Intraoperative Thyroid Frozen Section Consultation: A Continued Quality Dilemma and Monitoring Need
Clifford R Blieden, Joseph Zeitouni, Vania Nose. University of Miami/Jackson Memorial Hospital, Miami, FL
Background: The use of frozen sections (FS) on the thyroid is controversial. Most of the FS on thyroid are non-contributory since fine needle aspiration biopsy usually guides surgical procedures. However, many surgeons continue to request thyroid intraoperative consultation. Our goal was to investigate the prevalence and value of FS on resected thyroids within our institution in patients who had already undergone fine needle aspiration (FNA) and to determine whether or not the use of FS provided any diagnostic or therapeutic value.
Design: We gathered the reports of all patients with thyroid FNA and subsequently resected thyroid over a 24 month period within two institutions of our service. Patients were separated into two groups; those whose surgeons requested FS and those who did not. Among these groups, patients were categorized by age, gender, cytology diagnosis, final diagnosis, and specialty of surgeon. Those receiving FS were assessed for major discordances. Major discordance was defined as an intraoperative diagnosis of a benign lesion with a final diagnosis of malignancy, or vice versa.
Results: 211 patients over a 24 month period received thyroid FNA and subsequent resections (171 female and 40 male patients). Mean age for both genders was 49 (range 16 to 84). Three types of surgeons were identified in the study; endocrine, otolaryngology, and general. There were 78 resected thyroid for which FS were performed; 16 had major FS discordances (20.5%). 16 of 16 discordances were diagnosed as benign on frozen section and were found to be malignant on permanent sections (14 papillary carcinoma; 2 follicular carcinoma). Of the cases with discordance, the cytology diagnosis were as follows: 8 benign, 5 suspicious, 2 malignant, and 1 indeterminate. All FS for which the pathologist made a diagnosis of malignancy maintained concordance on permanent sections. 92% of surgeons requesting FS were otolaryngologists, 4% were endocrine, and 4 % were general. Of the surgeons who did not request FS 35% were otolaryngologists, 28% were general, and 37% were endocrine.
Conclusions: Otolaryngologists were far more likely to request FS on thyroid specimens than other surgeons. FS on thyroid glands had an extremely high rate of discordance (20.5%). In all cases of discordance, the FS did not contribute to the final diagnosis or give any additional information as compared to the FNA. Our study serves as a reminder of the ineffectiveness of FS on thyroid. Ineffective FS leads to unnecessary allocation of valuable time and resources as well as increases operative time.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 246, Monday Afternoon