 |
|
The Value of Frozen Section Examinations in Determining the Extent of Thyroid Surgery in Patients With Indeterminate Fine-Needle Aspiration Cytology
Jeffrey C. Roach, MD;
Keith S. Heller, MD;
Sanford Dubner, MD;
Laura A. Sznyter, MD
Arch Otolaryngol Head Neck Surg. 2002;128:263-267.
Objectives To determine the usefulness of intraoperative frozen section (FS) examinations
in establishing the diagnosis of thyroid cancer in patients undergoing thyroidectomy
for nodules with indeterminate cytological features and to determine the cost-effectiveness
of FS examinations in this situation.
Design Retrospective medical record review. The results of fine-needle aspiration
biopsies (FNABs), FS examinations, and final pathologic examinations are compared.
A cost-effectiveness analysis of routine FS examinations compared with the
cost of additional surgical procedures is performed.
Setting A private surgical practice in a medical school–affiliated teaching
hospital.
Patients The records of all 480 patients undergoing thyroidectomy between January
1, 1998, and September 30, 2000, were reviewed. All 199 patients with a dominant
thyroid nodule and FNAB results either highly suggestive of papillary cancer
or indeterminate were studied.
Results Of the patients with FNAB results highly suggestive of papillary cancer,
95% had cancer according to the final pathologic examination results. The
diagnosis of cancer was made by FS examination results in 67% of these patients.
Of the remaining 178 patients whose FNAB result was indeterminate, 64 (36%)
had thyroid cancer. Malignancy was diagnosed by FS examination results in
30 (47%) of these patients. If FS examinations had not been performed, these
30 patients would have required a second operation to complete a total thyroidectomy.
The cost savings of routine FS examinations in patients with indeterminate
FNAB results is $1298 per patient.
Conclusions The routine performance of FS examinations in patients with thyroid
nodules with indeterminate cytological features is a cost-effective way of
avoiding a second surgical procedure if a total thyroidectomy is indicated.
In patients with FNAB results highly suggestive of papillary cancer, FS examinations
are not useful. In these patients, the definitive operation can be based on
the results of the FNAB.
From the Head and Neck Services, Departments of Surgery and Otolaryngology,
Long Island Jewish Medical Center–Long Island Campus of the Albert Einstein
College of Medicine, New Hyde Park, NY.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Archives of Otolaryngology–Head & Neck Surgery Reader's Choice: Continuing Medical Education
Arch Otolaryngol Head Neck Surg. 2002;128(3):332-334.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Intraoperative Frozen-Section Analysis for Thyroid Nodules: A Step Toward Clarity or Confusion?
Huber et al.
Arch Otolaryngol Head Neck Surg 2007;133:874-881.
ABSTRACT
| FULL TEXT
|
