Hemithyroidectomy on principle in cases of unclear fine needle biopsy and frozen section findings

Abstract

Fine needle aspiration biopsy (FNB) and frozen section (FS) may help to validate pre- and intraoperatively dignity of thyroid nodules. Credibility and clinical valuation of both methods have to be taken into consideration of surgical treatment. Between 7/96 and 6/00 82 patients were operated for thyroid lesions using both diagnostic methods to verify thyroid lesions. The sensitivity of both methods is low. With FNB only 5/11 malignancies (45.5 %) were recognized. Within the group of "suspicious" FNB findings (22/82; 26.8 %) definitive histology demonstrated another 6 carcinomas. Only 1 of these initially not recognized carcinomas was verified by FS intraoperatively whereas 5 carcinomas were judged to be benign lesions. Follicular carcinomas and follicular variants of papillary carcinomas could not be assessed by FNB in 6/8 and by FS in 8/9 cases. Only very few malignancies, which are not found by FNB, can be verified by FS. A routine use of intraoperative FS to verify FNB results is not justified, but can give additional information about tumor size, lymph node status and extra-/intrathyroid nodules, which are not examined by FNB preoperatively. Hemithyroidectomy with lymph node dissection represents the operation of choice in cases with unclear FNB results to avoid a second operation with increased risk of recurrent nerve palsy and hypoparathyroidism.