title: Surgical treatment of solitary thyroid nodules via fine-needle aspiration biopsy and frozen-section analysis.
abstract: BACKGROUND
  Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy.
  
  
  METHODS
  This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy.
  
  
  RESULTS
  Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively.
  
  
  CONCLUSIONS
  FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.
authors.affiliation: Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan. tcchao@adm.cgmh.ort.tw
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
authors.forename: Jen-Der
authors.initials: JD
authors.lastname: Lin
authors.forename: Hsiao-Hsiang
authors.initials: HH
authors.lastname: Chao
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002648:Child; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy