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Frozen Section in Diagnosis of Thyroid Swelling: Does It Still Have Role?

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Purpose The present study correlates the frozen section diagnosis of thyroid swelling with the histopathological diagnosis and assesses the expression of immunohistochemical markers in malignant thyroid tumours. Also, the study aims to analyse the accuracy and limitations of the frozen section as an intraoperative tool for the diagnosis of thyroid swellings. Method Fifty-three cases of thyroid swelling were included in the study. Frozen section reports were classified as benign, malignant and deferred. A correlation between frozen section and histopathology examination (HPE) reports has been evaluated. The malignant cases confirmed on HPE were subjected to Immunohistochemistry (IHC) with TTF-1, Thyroglobulin, and CK-7. Results Among the 53 patients, 45 (84.9%) were females, and the majority were younger than 40 years (60.37%). On frozen section majority, 42 (79.25%) were benign, while a definitive diagnosis of malignancy was made in six cases (11.32%). On the frozen section, there were no false-positive cases, six true-positive cases, one false-negative case and 46 true-negative cases, with a sensitivity of 85.71%, specificity of 100%, the positive predictive value of 100%, the negative predictive value of 97.87% and diagnostic accuracy of 98.11% respectively. All the six papillary carcinomas and one follicular carcinoma showed immunoreactivity of tumor cells to TTF 1, CK 7 and Thyroglobulin. Conclusion There was a strong correlation between the frozen section and histopathological diagnosis. Still, it is not recommended in routine use for intraoperative diagnosis of thyroid swelling because of various limitations and the high diagnostic accuracy of FNAC. Adequate histopathologic diagnosis of thyroid disease is based on extensive subsampling of the specimen, which is not possible during an intraoperative frozen section procedure. If the frozen section is used, its limitations must be recognized, preferably based on first-hand data.

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References

  1. Unnikrishnan A, Menon U (2011) Thyroid disorders in India: an epidemiological perspective. Indian J Endocrinol Metab 15(6):78

    Article  Google Scholar 

  2. Usha Menon V, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar H (2009) High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population. J Indian Med Assoc 107(2):72–77

    CAS  PubMed  Google Scholar 

  3. Sekkath Veedu J, Wang K, Lei F, Chen Q, Huang B, Mathew A (2018) Trends in thyroid cancer incidence in India. J Clin Oncol 36(15_suppl):e18095–e18095. https://doi.org/10.1200/jco.2018.36.15_suppl.e18095

  4. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214

    Article  Google Scholar 

  5. Taneri F, Poyraz A, Salman B, Tekin E, Arkyuerek N, Bayram O, Onuk E (2001) Using imprint and frozen section in determining the surgical strategies for thyroid pathologies. Endocr Regul 35:71–74

    CAS  PubMed  Google Scholar 

  6. Hamburger JI, Hamburger SW (1985) Declining role of frozen section in surgical planning for thyroid nodules. Surgery 98(2):307–312

    CAS  PubMed  Google Scholar 

  7. Keller MP, Crabbe MM, Norwood SH (1987) Accuracy and significance of fine-needle aspiration and frozen section in determining the extent of thyroid resection. Surgery 101(5):632–635

    CAS  PubMed  Google Scholar 

  8. Richard M, deMay RM (1998) Frozen section of thyroid? Just say NO. Am J Clin Pathol 110:423–424

    Article  Google Scholar 

  9. Novis DA, Gephardt GN, Zarbo RJ (1996) College of American Pathologists. Interinstitutional comparison of frozen section consultation in small hospitals: a College of American Pathologists Q-Probes study of 18,532 frozen section consultation diagnoses in 233 small hospitals. Arch Pathol Lab Med 120(12):1087–1093

  10. Gephardt GN, Zarbo RJ (1996) Interinstitutional comparison of frozen section consultations. A college of American Pathologists Q-Probes study of 90,538 cases in 461 institutions. Arch Pathol Lab Med 120(9):804–809

  11. Miller MC, Rubin CJ, Cunnane M et al (2007) Intraoperative pathologic examination: cost effectiveness and clinical value in patients with cytologic diagnosis of cellular follicular thyroid lesion. Thyroid 17:557–565

