Frozen section in thyroid surgery: is it a necessity?
BACKGROUND
Many surgeons use intraoperative frozen-section (FS) biopsy of thyroid nodules to predict malignant disease, but the findings are often not in agreement with those of fine-needle aspiration (FNA) biopsy. Our objective in this study was to assess the value of intraoperative FS biopsy in patients with nodular disease of the thyroid gland.


METHODS
In this study, 203 patients underwent thyroid surgery at the Ankara Oncology Hospital. Nodules were assessed by FNA biopsy preoperatively, by FS intraoperatively and by histologic examination of the excised specimen. Sensitivity, specificity and accuracy were determined for FS and FNA with respect to the histologic findings.


RESULTS
The sensitivity, specificity and accuracy rates for FNA, excluding occult cancers, were 74.1%, 100% and 95.2%, respectively, and for FS were 87.1%, 100% and 97.8%, respectively. FS influenced operative decisions in 0.6% of nodules found to be benign by FNA and in 20% of nodules found to be suspicious by FNA. FS contributed nothing for FNA-malignant disease since all the results in this group were true positive.


CONCLUSIONS
Intraoperative FS was most helpful when the FNA findings were suspicious for malignant disease. FS does not seem to be necessary when FNA indicates malignant or benign disease. Both FNA and FS failed to detect occult thyroid carcinomas.
First Department of Surgery, Ankara Oncology Hospital, Ankara, Turkey. bahadircetin1@yahoo.com
Bahadir
B
Cetin
Sabahattin
S
Aslan
Celal
C
Hatiboglu
Bahattin
B
Babacan
Akin
A
Onder
Alper
A
Celik
Abdullah
A
Cetin
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005260:Female; D005629:Frozen Sections / Q000706:statistics & numerical data*; D006801:Humans; D007150:Immunohistochemistry; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery*; D019564:Unnecessary Procedures