Intraoperative Frozen Section May Reduce the Need for Reoperative Thyroid Surgery in Patients with Follicular Neoplasm (original) (raw)
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The value of frozen section in intraoperative surgical management of thyroid follicular carcinoma
Head & Neck, 2003
Background. Preoperative and intraoperative diagnosis of follicular carcinoma (FC), resulting in one-stage surgical treatment of follicular thyroid tumors, is an important issue in thyroid surgery. Methods. In the 10-year period there were 4158 operations performed on thyroid gland. There were 1559 patients with follicular tumors, 70 (4.4%) of them having FC. We analyzed the groups of patients with FC determined on frozen section (FS) and permanent section (PS) according to duration of clinical symptoms, ultrasound (US) examination, tumor size, patient gender and age, intensity of invasion, localization, and multiple or solitary occurrence of tumor. Results. FC was diagnosed in 39 (55.7%) patients on frozen section (FS). Among the encapsulated (minimal invasion) carcinomas, the FS was accurate in 19 of 33 (57.6%) FC and in 5 of 15 (27.8%) Hü rthle cell carcinomas (HCC); among extensively invasive carcinoma in 11 of 14 (78.6%) FC and in 4 of 5 (80.0%) HCC. FC was significantly more common in men (p < .001) and in the right lobe (p < .05). We did not find statistically significant differences concerning duration of symptoms, US examination, tumor size, patient age, and multiple or solitary occurrence of the tumor between the patients with FC diagnosed on FS and the patients with FC diagnosed on PS. Conclusions. The intraoperative diagnosis of FC is difficult. Although the percentage of false-negative results was relatively high (44.3%), there were no false-positive results. This means that the second operation was avoided in 55.7% of the patients, and no unnecessary thyroidectomies were performed. FS biopsy is an important method in surgery of follicular tumors. Improved technical support and the ability to analyze a greater number of slides will increase the accuracy of the method.
International Journal of Surgery, 2014
The most appropriate surgical management of "follicular neoplasm/suspicious for follicular neoplasm" lesions, is still controversial. Analysing and comparing the experience of two units for endocrine surgery, we retrospectively evaluated 721 patients, surgically treated after a follicular neoplasm diagnosis. Total thyroidectomy was routinely performed in one Institution, while in the other one it was selectively carried out. The main criteria leading to hemythyroidectomy were a single nodule, the age 45 years, the absence of thyroiditis or clinical/intraoperative suspicion of malignancy.
Surgery, 2008
Background. Histopathologic criterion for follicular variant of papillary thyroid cancer (FVPTC) has only recently been utilized universally. The purpose was to determine whether, on review, these criteria would result in a change in diagnosis of follicular neoplasm (FN). Methods. A ten-year clinical cohort included patients with a diagnosis of a follicular adenoma, follicular carcinoma (FC), or FVPTC. The archived sections were re-examined by two pathologists blinded to the original diagnoses. Clinical follow-up, including ultrasonography, was carried out on all patients with a change in diagnosis. Results. One hundred eighty-five patients met the inclusion criteria. Initially, 118 were benign, 56 were FVPTC, and 11 were FC. Overall, 46 (25%) patients had a change in diagnosis on re-review; 35 were reclassified from a benign diagnosis to a re-reviewed malignant diagnosis, with 5 reclassified as minimally invasive FC, 4 as occult PTC, and 26 (74%) as FVPTC. Of the 26 FVPTC, only 10 (38%) had undergone a total thyroidectomy (TT). The mean follow-up was 105 months (range, 24-156). None of these patients had evidence of recurrent or persistent disease. Eleven patients were reclassified to a benign diagnosis. Eight have undergone a TT, with 3 of these patients receiving I 131 ablation therapy. A third independent thyroid pathologist also reviewed the histopathologic slides of these 46 patients and concurred with the change in diagnosis in 41 of the 46 patients. Conclusions. Reclassification of FN increased malignant lesions from 36% to 48%. Although there have been no clinical ramifications in the patients with a changed diagnosis, the ethical issues surrounding these 46 patients are important and present a substantive quandary to the clinicians responsible for their care. (Surgery 2008;144:80-5.) From the
Utility of Routine Frozen Section of Thyroid Nodules Classified as Follicular Neoplasm
American Journal of Clinical Pathology, 2019
Objectives: To evaluate the diagnostic performance of frozen section in thyroid nodules classified as follicular neoplasm. Methods: A diagnostic test meta-analysis was designed. Studies that assessed frozen section in patients with thyroid nodules and a fine-needle aspiration biopsy result of Bethesda IV were selected. The outcomes measured were the number of false-and true-positive and-negative results. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) instrument for methodological quality assessment and a bivariate mixedeffects regression framework and a likelihood-based estimation of the exact binomial approach. Results: Forty-six studies from 1991 to 2018 were included. Most studies had moderate methodological quality. The overall sensitivity and specificity were 43% (95% confidence internal [CI], 0.34-0.53) and 100% (95% CI, 0.99-1.00), respectively. The hierarchic summary receiver operating characteristic curve showed an area under the curve of 0.91 (95% CI, 0.80-0.97). Conclusions: Frozen section demonstrates moderate diagnostic performance in patients with follicular neoplasm, and its utility for making intraoperative decisions is limited. Its routine use should be discouraged.
