The utility of routine frozen section examination for intraoperative diagnosis of thyroid cancer

The value of routine frozen section examination for intraoperative diagnosis of thyroid cancer and determination of extent of thyroidectomy is controversial and needs to be evaluated on an institution to institution basis.

A prospective evaluation of 76 patients with nodular thyroid disease who had an adequate fine needle aspiration biopsy (FNAB) underwent thyroidectomy with routine thyroid frozen section examination. A direct comparison of FNAB and frozen section examination, along with a cost benefit analysis of frozen section examination, was completed.

The thyroid pathology was carcinoma in 24, follicular adenoma in 24, multinodular goiter in 24, thyroiditis in 3, and a cyst in 1 patient. The sensitivity, specificity, and accuracy of frozen section examination were 93%, 100%, and 97%, respectively, compared with 88%, 89%, and 91% for FNAB (P > 0.05). Diagnosis was deferred in 38 patients (50%) in whom frozen section examination showed a follicular neoplasm. One to 6 frozen section examinations were obtained per patient with alteration in intraoperative management in only 2 patients (3%) at a charge of $246 to $606 per patient and a total charge of $26,040.

In patients with an adequate FNAB, frozen section examination rarely affected intraoperative decision making in thyroid surgery and its routine use was not cost effective.