    Article  Google Scholar 

  12. Makay O, Icoz G, Gurcu B et al (2007) The ongoing debate in thyroid surgery: should frozen section analysis be omitted. Endocr J 54:385–390

    Article  Google Scholar 

  13. Huber GF, Dziegielewski P, Matthews TW et al (2007) Intraoperative frozen-section analysis for thyroid nodules: a step toward clarity or confusion? Arch Otolaryngol Head Neck Surg 133:874–881

    Article  Google Scholar 

  14. Tamimi D (2001) Value of routine frozen section diagnosis of thyroid lesions. Saudi Med J 22(11):995–998

    CAS  PubMed  Google Scholar 

  15. Boyd LA, Earnhardt RC, Dunn JT, Frierson HF (1998) Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules. J Am Coll Surg 187:494–502

    Article  CAS  Google Scholar 

  16. Hamming GJ, Goslings BM, Songun I, Fleuren GJ, van de Velde CJ (1998) Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy. World J Surg 22:575–579

    Article  CAS  Google Scholar 

  17. Chang HY, Lin JD, Chen JF, Huang BY, Hsueh C, Jeng LB et al (1997) Correlation of fine-needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol 50:1005–1009

    Article  CAS  Google Scholar 

  18. Sabel MS, Staren ED, Giankakis LM, Dwarakanathan S, Prinz RA (1997) Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule. Surgery 122:1021–1027

    Article  CAS  Google Scholar 

  19. Davoudi MM, Yeh KA, Wei JP (1997) Utility of fine-needle aspiration cytology and frozen-section examination in the operative management of thyroid nodules. Am Surg 63(12):1084–1090

    CAS  PubMed  Google Scholar 

  20. Aguillar-Diosdado M, Contreras A, Gavian I, Escobar- Jimeinez L, Giron JA et al (1997) Thyroid nodules: Role of fine needle aspiration and intraoperative frozen section examination. Acta Cytol 41:677–682

    Article  Google Scholar 

  21. Ersoy E, Taneri F, Tekin E, Poyraz A, Cihan A (1999) Preoperative fine-needle aspiration cytology versus frozen section in thyroid surgery. Endocr Regul 33:141–144

    CAS  PubMed  Google Scholar 

  22. Lin HS, Komisar A, Opher E, Blaugrund SM (1999) Surgical management of thyroid masses: assessing the need for frozen section evaluation. Laryngoscope 109:868–873

    Article  CAS  Google Scholar 

  23. Mayooran N, Waters P, KaimKhani T, Kerin M, Quill D (2015) FNAC and frozen section correlations with definitive histology in thyroid diseases. Eur Arch Otorhinolaryngol 273(8):2181–2184. https://doi.org/10.1007/s00405-015-3742-2

    Article  PubMed  Google Scholar 

  24. McHenry CR, Raeburn C, Strickland T, Marty JJ (1996) The utility of routine frozen section examination for intraoperative diagnosis of thyroid cancer. Am J Surg 172:658–661

    Article  CAS  Google Scholar 

  25. Najah H, Tresallet C (2019) Role of frozen section in the surgical management of indeterminate thyroid nodules. Gland Surg 8(S2):S112–S117. https://doi.org/10.21037/gs.2019.04.07

    Article  PubMed  PubMed Central  Google Scholar 

  26. Pal R, Kar S, Basu M, Pal S, Zaman F, Sengupta A (2012) Clinico-pathological correlates of incidentally revealed thyroid swelling in Bihar, India. J Pharm Bioallied Sci 4(1):51

    Article  Google Scholar 

  27. Kahmke R, Lee W, Puscas L, Scher R, Shealy M, Burch W et al (2013) Utility of intraoperative frozen sections during thyroid surgery. Int J Otolaryngol 2013:1–4

    Article  Google Scholar 

  28. Cetin B, Aslan S, Hatiboglu C et al (2004) Frozen section in thyroid surgery: Is it a necessity? Can J Surg 47(1):29–33

    PubMed  PubMed Central  Google Scholar 

  29. Russel CFJ (1994) The management of the solitary thyroid nodule. In: Johnson CD, Taylor I (eds) Recent advances in surgery, vol 17. ChurchillLivingstone, London, pp 4–16

