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Intraoperative Frozen-Section Analysis for Thyroid NodulesA Step Toward Clarity or Confusion?
Gerhard F. Huber, MD;
Peter Dziegielewski, MD;
T. Wayne Matthews, MD;
S. Joseph Warshawski, MD;
Leanne M. Kmet, MSc;
Peter Faris, PhD;
Moosa Khalil, MD;
Joseph C. Dort, MD, MSc
Arch Otolaryngol Head Neck Surg. 2007;133(9):874-881.
Objectives To determine accuracy and intertest agreement of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen-section analysis (FS) findings in thyroid surgery, and to assess the influence of intraoperative FS findings on decision making and the utility of FS in thyroid surgery.
Design Retrospective analysis. The results of preoperative FNAC, intraoperative FS, and final histopathological analyses were taken from the histopathology reports. We calculated intertest agreement using the  statistic.
Patients Two-hundred fifteen patients who underwent primary thyroid surgery. All patients were treated by the same surgeon (S.J.W.).
Results T he sensitivity and specificity of FNAC were 57.4% and 91.7%, respectively. The sensitivity and specificity of FS were 32.4% and 96.5%, respectively. The intertest agreement was poor ( = 0.17). In case of malignant FNAC findings, the FS result did not influence treatment decisions; in case of a malignant FS result on the background of a benign, indeterminate, or nondiagnostic FNAC finding, the FS result influenced treatment decisions in 88% of cases.
Conclusions Intraoperative FS did not give additional information in cases where a malignant neoplasm was predicted by the FNAC finding. In this setting, it led to conflicting results and did not contribute to correct decision making.
Author Affiliations: Division of Otolaryngology–Head and Neck Surgery, Department of Surgery (Drs Huber, Dziegielewski, Matthews, Warshawski, and Dort), Center for Advancement of Health (Ms Kmet and Dr Faris); and Department of Pathology (Dr Khalil), Calgary Health Region, University of Calgary, Calgary, Alberta, Canada.
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