Does frozen section have a role in the intraoperative management of thyroid nodules?
Does frozen section have a role in the intraoperative management of thyroid nodules?
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DOI：
10.1046/j.1445-2197.2002.02474.x
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发表时间：
2002-08-01
影响因子：
1.7
通讯作者：
Serpell, JW
中科院分区：
文献类型：
--
作者：
Cheng, MSP;Morgan, JL;Serpell, JW
背景：甲状腺手术中的冰冻切片用于半甲状腺切除术时对甲状腺结节的恶性进行术中病理诊断。阳性诊断可以完成甲状腺切除术，从而避免再次手术。然而，细针抽吸细胞学在癌症的术前诊断中的应用导致冰冻切片缺乏明确的作用。方法：回顾1992年至2000年间由同一位内分泌医生行甲状腺切除术的所有患者。结果：共进行了209次冰冻切片，其中14 4例术前进行了细针吸取细胞学检查。冰冻切片报告135个良性结节，59个滤泡性肿瘤，5个可疑组织学标本和10个癌症。冰冻切片诊断甲状腺癌10例(灵敏度50%，特异度100%)，其中8例未明确诊断，2例良性病变。在144例细针抽吸细胞学检查中，7例可疑抽吸物冰冻切片发现2例癌，70例滤泡抽吸物冰冻切片确诊4例癌，术中中转全甲状腺切除术。7例恶性吸入物的冰冻切片证实有4例癌症，但由于冰冻切片报告不确定，导致3例再次手术。135例良性吸出物未发现癌。结论：良性吸出物冰冻切片不利于甲状腺结节的处理。细胞学证实的恶性甲状腺结节不需要进行手术。选择性使用冰冻切片补充了可疑或滤泡性病变的细针吸取细胞学检查结果，特别是在乳头状癌的亚组中，允许一期全甲状腺切除术。
Background: Frozen section in thyroid surgery is used to make an intraoperative pathological diagnosis of malignancy in a thyroid nodule at the time of hemithyroidectomy. A positive diagnosis allows completion of thyroidectomy, thus avoiding reoperation. However, the use of fine needle aspiration cytology in making a preoperative diagnosis of cancer has resulted in the lack of a defined role for frozen section. We examined the role of frozen section as an adjunct to fine needle aspiration cytology in determining which cytological subset will benefit from frozen section.Methods: All patients who underwent thyroidectomy between 1992 and 2000 by a single endocrine surgeon were reviewed.Results: Two hundred and nine frozen sections were performed, of which 144 underwent preoperative fine needle aspiration cytology. Frozen sections reported 135 benign nodules, 59 follicular neoplasms, five specimens with suspicious histology and 10 cancers. Ten out of 20 thyroid cancers were correctly identified by frozen section (sensitivity: 50%; specificity: 100%), eight cancers were reported on frozen section as indeterminate and two benign. Of 144 fine needle aspiration cytological procedures, frozen section on seven suspicious aspirates identified two cancers, and frozen section on 70 follicular aspirates identified four cancers, allowing intraoperative conversions to total thyroidectomy. Frozen section on seven malignant aspirates confirmed four cancers but resulted in reoperation for three because of the indeterminate frozen section reports. There were no cancers found on 135 benign aspirates.Conclusions: Frozen section on benign aspirates is unhelpful in the management of thyroid nodules. It need not be performed for cytologically proven malignant thyroid nodules. Selective use of frozen section complements fine needle aspiration cytology findings of suspicious or follicular lesions, especially in the subset with papillary cancer, allowing one-stage total thyroidectomy.