Utility of Intraoperative Frozen Sections during Thyroid Surgery.

Area of Science:

• Endocrinology
• Surgical Pathology
• Oncology

Background:

• Fine needle aspirate (FNA) biopsy is crucial for evaluating thyroid nodules.
• The Bethesda System for Reporting Thyroid Cytopathology classifies nodules, with follicular neoplasm requiring further diagnostic clarification.
• Intraoperative frozen section is sometimes used to aid surgical decision-making in these cases.

Purpose of the Study:

• To evaluate the diagnostic accuracy and clinical utility of intraoperative frozen section compared to FNA biopsy for thyroid nodules with follicular neoplasm.
• To determine if frozen section provides added benefit to FNA results in guiding surgical management.

Main Methods:

• Retrospective case series analysis of patients undergoing thyroid nodule surgery.
• Comparison of diagnostic performance (sensitivity, specificity, PPV, NPV) of FNA and intraoperative frozen section against final pathology.
• Assessment of changes in operative course based on frozen section results.

Main Results:

• Frozen section sensitivity was 76.9% and specificity 67.9%.
• Fine needle aspirate biopsy showed sensitivity of 53.8% and specificity of 74.1%.
• No modifications to the surgical plan occurred due to intraoperative frozen section findings.

Conclusions:

• Intraoperative frozen section does not offer significant added diagnostic or clinical benefit for thyroid nodules classified as follicular neoplasm by FNA.
• Current FNA results, within the Bethesda system, appear adequate for managing these thyroid nodules.
• Further investigation into optimizing diagnostic pathways for follicular neoplasms is warranted.