Open Access, Peer-reviewed
pISSN 2508-8149
eISSN 2508-8459
    Korean J Endocr Surg. 2015 Dec;15(4):79-85. Korean.
    Published online Dec 17, 2015.
    https://doi.org/10.16956/kjes.2015.15.4.79
    Copyright © 2015 Korean Association of Thyroid and Endocrine Surgeons; KATES. All Rights Reserved.
    Original Article

    Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

    Jeong Yoon Song, Sang Ah Han, Jae Hoon Jang and Jun Woo Bong
      • Department of Surgery at Gangdong Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
    • Correspondence: Jun Woo Bong. Department of Surgery at Gangdong Kyung Hee University Hospital, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea. Tel: +82-2-440-7000, Fax: +82-2-440-8197, Email: zest815@gmail.com
    Received November 16, 2015; Revised November 24, 2015; Accepted December 02, 2015.

    This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    Fine needle aspiration (FNA) is a useful preoperative diagnostic tool for thyroid nodule because of the high sensitivity and specificity. The aim of this study is to determine the necessity of intraoperative frozen section (IOFS) after fine needle aspiration.

    Methods

    Data of 534 patients with a single thyroid nodule who underwent thyroidectomy from June 2006 to August 2013 were reviewed retrospectively. FNA was performed preoperatively in all patients and IOFS was performed selectively according to the intraoperative findings and FNA results. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNA and IOFS for malignant nodules were analyzed.

    Results

    The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNA for malignant nodules were 100%, 95.5%, 99.8%, 100%, and 99.8%, respectively. All nodules diagnosed as benign by FNA were reaffirmed as benign nodules by permanent sections. When the result of FNA was suspicious for malignancy, specific features of preoperative ultrasound, including hypoechoic, size<10 mm showed high positive predictive value and accuracy (98%, 86.9%, and 100%, 78.7% respectively).

    Conclusion

    Performance of IOFS was not necessary when the result of FNA was consistent with malignancy or benign. However when the result of FNA was non-diagnostic or atypia, IOFS should be performed for more accurate detection of malignancy. When the result of FNA is suspicious for malignancy, IOFS is restrictively useful for excluding benign nodules using the features of ultrasound. In addition, IOFS is not useful in finding malignant thyroid nodules when the result of FNA is follicular neoplasm.

    Keywords
    Fine needle aspiration; Intraoperative frozen section; Thyroidectomy; Accuracy

    Figures

    Fig. 1
    Flow chart for the diagnosis of a single thyroid nodule. Suspicious features include hypoechoic, heterogeneity, ill-defined margin, microcalcification, taller-than-wide and solid, FNA = fine needle aspiration; IOFS = intraoperative frozen section; US = ultrasound.

    Tables

    Table 1
    Clinicopathological characteristics of patients who underwent operation for a single thyroid nodule

    Table 2
    Final histologic diagnosis

    Table 3
    Final result of fine needle aspiration, frozen section and histologic findings

    Table 4
    Correlation of fine needle aspiration and frozen section with final histologic findings

    Table 5
    Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of fine needle aspiration and intraoperative frozen section for a single malignant thyroid nodule

    Table 6
    Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and odd ratio of ultrasound findings of suspicious malignant nodules by FNA for a single thyroid nodule

    Notes

    All funding sources and support for the research from Gangdong Kyung Hee University Hospital.

    References

      1. LiVolsi VA, Baloch ZW. Use and abuse of frozen section in the diagnosis of follicular thyroid lesions. Endocr Pathol 2005;16:285–293.
      1. Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. The bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658–665.
      1. Duek SD, Goldenberg D, Linn S, Krausz MM, Hershko DD. The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules. Surg Today 2002;32:857–861.
      1. Kahmke R, Lee WT, Puscas L, Scher RL, Shealy MJ, Burch WM, et al. Utility of intraoperative frozen sections during thyroid surgery. Int J Otolaryngol 2013;2013:496138.
      1. Gibb GK, Pasieka JL. Assessing the need for frozen sections: still a valuable tool in thyroid surgery. Surgery 1995;118:1005–1009.
      1. Peng Y, Wang HH. A meta-analysis of comparing fine-needle aspiration and frozen section for evaluating thyroid nodules. Diagn Cytopathol 2008;36:916–920.
      1. Wong CK, Wheeler MH. Thyroid nodules: rational management. World J Surg 2000;24:934–941.
      1. Chang HY, Lin JD, Chen JF, Huang BY, Hsueh C, Jeng LB, et al. Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol 1997;50:1005–1009.
      1. Lee YD, Cho HJ. The role of fine-needle aspiration cytology and frozen section in the operative management of thyroid nodule. Korean J Endocr Surg 2001;1:78–83.
      1. Kesmodel SB, Terhune KP, Canter RJ, Mandel SJ, LiVolsi VA, Baloch ZW, et al. The diagnostic dilemma of follicular variant of papillary thyroid carcinoma. Surgery 2003;134:1005–1012.
      1. McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A. Follicular or Hürthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surgery 1999;126:798–802.
      1. Chen H, Nicol TL, Udelsman R. Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Ann Surg 1995;222:101–106.
      1. Boyd LA, Earnhardt RC, Dunn JT, Frierson HF, Hanks JB. Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules. J Am Coll Surg 1998;187:494–502.
      1. Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M, et al. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol 2013;2013:126084.
      1. Siddiqui MA, Griffith KA, Michael CW, Pu RT. Nodule heterogeneity as shown by size differences between the targeted nodule and the tumor in thyroidectomy specimen: a cause for a false-negative diagnosis of papillary thyroid carcinoma on fine-needle aspiration. Cancer 2008;114:27–33.
      1. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery 2007;142:837–844.
      1. Degirmenci B, Haktanir A, Albayrak R, Acar M, Sahin DA, Sahin O, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytologicalmaterial. Clin Radiol 2007;62:798–803.
      1. Yoon JH, Kwak JY, Moon HJ, Kim MJ, Kim EK. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger. Thyroid 2011;21:993–1000.
      1. Cappelli C, Castellano M, Pirola I, Cumetti D, Agosti B, Gandossi E, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM 2007;100:29–35.
      1. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006;91:3411–3417.
      1. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87:1941–1946.
    MeSH Terms
    Biopsy, Fine-Needle*
    Frozen Sections*
    Humans
    Retrospective Studies
    Sensitivity and Specificity
    Thyroid Gland*
    Thyroid Nodule*
    Thyroidectomy
    Ultrasonography
    Metrics
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    Funding Information
    PERMALINK