Related Experiment Video
Updated: Jun 24, 2025
08:06
Mixed Reality Assisted Radical Endoscopic Thyroidectomy
Published on: January 31, 2025
234
Intraoperative thyroid frozen section: indications, results and consequences.
Jesper Gern1,2,3, Michael Arbogast1,2,3, Hakan Alakus1,3
1Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, Cologne, Germany.
Gland Surgery
|June 7, 2024
Summary
Frozen section (FS) analysis in secondary care has 75% sensitivity for thyroid cancer, with missed diagnoses often being follicular variant papillary thyroid carcinoma. Omitting FS in specific cases may improve accuracy.
Area of Science:
- Pathology
- Surgical Oncology
- Diagnostic Accuracy
Background:
- Frozen section (FS) analysis is crucial in surgical pathology.
- Its performance is heavily dependent on the expertise of surgeons and pathologists.
- This study evaluates FS performance in a secondary care setting with transferred expertise.
Purpose of the Study:
- To assess the diagnostic accuracy and performance of frozen section (FS) analysis for thyroid procedures in a secondary care hospital.
- To identify factors influencing FS accuracy, particularly in the context of transferred expertise from a university hospital.
Main Methods:
- A retrospective review of all thyroid FS procedures performed between January 1, 2021, and December 31, 2022.
- Analysis of indications, intraoperative results, and final histology for all FS cases.
- Calculation of FS sensitivity, specificity, and identification of factors affecting diagnostic accuracy.
Main Results:
- FS was performed in 90 (26.5%) of 340 thyroid procedures.
- Malignancy was diagnosed in 21 (23.3%) FS cases, with 100% confirmation by final histology.
- Overall FS sensitivity was 75%, with 25% of thyroid carcinomas missed, predominantly follicular variant papillary thyroid carcinoma (fvPTC).
- Lowest sensitivity was observed in MIBI-retaining hypofunctional nodules (33%) and Bethesda III cases (50%).
- Two-stage surgeries were required in 15.8% of confirmed carcinomas.
Conclusions:
- The sensitivity of FS for thyroid malignancy in a secondary care setting with transferred expertise is 75%.
- The prevalence of fvPTC significantly impacts FS accuracy.
- Consideration should be given to omitting FS in Bethesda III and MIBI-positive hypofunctional nodules to potentially enhance overall diagnostic performance.