    Google Scholar 

  30. Kaplan EL, Sugimoto J, Yang H, Fredland A (1983) In: Kaplan EL (ed) Postoperative hypoparathyroidism: diagnosis and management. Surgery of the thyroid and parathyroid glands. Churchill Livingstone, New York, pp 262–274

  31. Almeida JP, CoutoNetto SD, Rocha RP, Pfuetzenreiter EG Jr, Dedivitis RA (2009) The role of intraoperative frozen sections for thyroid nodules. Braz J Otorhinolaryngol 75(2):256–260. https://doi.org/10.1016/s1808-8694(15)30787-4

    Article  PubMed  Google Scholar 

  32. Chen H, Nicol TL, Udelsman R (1995) Follicular lesions of the thyroid. Does frozen section alter operative management? Ann Surg 222:101–106

  33. Udelsman R, Westra WH et al (2001) Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid. Ann Surg 233:716–722

    Article  CAS  Google Scholar 

  34. Mandell DL et al (2001) Diagnostic accuracy of fine needle aspiration and frozen section in nodular thyroid disease. Otolaryngol Head Neck Surg 124(5):531–536

    Article  CAS  Google Scholar 

  35. Chen H, Zeiger MA, Clark DP, Westra WH, Udelsman R (1997) Papillary carcinoma of the thyroid: Can operative management be based solely on fine-needle aspiration? J Am Coll Surg 184:605–610

    CAS  PubMed  Google Scholar 

  36. Chadwick DR, Harrison BJ (1998) The role of fine-needle aspiration cytology and frozen section histology in management of differentiated thyroid cancer: the UK experience. Langenbecks Arch Surg 383:164–166

    Article  CAS  Google Scholar 

  37. Basolo F, Baloch ZW, Baldanzi A, Miccoli P (1999) Usefulness of Ultrafast Papanicolaou-stained scrape preparations in intraoperative management of thyroid lesions. Mod Pathol 12:653–657

    CAS  PubMed  Google Scholar 

  38. Layfield LJ, Mohrmann RL, Kopald KH, Giuliano AE (1991) Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules. Cancer 68:130–134

    Article  CAS  Google Scholar 

  39. Rosen Y, Rosenblatt P, Saltzman E (1990) Intraoperative pathologic diagnosis of thyroid neoplasms: report on experience with 504 specimens. Cancer 66:2001–2006

    Article  CAS  Google Scholar 

  40. Kingston GW, Bugis SP, Davis N (1992) Role of frozen section and clinical parameters in distinguishing benign from malignant follicular neoplasms of the thyroid. Am J Surg 164(6):603–605

    Article  CAS  Google Scholar 

  41. Paphavasit A, Thompson GB, Hay ID et al (1997) Follicular and Hürthle cell thyroid neoplasms. Is frozen-section evaluation worthwhile? Arch Surg 132:674–678

    Article  CAS  Google Scholar 

  42. Dzodic R, Markovic I, Inic M, Jokic N, Djurisic I, Zegarac M, Pupic G, Milovanovic Z, Jovic V, Jovanovic N (2006) Sentinel lymph node biopsy may be used to support the decision to perform modified radical neck dissection in differentiated thyroid carcinoma. World J Surg 30(5):841–846

    Article  Google Scholar 

  43. Giuliani D, Willemsen P, Verhelst J, Kockx M, Vanderveken M (2006) Frozen section in thyroid surgery. Acta Chir Belg 106(2):199–201

    Article  CAS  Google Scholar 

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Funding

None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, 781301, India

    Michimi Daimary

  2. Department of Pathology, Silchar Medical College, Silchar, Assam, India

    R. N. Chaubey

  3. Department of Radiation Oncology, Dr B. Borooah Cancer Institute, Guwahati, Assam, India

    Jyotiman Nath

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  1. Michimi Daimary
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  2. R. N. Chaubey
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Correspondence to Michimi Daimary.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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The study was approved by Institutional Ethics Committee of Silchar Medical College. Written informed consent was taken from all the patients.

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Daimary, M., Chaubey, R.N. & Nath, J. Frozen Section in Diagnosis of Thyroid Swelling: Does It Still Have Role?. Indian J Otolaryngol Head Neck Surg 74, 383–393 (2022). https://doi.org/10.1007/s12070-021-02946-6

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