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Thyroid surgery: Does frozen section have a role? If yes, in which cases?

  • Review Article
  • Published:
Hellenic Journal of Surgery

Abstract

Many countries and medical associations have developed guidelines for the management of thyroid pathology, including the surgical procedures and diagnostic preoperative and intraoperative procedures. As clearly stated in most guidelines, the aim of any diagnostic procedure is to clarify the nature of the thyroid lesion and properly direct the correct management. Our aim is to provide evidence to support or reject the intraoperative use of frozen section during the surgical management of thyroid pathology. In the past, frozen section was a basic tool in thyroid surgery since the preoperative diagnosis was not that accurate, and given that many different procedures were used for the surgical management of benign and malignant thyroid lesions, the decision as to the appropriate surgical technique was based on the results of the frozen section. With the evolution of ultrasonography and the extensive use of fine needle aspiration FNA cytology, the value of frozen section was soon questioned. Eventually, FNA proved to be sufficiently sensitive as to replace the frozen section in almost 99% of cases, and it provided a safe preoperative diagnosis. Today, almost all endocrine surgery societies agree that FNA should be the initial diagnostic procedure during the assessment of thyroid pathology, and this is recommended in their national guidelines. Based on the current literature, there are certain pertinent facts concerning frozen section:

  1. a.

    In thyroid surgery, frozen section is not always conclusive.

  2. b.

    In thyroid surgery there are still debatable issues concerning both the type of surgery and the extent of surgery.

  3. c.

    The basic question lies in whether frozen section can alter the surgical plan and in what way.

If the operation to be performed is total thyroidectomy, it is unlikely that the results of frozen section will alter the surgical plan since it is a radical operation adequate for both benign and malignant thyroid lesions.

  • FNA today is the indicated initial diagnostic method and should be used in all cases to obtain preoperative diagnosis (2A) (NCCN v.2013)

  • Frozen section can be used in addition to FNA only if the results will alter the operative plan or the extent of the operation.

  • Frozen section should not be used to distinguish benign from malignant follicular lesions or Hurthle cell tumours (Ib, A).

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Authors and Affiliations

  1. Department of Surgery, Red Cross Hospital, Athens, Greece

    S. Lanitis, G. Sourtse, A. Kouloura & V. Ganis

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  1. S. Lanitis
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  2. G. Sourtse
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  3. A. Kouloura
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  4. V. Ganis
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Correspondence to S. Lanitis.

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Lanitis, S., Sourtse, G., Kouloura, A. et al. Thyroid surgery: Does frozen section have a role? If yes, in which cases?. Hellenic J Surg 87, 31–33 (2015). https://doi.org/10.1007/s13126-015-0175-8

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  • DOI: https://doi.org/10.1007/s13126-015-0175-8

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