Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid

Robert Udelsman, William H. Westra, Patricia I. Donovan, Taylor A. Sohn, John L. Cameron

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Objective: To evaluate the clinical utility of frozen section in patients with follicular neoplasms of the thyroid in a randomized prospective trial. Summary Background Data: The finding of a follicular neoplasm on fine-needle aspiration prompts many surgeons to perform intraoperative frozen section during thyroid lobectomy. However, the focal distribution of key diagnostic features of malignancy contributes to a high rate of noninformative frozen sections. Methods: The series comprised 68 consecutive patients with a solitary thyroid nodule in whom fine-needle aspiration showed a follicular neoplasm. Patients were excluded for bilateral or nodal disease, extrathyroidal extension, or a definitive fine-needle aspiration diagnosis. Final pathologic findings were compared with frozen sections, and cost analyses were performed. Results: Sixty-one patients met the inclusion criteria. Twenty-nine were randomized to the frozen-section group and 32 to the nonfrozen-section group. In the non-frozen-section group, one patient was excluded when gross examination of the specimen was suggestive of malignancy and a directed frozen section was diagnostic of follicular carcinoma. Frozen-section analysis rendered a definitive diagnosis of malignancy in 1 of 29 (3.4%) patients, who then underwent a one-stage total thyroidectomy. In the remaining 28 patients, frozen section showed a "follicular or Hürthle cell neoplasm." Permanent histology demonstrated well-differentiated thyroid cancer in 6 of these 28 patients (21%). Of the 31 patients in the non-frozen-section group, 3 (10%) showed well-differentiated thyroid carcinoma on permanent histology. Complications were limited to one transient unilateral vocal cord dysfunction. All but one patient had a 1-day hospital stay. There were no significant differences between the groups in surgical time or total hospital charges; however, the charge per informative frozen section was approximately $12,470. Conclusions For the vast majority of patients (96.4%) with follicular neoplasms of the thyroid, frozen section is neither informative nor cost-effective.

Original languageEnglish (US)
Pages (from-to)716-722
Number of pages7
JournalAnnals of Surgery
Volume233
Issue number5
DOIs
StatePublished - 2001
Externally publishedYes

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Frozen Sections
Thyroid Neoplasms
Fine Needle Biopsy
Neoplasms
Histology
Vocal Cord Dysfunction
Hospital Charges
Costs and Cost Analysis
Thyroid Nodule
Thyroidectomy
Operative Time
Length of Stay
Thyroid Gland
Carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid. / Udelsman, Robert; Westra, William H.; Donovan, Patricia I.; Sohn, Taylor A.; Cameron, John L.

In: Annals of Surgery, Vol. 233, No. 5, 2001, p. 716-722.

Research output: Contribution to journalArticle

Udelsman, Robert ; Westra, William H. ; Donovan, Patricia I. ; Sohn, Taylor A. ; Cameron, John L. / Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid. In: Annals of Surgery. 2001 ; Vol. 233, No. 5. pp. 716-722.
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abstract = "Objective: To evaluate the clinical utility of frozen section in patients with follicular neoplasms of the thyroid in a randomized prospective trial. Summary Background Data: The finding of a follicular neoplasm on fine-needle aspiration prompts many surgeons to perform intraoperative frozen section during thyroid lobectomy. However, the focal distribution of key diagnostic features of malignancy contributes to a high rate of noninformative frozen sections. Methods: The series comprised 68 consecutive patients with a solitary thyroid nodule in whom fine-needle aspiration showed a follicular neoplasm. Patients were excluded for bilateral or nodal disease, extrathyroidal extension, or a definitive fine-needle aspiration diagnosis. Final pathologic findings were compared with frozen sections, and cost analyses were performed. Results: Sixty-one patients met the inclusion criteria. Twenty-nine were randomized to the frozen-section group and 32 to the nonfrozen-section group. In the non-frozen-section group, one patient was excluded when gross examination of the specimen was suggestive of malignancy and a directed frozen section was diagnostic of follicular carcinoma. Frozen-section analysis rendered a definitive diagnosis of malignancy in 1 of 29 (3.4{\%}) patients, who then underwent a one-stage total thyroidectomy. In the remaining 28 patients, frozen section showed a {"}follicular or H{\"u}rthle cell neoplasm.{"} Permanent histology demonstrated well-differentiated thyroid cancer in 6 of these 28 patients (21{\%}). Of the 31 patients in the non-frozen-section group, 3 (10{\%}) showed well-differentiated thyroid carcinoma on permanent histology. Complications were limited to one transient unilateral vocal cord dysfunction. All but one patient had a 1-day hospital stay. There were no significant differences between the groups in surgical time or total hospital charges; however, the charge per informative frozen section was approximately $12,470. Conclusions For the vast majority of patients (96.4{\%}) with follicular neoplasms of the thyroid, frozen section is neither informative nor cost-effective.",
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AU - Cameron, John L.

