Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.  J Clin Pathol 1997;50 (12) 1005- 1009PubMedGoogle ScholarCrossref
Paphavasit  AThompson  GBHay  ID  et al.  Follicular and Hürthle cell thyroid neoplasms: is frozen-section evaluation worthwhile?  Arch Surg 1997;132 (6) 674- 678PubMedGoogle ScholarCrossref
Udelsman  RWestra  WHDonovan  PISohn  TACameron  JL Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid.  Ann Surg 2001;233 (5) 716- 722PubMedGoogle ScholarCrossref
Shaha  AR Controversies in the management of thyroid nodule.  Laryngoscope 2000;110 (2, pt 1) 183- 193PubMedGoogle ScholarCrossref
Kini  SRMiller  JMHamburger  JI  et al.  Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration.  Acta Cytol 1980;24 (6) 511- 521PubMedGoogle Scholar
Gharib  HGoellner  JRZinsmeister  AR  et al.  Fine-needle aspiration biopsy of the thyroid: the problem of suspicious cytologic findings.  Ann Intern Med 1984;101 (1) 25- 28PubMedGoogle ScholarCrossref
Goldstein  RENetterville  JLBurkey  B  et al.  Implication of follicular neoplasms, atypia and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules.  Ann Surg 2002;235 (5) 656- 664PubMedGoogle ScholarCrossref
Wein  ROWeber  RS Contemporary management of differentiated thyroid carcinoma.  Otolaryngol Clin North Am 2005;38 (1) 161- 178PubMedGoogle ScholarCrossref
Punthakee  XPalme  CEFranklin  JHZhang  IFreeman  JLBedard  YC Fine-needle aspiration biopsy findings suspicious for papillary thyroid carcinoma: a review of cytopathological criteria.  Laryngoscope 2005;115 (3) 433- 436PubMedGoogle ScholarCrossref
Mulcahy  MMCohen  JIAnderson  PEDitamasso  JSchmidt  W Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of well-differentiated thyroid cancer.  Laryngoscope 1998;108 (4, pt 1) 494- 496PubMedGoogle ScholarCrossref
Alonso  NLucas  ASalinas  ICastella  ESanmarti  A Frozen section in a cytological diagnosis of thyroid follicular neoplasm.  Laryngoscope 2003;113 (3) 563- 566PubMedGoogle ScholarCrossref
McHenry  CRRaeburn  CStrickland  TMarty  JJ The utility of routine frozen section examination for intraoperative diagnosis of thyroid cancer.  Am J Surg 1996;172 (6) 658- 661PubMedGoogle ScholarCrossref
Davoudi  MMYeh  KAWei  JP Utility of fine-needle aspiration cytology and frozen-section examination in the operative management of thyroid nodules.  Am Surg 1997;63 (12) 1084- 1089PubMedGoogle Scholar
Brooks  ADShaha  ARDuMornay  W  et al.  Role of fine-needle aspiration biopsy and frozen section analysis in the surgical management of thyroid tumors.  Ann Surg Oncol 2001;8 (2) 92- 100PubMedGoogle ScholarCrossref
Duek  SDGoldenberg  DLinn  SKrausz  MMHershko  DD The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules.  Surg Today 2002;32 (10) 857- 861PubMedGoogle ScholarCrossref
Richards  MLChisholm  RBruder  JMStrodel  WE Is thyroid frozen section too much for too little?  Am J Surg 2002;184 (6) 510- 514PubMedGoogle ScholarCrossref
Roach  JCHeller  KSDubner  SSznyter  LA The value of frozen section examinations in determining the extent of thyroid surgery in patients with indeterminate fine-needle aspiration cytology.  Arch Otolaryngol Head Neck Surg 2002;128 (3) 263- 267PubMedGoogle ScholarCrossref
Anton  RCWheeler  TM Frozen section of thyroid and parathyroid specimens.  Arch Pathol Lab Med 2005;129 (12) 1575- 1584PubMedGoogle Scholar
Guyétant  SSaint-Andre  JP Frozen section examination in thyroid pathology: technique and effective indications [in French].  Arch Anat Cytol Pathol 1998;46 (1-2) 121- 127PubMedGoogle Scholar
Irish  JCvan Nostrand  AWAsa  SLGullane  PRotstein  L Accuracy of pathologic diagnosis in thyroid lesions.  Arch Otolaryngol Head Neck Surg 1992;118 (9) 918- 922PubMedGoogle ScholarCrossref
Chen  HZeiger  MAClark  DPWestra  WHUdelsman  R Papillary carcinoma of the thyroid: can operative management be based solely on fine-needle aspiration?  J Am Coll Surg 1997;184 (6) 605- 610PubMedGoogle Scholar
Original Article
September 2007

Intraoperative Frozen-Section Analysis for Thyroid Nodules: A Step Toward Clarity or Confusion?

Author Affiliations

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery, Department of Surgery (Drs Huber, Dziegielewski, Matthews, Warshawski, and Dort), Center for Advancement of Health (Ms Kmet and Dr Faris); and Department of Pathology (Dr Khalil), Calgary Health Region, University of Calgary, Calgary, Alberta, Canada.

Arch Otolaryngol Head Neck Surg. 2007;133(9):874-881. doi:10.1001/archotol.133.9.874

Objectives  To determine accuracy and intertest agreement of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen-section analysis (FS) findings in thyroid surgery, and to assess the influence of intraoperative FS findings on decision making and the utility of FS in thyroid surgery.

Design  Retrospective analysis. The results of preoperative FNAC, intraoperative FS, and final histopathological analyses were taken from the histopathology reports. We calculated intertest agreement using the κ statistic.

Patients  Two-hundred fifteen patients who underwent primary thyroid surgery. All patients were treated by the same surgeon (S.J.W.).

Results  T he sensitivity and specificity of FNAC were 57.4% and 91.7%, respectively. The sensitivity and specificity of FS were 32.4% and 96.5%, respectively. The intertest agreement was poor (κ = 0.17). In case of malignant FNAC findings, the FS result did not influence treatment decisions; in case of a malignant FS result on the background of a benign, indeterminate, or nondiagnostic FNAC finding, the FS result influenced treatment decisions in 88% of cases.

Conclusions  Intraoperative FS did not give additional information in cases where a malignant neoplasm was predicted by the FNAC finding. In this setting, it led to conflicting results and did not contribute to correct decision making.