International Surgery Journal
Background: The optimal management of cytologically indeterminate thyroid nodules in follicular neoplasm is controversial. We examined the prevalence of malignancy within cytologically indeterminate follicular thyroid lesions in an attempt to predict malignancy based on clinical, sonographic and cytologic features.Methods: Retrospective study was done in between April 2017 to July 2019 of 46 patients having a diagnosis of follicular neoplasm on fine needle aspiration cytology.Results: A total of 46 patients (8 men, 38 women; mean age 47 year) with indeterminate cytology underwent thyroidectomy and had histopathological diagnoses. The prevalence of malignancy in patients was 34.7%. The size of nodules and ultrasonographic feature were significant predictor of malignancy with p value <0.05.Conclusions: Author can predict malignancy in follicular neoplasm of thyroid with indeterminate nodule by using clinical and sonographic feature for the best compromise between the risk of missing...
Annals of Surgical Oncology, 2009
Background. Subclassifying indeterminate thyroid fineneedle aspiration (FNA) biopsy findings as follicular lesion or follicular neoplasm has been suggested as useful in triaging patients to observation or surgery, respectively. However, terminology and therefore the probability of malignancy vary between pathologists and institutions. The purpose of this study was to evaluate a single institution's experience with indeterminate thyroid FNA results to determine if subclassification (neoplasm versus lesion) aids in identifying patients at higher risk for malignancy. Methods. From 1990 to 2006, all patients with indeterminate thyroid FNA results (follicular lesion or neoplasm) at The University of Texas M.D. Anderson Cancer Center were evaluated for FNA correlation with the surgical specimen diagnosis. Patients with FNAs suspicious for papillary thyroid carcinoma or with definitive malignant disease (i.e., metastases) were excluded. Results. Indeterminate FNA results were present in 540 patients, including 410 as follicular lesion and 130 as follicular neoplasm. Two hundred ninety-seven (55.0%) patients underwent surgical resection: 199 (48.5%) follicular lesions and 98 (75.4%) follicular neoplasms. Incidence of malignancy was higher in thyroid nodules classified as neoplasm compared with lesion (21.4% versus 7.0%, respectively; P = 0.0005) and increased in follicular neoplasms with nodule size (37.5% malignant if nodule was [4 cm, P = 0.03).
Diagnostic Cytopathology, 2009
We performed a retrospective analysis of follicular neoplasm data obtained from frozen section examinations of thyroid nodules. A total of 5,660 patients underwent preoperative neck ultrasonography and fine-needle aspiration cytology (FNAC), surgical treatment, and follow-up at a medical institute. Patients with papillary thyroid microcarcinoma were excluded from this study. In 971 cases, frozen section examination was performed during the surgical treatment of follicular neoplasm that was diagnosed via FNAC. Thyroid malignancies were histologically confirmed in 25.1% of cases (244/971). Among the patients with papillary thyroid carcinoma, 45 were diagnosed with the follicular variant of papillary thyroid carcinomas (27.4%). The diagnostic sensitivity of frozen section for the nonfollicular variant of papillary thyroid carcinoma was better than that for the follicular variant of papillary thyroid carcinoma (89.1% versus 78.9%; P ¼ 0.1023). For 12 cases the diagnosis was atypical follicular adenomas. The diagnostic accuracy of frozen section in cases of follicular neoplasm was 76.9% with a sensitivity of 84.8% and a specificity of 98.9%. In conclusion, our analysis revealed high rates of accuracy when using frozen tissue sections for early diagnosis and treatment of follicular neoplasm; thus, an early decision to extent of surgery prevents a risky follow-up surgery.
Diagnostic Cytopathology, 2010
State of the Science Conference on thyroid fine-needle aspiration (FNA) proposed that follicular patterned lesions can be divided into two diagnostic categories; follicular lesion of undetermined significance/Atypia of undetermined significance (FLUS/AUS) and suspicious for follicular neoplasm/follicular neoplasm (SFON/FON). The former group can benefit from repeat FNA (RFNA) to achieve a more definitive diagnosis and the latter should undergo surgical excision for histologic characterization (adenoma vs. carcinoma). In this study, we report the combined experience from our institutions with thyroid FNA cases that can be placed into NCI-designated thyroid FNA diagnostic categories for follicular patterned lesions.
Revista Española de Patología, 2023
Purpose. To investigate the impact of the nomenclature change to ''noninvasive follicular thyroid neoplasm with papillary-like nuclear features'' (NIFTP) on reported malignancy rates following thyroidectomy. Methods. Retrospective cohort study of patients with thyroid nodules sampled preoperatively with fine-needle aspiration (FNA) and subsequently removed at one tertiarycare hospital from 4/2016 to 2/2017. Surgical procedure, anatomic pathology, thyroid cytopathology classification, and demographic characteristics were recorded. Results. Thyroidectomy was performed in 353 patients. Twenty-six patients (7.3%) had NIFTP on anatomic pathology. Preoperative FNA demonstrated atypia of undetermined significance (AUS/Bethesda III) in 13 (50%), suspicious for malignancy (SUS/Bethesda V) in 6 (23%), suspicious for follicular neoplasm (SFN/Bethesda IV) in 4 (15%), benign/Bethesda I in 2 (8%), and malignant/Bethesda VI in 1 (4%). Invasive malignancy rates across cytologic categories changed as follows: benign (n = 74) from 4 to 1%, AUS (n = 85) from 33 to 18% (p \ 0.05), SFN (n = 58) from 29 to 22%, SUS (n = 33) from 91 to 73% (p \ 0.05), and malignant (n = 99) from 99 to 98%. Overall decrease in invasive malignancy was 7.3% for the entire population and 13.1% for indeterminate preoperative FNA cytology (Bethesda III-V). Among 26 NIFTP patients, 17 had thyroid lobectomy (TL) and 9