Is Frozen-Section Analysis During Thyroid Operation Useful in the Era of Molecular Testing? - 17/03/19

Doi : 10.1016/j.jamcollsurg.2018.12.002

Reema Mallick, MD ^a, Todd M. Stevens, MD ^b, Thomas S. Winokur, MD ^b, Ammar Asban, MD ^a, Thomas N. Wang, MD, FACS ^a, Brenessa M. Lindeman, MD, MEHP ^a, John R. Porterfield, MD, FACS ^a, Herbert Chen, MD, FACS ^a,^⁎
^a Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
^b Department of Pathology, University of Alabama at Birmingham, Birmingham, AL

^∗Correspondence address: Herbert Chen, MD, FACS, Department of Surgery, University of Alabama at Birmingham, 1808 7th Ave South, Suite 502, Boshell Diabetes Building, Birmingham, AL 35233.Department of SurgeryUniversity of Alabama at Birmingham1808 7th Ave SouthSuite 502Boshell Diabetes BuildingBirminghamAL35233

Abstract

Background

With the increased use of molecular testing of thyroid fine-needle biopsies, the frequency and extent of thyroid resection for thyroid nodules has changed. Although the role of frozen-section analysis of the thyroid has been reduced markedly in recent years, many surgeons still routinely use it intraoperatively. We sought to determine the utility of frozen section during thyroidectomy in the era of molecular testing.

Study Design

We reviewed 236 consecutive patients who had thyroidectomy with intraoperative frozen-section analysis at our institution between November 2015 and October 2017. We re-reviewed the preoperative diagnosis, frozen-section diagnosis, final pathology, and whether operative management changed from the initial plan based on frozen section.

Results

Mean age of the patients was 55.6 ± 14.1 years, and 83% were female. Of the 236 patients, frozen section did not change the intraoperative management in 225 (95%). Of the 11 patients whose thyroid operation was modified, the operation was either too much or not enough in 6 patients. In only 5 (2.1%) patients, frozen-section analysis correctly changed the extent of thyroidectomy.

Conclusions

Thyroid frozen-section analysis adds cost and time to thyroid operations without notable benefit. In our cohort, only 2.1% of frozen sections accurately changed intraoperative management. We recommend against its routine use.

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