Does frozen section alter surgical management of multinodular thyroid disease?

Abstract

Background: Frozen section (FS) evaluation during thyroid surgery is often utilized to guide intraoperative management. For instance, a previously unrecognized thyroid cancer diagnosed by FS analysis allows an initial definitive operation and reduces the need for re-operation. We sought to determine the utility of FS in patients undergoing thyroidectomy for multinodular thyroid disease. Methods: From May 1994 through November 2004, 236 patients with multinodular goiter underwent thyroidectomy at our institution. Patient data were retrospectively analyzed to see if a frozen section was performed during the procedure and whether it affected the outcome. Results: Of the 236 patients, 135 (57%) had intra-operative FS. There were no differences between patients who had FS analysis and those who did not with regard to age, gender, and the incidence of malignancy. Of the patients who had FS, 4/135 (3%) were subsequently diagnosed with thyroid cancer on permanent histology. Three of these FS were misread as benign. Therefore, the sensitivity of FS for the diagnosis of thyroid cancer was only 25%. Importantly, in none of the 135 patients did FS alter the intraoperative management. Conclusion: While FS was commonly utilized in patients undergoing thyroidectomy at our institution, in no patient over the last decade did FS correctly alter the intraoperative management. Given the time required to perform FS and the cost associated with it, we believe that routine FS should not be performed in these patients. Tabled 1 N Mean Age(yrs) Gender (%female) % Malignancy Frozen Section 135 50 ± 14 85% 3% No Frozen Section 101 53 ± 16 80% 8% p-value 0.133 0.312 0.086 Open table in a new tab