The ongoing debate in thyroid surgery: should frozen section analysis be omitted?

Area of Science:

• Surgical Pathology
• Oncology
• Diagnostic Cytology

Background:

• The utility of frozen section (FS) in intraoperative decision-making for thyroid nodules remains debated.
• Accurate intraoperative assessment is crucial for determining appropriate surgical management of thyroid malignancies.

Purpose of the Study:

• To evaluate the role of intraoperative frozen section (FS) analysis in guiding surgical decisions for thyroid cancer.
• To assess the diagnostic accuracy and cost-effectiveness of FS in detecting thyroid malignancies in Turkey.

Main Methods:

• Retrospective analysis of 178 patients who underwent surgery for thyroid cancer between January 1996 and August 2004.
• Intraoperative frozen section (FS) analysis was performed on all evaluated patients.
• Comparison of FS results with final histopathology and assessment of changes in surgical strategy.

Main Results:

• Intraoperative FS correctly identified malignancy in 58.4% of cases, altering surgical strategy in 27.6% of these.
• The sensitivity of FS (58.4%) was significantly higher than fine-needle aspiration biopsy (FNAB) (22.5%) for thyroid cancer.
• False negative FS results increased the cost per informative FS from €25 to €42.7.

Conclusions:

• Intraoperative frozen section (FS) plays a valuable role in the surgical assessment of thyroid nodules, enhancing diagnostic accuracy.
• Routine use of FS is recommended for operative assessment, with potential omission only if FNAB definitively indicates malignancy.
• Despite limitations, FS remains a relevant tool in managing thyroid cancer, contrary to suggestions of its diminishing role.