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N2 - Objective: To evaluate the clinical utility of frozen section in patients with follicular neoplasms of the thyroid in a randomized prospective trial. Summary Background Data: The finding of a follicular neoplasm on fine-needle aspiration prompts many surgeons to perform intraoperative frozen section during thyroid lobectomy. However, the focal distribution of key diagnostic features of malignancy contributes to a high rate of noninformative frozen sections. Methods: The series comprised 68 consecutive patients with a solitary thyroid nodule in whom fine-needle aspiration showed a follicular neoplasm. Patients were excluded for bilateral or nodal disease, extrathyroidal extension, or a definitive fine-needle aspiration diagnosis. Final pathologic findings were compared with frozen sections, and cost analyses were performed. Results: Sixty-one patients met the inclusion criteria. Twenty-nine were randomized to the frozen-section group and 32 to the nonfrozen-section group. In the non-frozen-section group, one patient was excluded when gross examination of the specimen was suggestive of malignancy and a directed frozen section was diagnostic of follicular carcinoma. Frozen-section analysis rendered a definitive diagnosis of malignancy in 1 of 29 (3.4%) patients, who then underwent a one-stage total thyroidectomy. In the remaining 28 patients, frozen section showed a "follicular or Hürthle cell neoplasm." Permanent histology demonstrated well-differentiated thyroid cancer in 6 of these 28 patients (21%). Of the 31 patients in the non-frozen-section group, 3 (10%) showed well-differentiated thyroid carcinoma on permanent histology. Complications were limited to one transient unilateral vocal cord dysfunction. All but one patient had a 1-day hospital stay. There were no significant differences between the groups in surgical time or total hospital charges; however, the charge per informative frozen section was approximately $12,470. Conclusions For the vast majority of patients (96.4%) with follicular neoplasms of the thyroid, frozen section is neither informative nor cost-effective.

AB - Objective: To evaluate the clinical utility of frozen section in patients with follicular neoplasms of the thyroid in a randomized prospective trial. Summary Background Data: The finding of a follicular neoplasm on fine-needle aspiration prompts many surgeons to perform intraoperative frozen section during thyroid lobectomy. However, the focal distribution of key diagnostic features of malignancy contributes to a high rate of noninformative frozen sections. Methods: The series comprised 68 consecutive patients with a solitary thyroid nodule in whom fine-needle aspiration showed a follicular neoplasm. Patients were excluded for bilateral or nodal disease, extrathyroidal extension, or a definitive fine-needle aspiration diagnosis. Final pathologic findings were compared with frozen sections, and cost analyses were performed. Results: Sixty-one patients met the inclusion criteria. Twenty-nine were randomized to the frozen-section group and 32 to the nonfrozen-section group. In the non-frozen-section group, one patient was excluded when gross examination of the specimen was suggestive of malignancy and a directed frozen section was diagnostic of follicular carcinoma. Frozen-section analysis rendered a definitive diagnosis of malignancy in 1 of 29 (3.4%) patients, who then underwent a one-stage total thyroidectomy. In the remaining 28 patients, frozen section showed a "follicular or Hürthle cell neoplasm." Permanent histology demonstrated well-differentiated thyroid cancer in 6 of these 28 patients (21%). Of the 31 patients in the non-frozen-section group, 3 (10%) showed well-differentiated thyroid carcinoma on permanent histology. Complications were limited to one transient unilateral vocal cord dysfunction. All but one patient had a 1-day hospital stay. There were no significant differences between the groups in surgical time or total hospital charges; however, the charge per informative frozen section was approximately $12,470. Conclusions For the vast majority of patients (96.4%) with follicular neoplasms of the thyroid, frozen section is neither informative nor cost-effective.

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