Updated: Jun 29, 2026

Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Robert Y Osamura1, Jennifer L Hunt
1Department of Pathology, Tokai University School of Medicine, Isehara City, Kanagawa, 259-1193, Japan. osamura@is.icc.u-tokai.ac.jp
Frozen sections are a type of intraoperative diagnostic test used in surgery. For thyroid surgery, their use has decreased because preoperative tests like fine needle aspiration have improved accuracy for common cancers like papillary carcinoma. Follicular tumors are also less suited for frozen sections due to diagnostic challenges. In contrast, frozen sections are more commonly used in parathyroid surgery, especially in dialysis patients who need tissue removal for hyperplasia. The review suggests that frozen sections should be used selectively based on preoperative findings and surgical needs. The authors do not claim frozen sections are obsolete but emphasize their appropriate use in specific situations.
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Area of Science:
Background:
The use of frozen sections in surgical pathology has evolved over time. Thyroid surgery has seen a shift in diagnostic approaches. Preoperative fine needle aspiration has improved accuracy for papillary carcinomas. This has reduced the need for intraoperative frozen sections. Some studies suggest frozen sections are less helpful for follicular tumors. Parathyroid surgery has different trends. Dialysis patients often require parathyroidectomies. These surgeries create a demand for frozen sections. The reasons for these changes remain under discussion.
Purpose Of The Study:
This review aims to summarize current practices in frozen sections for thyroid and parathyroid surgeries. It compares trends between these two areas. The study highlights factors influencing the use of frozen sections. One focus is the decline in thyroid frozen sections. Another is the rise in parathyroid frozen sections. The review considers diagnostic accuracy and surgical needs. It also addresses the role of preoperative testing. The goal is to clarify when frozen sections are most useful.
Thyroid frozen sections have declined due to improved preoperative fine needle aspiration for papillary carcinomas and the recognition of limitations in diagnosing follicular tumors.
Frozen sections in parathyroid surgery are used to confirm tissue removal for either cyropreservation or auto-transplantation, especially in dialysis patients.
Follicular tumors are less suitable for frozen sections because the technique has known diagnostic limitations for these types of thyroid lesions.
Frozen sections in thyroid surgery are influenced by preoperative fine needle aspiration results and the presence of atypical or suspicious cytology findings.
Main Methods:
The authors reviewed published literature on frozen section practices. They focused on thyroid and parathyroid surgeries. Data were collected from multiple countries, including Japan. The review considered trends over the past decade. It analyzed reasons for changes in frozen section use. Diagnostic accuracy of fine needle aspiration was a key factor. The impact of follicular tumor diagnosis was also assessed. The role of parathyroidectomies in dialysis patients was examined.
Main Results:
Thyroid frozen sections have declined significantly in recent years. This is linked to improved preoperative fine needle aspiration results. Papillary carcinoma diagnosis is now more accurate before surgery. Follicular tumors are less suited for frozen sections due to diagnostic limitations. Some experts suggest limiting frozen sections to atypical or suspicious cases. Parathyroid frozen sections have increased in frequency. This is due to the rise in parathyroidectomies for dialysis patients. Frozen sections help confirm tissue removal for cyropreservation or auto-transplantation.
Conclusions:
Frozen sections are now used selectively in thyroid and parathyroid surgeries. Thyroid frozen sections are reserved for uncertain preoperative cases. Parathyroid frozen sections are more common due to surgical needs. The review supports limiting frozen sections to specific situations. Diagnostic accuracy and surgical goals influence this decision. The authors stress the importance of context in frozen section use. They do not claim frozen sections are unnecessary. Instead, they emphasize appropriate application based on evidence.
Dialysis patients often require parathyroidectomies for secondary hyperplasia, increasing the need for frozen sections to confirm tissue removal.
The authors conclude that frozen sections should be restricted to selected cases where they provide diagnostic or surgical value.