The Utility of Frozen Section in Surgical Management of Patients with Prior Indeterminate Thyroid FNA
Laura Nelsen, Melinda Lewis, George Birdsong, Talaat Tadros, Krisztina Hanley. Emory School of Medicine, Atlanta, GA
Background: Fine needle aspiration (FNA) is a safe and widely used diagnostic tool for evaluation of thyroid nodules, with a high accuracy in detection of papillary thyroid carcinoma (PTC). FNA results that fall into the atypical (Bethesda category III) or suspicious for PTC (Bethesda category V) remain a surgical dilemma. Intraoperative frozen section (FS) is often used to help guide the surgical choice of lobectomy vs total thyroidectomy. The accuracy of FS is limited due to sampling errors and freezing artifacts. We retrospectively reviewed cases of PTC diagnosed on thyroidectomy that had concurrent FS and FNA performed. Our goal was to assess the role of FS in patients with prior inconclusive or suspicious for PTC FNA diagnoses.
Design: We reviewed final surgical pathology (SP), FS and prior FNA results in cases diagnosed as PTC on resection specimens from 2008 to 2012. All FNA diagnoses were reclassified according The Bethesda System. Discrepancies in the SP, FS and FNA diagnoses were analyzed.
Results: 56 patients were included in the study.
|FS↓ \ FNA→||I Non-diagnostic||II. Benign||III. AUS||IV. Suspicious for FN||V. Suspicious for PTC||VI. Malignant||Total|