Influence of fine-needle aspiration biopsy and frozen section examination on the management of thyroid cancer

Abstract

In order to delineate the influence of fine-needle aspiration biopsy (FNAB) and frozen section examination (FS) on the management of patients with thyroid cancer, a review of 310 patients with thyroid cancer, seen in follow-up during a 3-year period, was completed. Combined FNAB and FS examination were assessed in 225 patients, 172 (76%) with papillary carcinoma, 36 (16%) with follicular carcinoma, 13 (6%) with Hürthle cell carcinoma, and 4 (2%) with medullary carcinoma. The diagnosis according to FNAB was malignant in 78 patients (35%), cellular in 135 (60%), and benign in 12 (5%). All 78 patients with a malignant FNAB diagnosis had papillary cancer. The results of FS examination correlated with the FNAB findings in 74 patients (95%), whereas 4 patients (5%) had a false-negative FS diagnosis of "adenoma." Of the 135 patients with a cellular FNAB diagnosis, FS examination showed cancer in 75 (56%): 58 with papillary carcinoma, 7 with follicular carcinoma, and 10 with Hürthle cell carcinoma. Sixty patients (44%), 30 with papillary carcinoma, 27 with follicular carcinoma, and 3 with Hürthle cell carcinoma, had a cellular FNAB diagnosis and a FS diagnosis of a follicular neoplasm. Twelve patients (5%), 6 with papillary carcinoma, 4 with medullary carcinoma, and 2 with follicular carcinoma, had both false-negative FNAB and FS. From these results, we conclude that FS examination is indicated for intraoperative decision-making in patients with a cellular FNAB diagnosis but is unnecessary when the FNAB diagnosis is either benign or malignant. In order to avoid possible reoperation, near-total thyroidectomy should be presented as an alternative for the treatment of a hypofunctioning thyroid nodule when both FNAB and FS results are consistent with "follicular neoplasm."