Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Jeong Yoon Song; Sang Ah Han; Jae Hoon Jang; Jun Woo Bong

doi:10.16956/kjes.2015.15.4.79

Journal List > Korean J Endocr Surg > v.15(4) > 1060151

Go to TopGo to Top Go to BottomGo to Bottom

This article has been corrected. See "Erratum: Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?" in Volume 16 on page 56.

TOOLS

Song, Han, Jang, and Bong: Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Original Article

Korean Journal of Endocrine Surgery 2015; 15(4): 79-85.

Published online: 17 December 2015

DOI: https://doi.org/10.16956/kjes.2015.15.4.79

Can We Omit Intraoperative Frozen Section According to the Result of the Preoperative Fine-needle Aspiration Cytology of a Thyroid Nodule?

Jeong Yoon Song, Sang Ah Han, Jae Hoon Jang, Jun Woo Bong

Department of Surgery at Gangdong Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.

Correspondence: Jun Woo Bong. Department of Surgery at Gangdong Kyung Hee University Hospital, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea. Tel: +82-2-440-7000, Fax: +82-2-440-8197, zest815@gmail.com

Received 16 November 2015 Revised 24 November 2015 Accepted 2 December 2015

(open-access):

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Fine needle aspiration (FNA) is a useful preoperative diagnostic tool for thyroid nodule because of the high sensitivity and specificity. The aim of this study is to determine the necessity of intraoperative frozen section (IOFS) after fine needle aspiration.

Methods

Data of 534 patients with a single thyroid nodule who underwent thyroidectomy from June 2006 to August 2013 were reviewed retrospectively. FNA was performed preoperatively in all patients and IOFS was performed selectively according to the intraoperative findings and FNA results. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNA and IOFS for malignant nodules were analyzed.

Results

The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNA for malignant nodules were 100%, 95.5%, 99.8%, 100%, and 99.8%, respectively. All nodules diagnosed as benign by FNA were reaffirmed as benign nodules by permanent sections. When the result of FNA was suspicious for malignancy, specific features of preoperative ultrasound, including hypoechoic, size<10 mm showed high positive predictive value and accuracy (98%, 86.9%, and 100%, 78.7% respectively).

Conclusion

Performance of IOFS was not necessary when the result of FNA was consistent with malignancy or benign. However when the result of FNA was non-diagnostic or atypia, IOFS should be performed for more accurate detection of malignancy. When the result of FNA is suspicious for malignancy, IOFS is restrictively useful for excluding benign nodules using the features of ultrasound. In addition, IOFS is not useful in finding malignant thyroid nodules when the result of FNA is follicular neoplasm.

Keywords: Fine needle aspiration, Intraoperative frozen section, Thyroidectomy, Accuracy

Figures and Tables

Fig. 1

Flow chart for the diagnosis of a single thyroid nodule. Suspicious features include hypoechoic, heterogeneity, ill-defined margin, microcalcification, taller-than-wide and solid, FNA = fine needle aspiration; IOFS = intraoperative frozen section; US = ultrasound.

Table 1

Clinicopathological characteristics of patients who underwent operation for a single thyroid nodule

Table 2

Final histologic diagnosis

Table 3

Final result of fine needle aspiration, frozen section and histologic findings

FNA = fine needle aspiration; IOFS = intraoperative frozen section.

Table 4

Correlation of fine needle aspiration and frozen section with final histologic findings

NH = Nodular hyperplasia; FC = Follicular carcinoma; FA = follicular adenoma; PTC = Papillary thyroid carcinoma; UC = undifferentiated carcinoma; FNA = fine needle aspiration; IOFS = intraoperative frozen section. ^*Other benign includes Chronic lymphocytic thyroiditis with oncocytic cells, granulomatous thyroiditis, fibroinflammatory lesion, lymphocytic thyroiditis, hyalinizing trabecular tumor.

Table 5

Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of fine needle aspiration and intraoperative frozen section for a single malignant thyroid nodule

Positive results include cases diagnosed as malignant by FNA or IOFS and negative results include cases diagnosed as benign by FNA or IOFS. FNA = fine needle aspiration; IOFS = intraoperative frozen section.

Table 6

Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and odd ratio of ultrasound findings of suspicious malignant nodules by FNA for a single thyroid nodule

PPV = positive predictive value; NPV = negative predictive value; FNA = fine needle aspiration; IOFS = intraoperative frozen section. Positive results include cases diagnosed as malignant by FNA or IOFS and negative results include cases diagnosed as benign by FNA or IOFS.

Notes

All funding sources and support for the research from Gangdong Kyung Hee University Hospital.

References

1. LiVolsi VA, Baloch ZW. Use and abuse of frozen section in the diagnosis of follicular thyroid lesions. Endocr Pathol. 2005; 16:285–293.

2. Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. The bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009; 132:658–665.

3. Duek SD, Goldenberg D, Linn S, Krausz MM, Hershko DD. The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules. Surg Today. 2002; 32:857–861.

4. Kahmke R, Lee WT, Puscas L, Scher RL, Shealy MJ, Burch WM, et al. Utility of intraoperative frozen sections during thyroid surgery. Int J Otolaryngol. 2013; 2013:496138.

5. Gibb GK, Pasieka JL. Assessing the need for frozen sections: still a valuable tool in thyroid surgery. Surgery. 1995; 118:1005–1009.

6. Peng Y, Wang HH. A meta-analysis of comparing fine-needle aspiration and frozen section for evaluating thyroid nodules. Diagn Cytopathol. 2008; 36:916–920.

7. Wong CK, Wheeler MH. Thyroid nodules: rational management. World J Surg. 2000; 24:934–941.

8. Chang HY, Lin JD, Chen JF, Huang BY, Hsueh C, Jeng LB, et al. Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol. 1997; 50:1005–1009.

9. Lee YD, Cho HJ. The role of fine-needle aspiration cytology and frozen section in the operative management of thyroid nodule. Korean J Endocr Surg. 2001; 1:78–83.

10. Kesmodel SB, Terhune KP, Canter RJ, Mandel SJ, LiVolsi VA, Baloch ZW, et al. The diagnostic dilemma of follicular variant of papillary thyroid carcinoma. Surgery. 2003; 134:1005–1012.

11. McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A. Follicular or Hürthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surgery. 1999; 126:798–802.

12. Chen H, Nicol TL, Udelsman R. Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Ann Surg. 1995; 222:101–106.

13. Boyd LA, Earnhardt RC, Dunn JT, Frierson HF, Hanks JB. Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules. J Am Coll Surg. 1998; 187:494–502.

14. Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M, et al. Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. Int J Endocrinol. 2013; 2013:126084.

15. Siddiqui MA, Griffith KA, Michael CW, Pu RT. Nodule heterogeneity as shown by size differences between the targeted nodule and the tumor in thyroidectomy specimen: a cause for a false-negative diagnosis of papillary thyroid carcinoma on fine-needle aspiration. Cancer. 2008; 114:27–33.

16. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007; 142:837–844.

17. Degirmenci B, Haktanir A, Albayrak R, Acar M, Sahin DA, Sahin O, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytologicalmaterial. Clin Radiol. 2007; 62:798–803.

18. Yoon JH, Kwak JY, Moon HJ, Kim MJ, Kim EK. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger. Thyroid. 2011; 21:993–1000.

19. Cappelli C, Castellano M, Pirola I, Cumetti D, Agosti B, Gandossi E, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM. 2007; 100:29–35.

20. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 2006; 91:3411–3417.

21. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002; 87:1941–1946.

TOOLS

Similar articles