Does frozen section alter surgical management of multinodular thyroid disease?
BACKGROUND
Frozen section (FS) evaluation during thyroid surgery is often used to guide intraoperative management. We sought to determine the utility of FS in patients undergoing thyroidectomy for multinodular thyroid disease.


METHODS
From May 1994 through November 2004, 236 patients with multinodular goiter underwent thyroidectomy at our institution. Patient data were retrospectively analyzed to see if a frozen section was performed during the procedure and whether it changed the patient's outcome.


RESULTS
Of the 236 patients, 135 (57%) had intra-operative FS. There were no differences between patients who had FS analysis and those who did not with regard to age, gender, and the incidence of malignancy. Of the patients who had FS, 4/135 (3%) were subsequently diagnosed with thyroid cancer on permanent histology. Three of these FS were misread as benign. Therefore, the sensitivity of FS for the diagnosis of thyroid cancer was only 25%. Importantly, in none of the 135 patients did FS alter the intraoperative management.


CONCLUSIONS
While FS was commonly used in patients undergoing thyroidectomy at our institution, in no patient over the last decade did FS correctly alter the intraoperative management. Given the time required to perform FS and the cost associated with it, we believe that routine FS should not be performed in these patients.
Olson
Sarah
S
Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin 58792, USA.
Cheema
Yusra
Y
Harter
Josephine
J
Starling
James
J
Chen
Herbert
H
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006044:Goiter, Nodular / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D008223:Lymphoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D016896:Treatment Outcome