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Touch imprint and crash preparation intra operative cytology versus frozen section in thyroid nodule
Ali Chehrei1, Mojtaba Ahmadinejad, Sayyed Abbas Tabatabaee
1Department of Pathology, Thyroid Research Centre, Arak University of Medical Sciences, Arak, Iran.
Insights
Intraoperative cytology, including touch imprints and crash preparations, is a valuable diagnostic tool for thyroid nodules, especially when frozen sections are unavailable. Combining these methods with frozen sections enhances diagnostic accuracy.
Area of Science:
- Surgical Pathology
- Cytopathology
- Oncology
Background:
- Intraoperative cytology (IC) methods like touch imprints (TI) and crash preparations (CP) are debated for thyroid nodule diagnosis.
- The diagnostic accuracy of frozen section (FS), TI, CP, and their combinations for thyroid nodules requires further evaluation.
Purpose of the Study:
- To assess the diagnostic value of FS, TI, CP, and combined techniques for thyroid nodules.
- To compare the accuracy of different intraoperative diagnostic methods against permanent sections.
Main Methods:
- Evaluated 55 intraoperative thyroidectomy specimens.
- Obtained and reviewed FS, TI, and CP concurrently by two pathologists.
- Calculated sensitivity, specificity, PPV, NPV, and accuracy against gold standard permanent sections.
Main Results:
- Frozen section (FS) demonstrated high accuracy (98.1%), sensitivity (100%), and specificity (97.6%).
- Intraoperative cytology methods (TI and CP) showed varying accuracy, with combined FS, TI, and CP achieving 98.18% accuracy.
- Combined FS, TI, and CP yielded the highest diagnostic performance, matching FS alone.
Conclusions:
- Intraoperative cytology (TI and CP) is a valuable, cost-effective alternative where FS equipment is lacking.
- Combining intraoperative cytology with FS significantly improves diagnostic accuracy for thyroid nodules.
- Further research is recommended to validate these findings.
Background:
Intra operative cytology (IC), including touch imprint (TI) and crash preparations (CP), in general has been demonstrated to be a diagnostic tool for many organs but its validity and reliability for diagnosis of thyroid nodules remain controversial. We evaluate the diagnostic value of frozen section, touch imprint, crash preparation and the combination of touch imprint and crash preparation and the combination of frozen section, touch imprint and crash preparation.
Materials And Methods:
[corrected] 55 intra operative specimens from patients with thyroid nodules who underwent thyroidectomy were evaluated at Alzahra and vali-Asr hospital laboratories. For all of the patients frozen section (FS), touch imprint (TI) and crash preparation (CP) was obtained and reviewed by two pathologists at the same time. Serial TI and CP, and FS, TI and CP were reviewed by the same pathologists. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy were calculated according to the permanent section as the gold standard test.
Results:
In our study sensitivity, specificity and accuracy for FS was 100%, 97.6% and 98.1% respectively; for TI they were 78.6%, 95% and 92.4%; for CP they were 78.6%, 92.7% and 89.9%; for serial TI and CP they were 85.7%, 92.7% and 90.9%; and for the combination of FS and TI and CP they were 100%, 97.6% and 98.18% respectively.
Conclusions:
Intra operative cytology (including TI and CP) seems to be a useful, valuable and inexpensive method in clinics, which do not have equipment for frozen sections. Intra operative cytology combined with FS increased the overall accuracy of diagnosis. Further studies are needed to validate the obtained results of this study.
