Role of frozen section analysis in nodular thyroid pathology

Area of Science:

• Surgical Pathology
• Cytopathology
• Oncology

Background:

• Traditionally, frozen section (FS) analysis guided surgical strategy for thyroid nodules.
• Fine-needle aspiration cytology (FNAC) has emerged as a standardized diagnostic tool, challenging the role of FS.
• The study evaluates the contemporary utility of FS compared to FNAC in surgical decision-making.

Purpose of the Study:

• To compare the diagnostic accuracy and impact on surgical strategy of frozen section (FS) analysis versus fine-needle aspiration cytology (FNAC) for thyroid nodules.
• To assess the specific contribution of FS in cases with indeterminate or non-diagnostic FNAC results.

Main Methods:

• A retrospective analysis of 1515 thyroid samples over six years.
• Comparison of FS and FNAC results in 252 patients who underwent both procedures.
• Evaluation of surgical decisions based on FS and FNAC findings, including sensitivity and specificity calculations.

Main Results:

• FS sensitivity was 75.36% and specificity 100%, while FNAC sensitivity was 31.88% and specificity 100%.
• FS influenced surgical indications in 13% of cases with initially non-malignant FNAC findings.
• In follicular lesions (Bethesda 3 and 4), FS modified strategy in 6.2% of cases, diagnosing 81.25% of cancers in Bethesda 5 and 69% in Bethesda 1 categories.

Conclusions:

• Despite lower sensitivity, FS remains valuable for optimizing surgical management in select thyroid nodule cases.
• Systematic FS implementation may be cost-effective, particularly for improving the interpretation of challenging FNAC results, especially in follicular lesions.
• FS enhances diagnostic certainty for difficult FNAC findings, supporting its continued role in surgical pathology.