Role of fine-needle aspiration biopsy and frozen section analysis in the surgical management of thyroid tumors Journal Article

Authors: Brooks, A. D.; Shaha, A. R.; Dumornay, W.; Huvos, A. G.; Zakowski, M.; Brennan, M. F.; Shah, J.
Article Title: Role of fine-needle aspiration biopsy and frozen section analysis in the surgical management of thyroid tumors
Abstract: Introduction: The role of fine-needle aspiration (FNA) and frozen section (FS) in the management of thyroid neoplasms continues to generate considerable controversy. We reviewed our recent experience to determine the clinical utility of FNA and FS in our surgical management and intraoperative decision-making. Methods: All patients who had operations for thyroid disease between January 1996 and June 1999 were identified in our prospective database. Completion and incidental thyroidectomies were excluded. Data obtained from the pathology files included FNA, FS, and the final histologic diagnosis. Results: Five hundred sixty-four patients, including 409 women (73%), with a median age of 50 years (range, 6-94) were identified, of whom 293 (52%) had cancer diagnosed on permanent sections. Three hundred twenty-nine patients (58%) had evaluable FNA, of which 91 (28%) were benign, 94 were malignant (28%), and 144 (44%) were suspicious (46% of these were malignant on final). Frozen section was performed in 397 (70%) patients; of these samples, 170 (43%) were found to be benign, 106 (27%) were malignant, and 121 (30%) were deferred (46% malignant on final). Fine-needle aspiration positively identified 51% of confirmed malignancies; 13% of patients with malignancy had a benign FNA result. Total thyroidectomy was performed in 64% of malignant tumors and 29% of benign thyroid disease (P < .001). Logistic regression revealed no association of extent of surgery with FNA results. A frozen section positive for malignancy was associated with total thyroidectomy (P < .001, RR 6 [CI 3-10]), and a negative frozen section report was associated with lobectomy (P < .05, RR 0.5 [CI 0.3-0.96]). Frozen sections results altered the preoperative plan in only 29 patients (5%). Conclusion: Results of preoperative FNA had no direct impact on the selection of the surgical procedure in this selected cohort. Intraoperative FS added very little to surgical management. The majority of thyroid operations at this institution are planned and performed based on known prognostic factors and intraoperative findings.
Keywords: neoplasms; cytology; diagnosis; needle biopsy; prognostic factors; thyroid neoplasms; papillary carcinoma; frozen section; thyroid surgery; nodules; pathological; completion thyroidectomy; risk group; cancer; operative management
Journal Title: Annals of Surgical Oncology
Volume: 8
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2001-03-01
Start Page: 92
End Page: 100
Language: English
ACCESSION: WOS:000167344700003
DOI: 10.1245/aso.2001.8.2.92
PUBMED: 11258788
Notes: Article; Proceedings Paper -- Presented at 53rd SSO Annual Cancer Symposium (2000) -- 2000 Mar 16-19 -- New Orleans, LA -- Source: Wos
Citation Impact
MSK Authors
  1. Murray F Brennan
    924 Brennan
  2. Ashok R Shaha
    580 Shaha
  3. Ari D Brooks
    25 Brooks
  4. Maureen F Zakowski
    287 Zakowski
  5. Jatin P Shah
    611 Shah
  6. Andrew G Huvos
    257 Huvos