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Intraoperative frozen section performance for thyroid cancer diagnosis
Iuri Martin Goemann1,2, Francisco Paixão3, Alceu Migliavacca3
1Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Archives of Endocrinology and Metabolism
|March 9, 2022
Summary
Fine-needle aspiration biopsy (FNAB) and intraoperative frozen section (iFS) are compared for thyroid cancer diagnosis. Results show iFS is not reliable for indeterminate nodules, unlike FNAB.
Area of Science:
- Endocrinology
- Surgical Pathology
- Oncology
Background:
- Thyroid nodules require accurate diagnosis to exclude malignancy, which occurs in about 5% of cases.
- Fine-needle aspiration biopsy (FNAB) is a primary diagnostic tool for thyroid nodules.
- Intraoperative frozen section (iFS) is considered for surgical planning, particularly for indeterminate nodules.
Purpose of the Study:
- To compare the diagnostic performance of FNAB and iFS for thyroid cancer across Bethesda Categories (BC) I-VI.
- To evaluate the utility of iFS in guiding intraoperative management for different thyroid nodule classifications.
Main Methods:
- Retrospective analysis of 316 patients undergoing thyroid nodule evaluation.
- Comparison of FNAB and iFS diagnostic accuracy against final histopathology.
- Calculation of sensitivity, specificity, and accuracy for both methods across Bethesda Categories.
Main Results:
- The overall malignancy rate was 30.4%.
- FNAB demonstrated high accuracy for benign (BC II) and malignant (BC V, VI) nodules (89.5% sensitivity, 97.1% specificity).
- iFS showed lower sensitivity (25%) for indeterminate nodules (BC III, IV) but high specificity (100%).
Conclusions:
- Routine use of iFS for indeterminate thyroid nodules (BC III, IV) is not supported due to its low sensitivity.
- iFS accuracy is insufficient to guide intraoperative decisions for indeterminate nodules.
- Further investigation into the utility of iFS for BC I nodules is warranted.
