Determining the Value of Intra-Operative Frozen Section in Thyroid Neoplasm Management

Abstract

Aim: To analyse the value of the Frozen section (FS) in the management of patients with thyroid disease and to review our personal experience with it in thyroid surgery.

Methods: The results of 1110 frozen sections of thyroid tissues studied throughout a ten-year period from 2003 to 2012, as well as their connections with the final histological evaluation, were reviewed in this retrospective analysis. For statistical computations, deferred responses were not taken into consideration.

Results: In our study, 85.4 percent of cases, FS and the final histological diagnosis agreed, whereas 5.5 percent disagreed. 9.1% of the cases were put on hold. For all histological subtypes, the global specificity and sensitivity of FS analysis were 99.3 percent and 64.7 percent, respectively. It had a 61.7 percent sensitivity for papillary cancer, an 83.3 percent sensitivity for follicular carcinoma, and a 100 percent sensitivity for anaplastic carcinoma. Six false-positive (FP) diagnoses and 55 false-negative (FN) diagnoses caused the discrepancies. Papillary micro-carcinoma accounted for 50% of the FN. The FS examination has a 94.4 percent positive predictive value (PPV) and a 93.9 percent negative predictive value (NPV).

Conclusions: Our findings support the use of intraoperative FS in the confirmation of thyroid nodule malignancy. It's linked to a high level of specificity and a reasonable sensitivity rate. Papillary microcarcinoma explained the majority of the discrepancies between FS and final histological diagnosis. A standardised language could aid pathologists in their evaluations as well as surgeons in making decisions in the operating room.