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P157 Intraoperative Frozen Section Analysis for Follicular Neoplasm of the Thyroid: Is It Worth the Effort?

P157 Intraoperative Frozen Section Analysis for Follicular Neoplasm of the Thyroid: Is It Worth... Objective: The utility of frozen section analysis for follicular thyroid neoplasms has been debated in the literature and a broad range of sensitivities are reported for frozen section diagnosis of follicular malignancy (40%-78%). In this study, we review our experience with intra-operative frozen section analysis to determine the utility of this diagnostic tool for follicular neoplasms. Design: A retrospective review. Setting: Two University of Louisville–affiliated hospitals. Patients: A total of 294 patients who underwent thyroid surgery with intraoperative frozen section analysis for follicular neoplasms between 1993 and 2003. Intervention: Thyroid surgery with intraoperative frozen section analysis. Results: Follicular and/or Hürthle cell carcinoma was identified in 19 (6%) of 294 patients on permanent section histologic tissue analysis. Of these 19 patients, 4 were diagnosed as having carcinoma on frozen section. The remaining 15 required more detailed analysis, including external review in 5 (26%). The sensitivity, specificity, positive predictive value, and accuracy of frozen section for identifying follicular and/or Hürthle cell carcinoma were 21.1%, 100%, 100%, and 82.1%, respectively. The probability of recognizing follicular and/or Hürthle cell carcinoma by frozen section analysis in this group of patients was 1% (4/294). Conclusions: Based on a low sensitivity of frozen section for follicular thyroid neoplasms and a very low probability of identifying follicular and/or Hürthle cell carcinoma on frozen section, this study indicated that the intraoperative decision process was enhanced in fewer than 1% to 2% of patients with suspected follicular thyroid neoplasms. The routine use of intraoperative frozen section histologic tissue analysis for follicular thyroid neoplasms should be limited to tertiary referral centers that can demonstrate by volume, experience, and quality parameters the value of this test in the intra-operative decision process. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

P157 Intraoperative Frozen Section Analysis for Follicular Neoplasm of the Thyroid: Is It Worth the Effort?

P157 Intraoperative Frozen Section Analysis for Follicular Neoplasm of the Thyroid: Is It Worth the Effort?

Abstract

Objective: The utility of frozen section analysis for follicular thyroid neoplasms has been debated in the literature and a broad range of sensitivities are reported for frozen section diagnosis of follicular malignancy (40%-78%). In this study, we review our experience with intra-operative frozen section analysis to determine the utility of this diagnostic tool for follicular neoplasms. Design: A retrospective review. Setting: Two University of Louisville–affiliated hospitals....
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.132.8.896-a
Publisher site
See Article on Publisher Site

Abstract

Objective: The utility of frozen section analysis for follicular thyroid neoplasms has been debated in the literature and a broad range of sensitivities are reported for frozen section diagnosis of follicular malignancy (40%-78%). In this study, we review our experience with intra-operative frozen section analysis to determine the utility of this diagnostic tool for follicular neoplasms. Design: A retrospective review. Setting: Two University of Louisville–affiliated hospitals. Patients: A total of 294 patients who underwent thyroid surgery with intraoperative frozen section analysis for follicular neoplasms between 1993 and 2003. Intervention: Thyroid surgery with intraoperative frozen section analysis. Results: Follicular and/or Hürthle cell carcinoma was identified in 19 (6%) of 294 patients on permanent section histologic tissue analysis. Of these 19 patients, 4 were diagnosed as having carcinoma on frozen section. The remaining 15 required more detailed analysis, including external review in 5 (26%). The sensitivity, specificity, positive predictive value, and accuracy of frozen section for identifying follicular and/or Hürthle cell carcinoma were 21.1%, 100%, 100%, and 82.1%, respectively. The probability of recognizing follicular and/or Hürthle cell carcinoma by frozen section analysis in this group of patients was 1% (4/294). Conclusions: Based on a low sensitivity of frozen section for follicular thyroid neoplasms and a very low probability of identifying follicular and/or Hürthle cell carcinoma on frozen section, this study indicated that the intraoperative decision process was enhanced in fewer than 1% to 2% of patients with suspected follicular thyroid neoplasms. The routine use of intraoperative frozen section histologic tissue analysis for follicular thyroid neoplasms should be limited to tertiary referral centers that can demonstrate by volume, experience, and quality parameters the value of this test in the intra-operative decision process.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Aug 1, 2006

Keywords: frozen sections,intraoperative care,thyroid

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