Virchows Archiv

, Volume 453, Issue 5, pp 433–440 | Cite as

Current practices in performing frozen sections for thyroid and parathyroid pathology

Review and Perspective


In this review article, current trends in thyroid and parathyroid frozen sections are discussed. In Japan and other countries, the numbers of thyroid frozen sections have been dramatically decreasing over the past decade. The decline in the number of thyroid frozen sections has been attributed to two major factors: highly diagnostic preoperative fine needle aspiration for papillary carcinomas, the most frequent type of thyroid cancers, and the acknowledgment in the literature of the disadvantageous frozen sections for follicular tumors. Several authors have argued that the frozen section of thyroid nodules should be limited only to cases that have a preoperative cytology diagnosis as “atypical” or “suspicious”. In contrast, frozen sections for parathyroid glands have been increasing in numbers. This increase is thought to be largely due to the high number of parathyroidectomies for secondary hyperplasia in dialysis patients. Frozen sections are usually performed to confirm the removal of parathyroid tissue for either cyropreservation or auto-transplantation. It is concluded that thyroid and parathyroid frozen section examination is restricted to selected situations.


Thyroid Cancer Parathyroid Hyperparathyroidism Frozen section 



The authors thank Dr. Kaori Kameyama and Dr. Mitsuyoshi Hirokawa for providing pertinent data at Itoh Hospital and Kuma Hospital, respectively, and Professor Guenter Klöppel for reading the manuscript. The authors also thank Itoh Hospital, Kuma Hospital and Isehara Kyodo Hospital for providing pertinent data to pursue this study.

Conflict of interest statement

We declare that we have no conflict of interest.


  1. 1.
    Novis DA, Gephardt GN, Zarbo RJ (1996) 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 120:1087–1093PubMedGoogle Scholar
  2. 2.
    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 120:804–809PubMedGoogle Scholar
  3. 3.
    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 17:557–565PubMedCrossRefGoogle Scholar
  4. 4.
    Makay O, Icoz G, Gurcu B et al (2007) The ongoing debate in thyroid surgery: should frozen section analysis be omitted? Endocr J 54:385–390PubMedCrossRefGoogle Scholar
  5. 5.
    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 133:874–881PubMedCrossRefGoogle Scholar
  6. 6.
    Iacobone M, Scarpa M, Lumachi F, Favia G (2005) Are frozen sections useful and cost-effective in the era of intraoperative qPTH assays? Surgery 138:1159–1164, (discussion 1164–1165)PubMedCrossRefGoogle Scholar
  7. 7.
    Elliott DD, Monroe DP, Perrier ND (2006) Parathyroid histopathology: is it of any value today? J Am Coll Surg 203:758–765PubMedCrossRefGoogle Scholar
  8. 8.
    Karakousis GC, Han D, Kelz RR et al (2007) Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT). Surgery 142:845–850, (discussion 850 e1–e2)PubMedCrossRefGoogle Scholar
  9. 9.
    Haymart MR, Greenblatt DY, Elson DF, Chen H (2008) The role of intraoperative frozen section if suspicious for papillary thyroid cancer. Thyroid 18:419–423PubMedCrossRefGoogle Scholar
  10. 10.
    Anton RC, Wheeler TM (2005) Frozen section of thyroid and parathyroid specimens. Arch Pathol Lab Med 129:1575–1584PubMedGoogle Scholar
  11. 11.
    Basolo F, Ugolini C, Proietti A, Iacconi P, Berti P, Miccoli P (2007) Role of frozen section associated with intraoperative cytology in comparison to FNA and FS alone in the management of thyroid nodules. Eur J Surg Oncol 33:769–775PubMedGoogle Scholar
  12. 12.
    LiVolsi VA, Baloch ZW (2005) Use and abuse of frozen section in the diagnosis of follicular thyroid lesions. Endocr Pathol 16:285–293PubMedCrossRefGoogle Scholar
  13. 13.
    Mittendorf EA, Khiyami A, McHenry CR (2006) When fine-needle aspiration biopsy cannot exclude papillary thyroid cancer: a therapeutic dilemma. Arch Surg. 141:961–966, (discussion 966)PubMedCrossRefGoogle Scholar
  14. 14.
    Mihai R, Gleeson F, Buley ID, Roskell DE, Sadler GP (2006) Negative imaging studies for primary hyperparathyroidism are unavoidable: correlation of sestamibi and high-resolution ultrasound scanning with histological analysis in 150 patients. World J Surg 30:697–704PubMedCrossRefGoogle Scholar
  15. 15.
    Dewan AK, Kapadia SB, Hollenbeak CS, Stack BC Jr (2005) Is routine frozen section necessary for parathyroid surgery? Otolaryngol Head Neck Surg 133:857–862PubMedCrossRefGoogle Scholar
  16. 16.
    Guarda LA (2004) Rapid intraoperative parathyroid hormone testing with surgical pathology correlations: the “chemical frozen section”. Am J Clin Pathol 122:704–712PubMedCrossRefGoogle Scholar
  17. 17.
    Carter AB, Howanitz PJ (2003) Intraoperative testing for parathyroid hormone: a comprehensive review of the use of the assay and the relevant literature. Arch Pathol Lab Med 127:1424–1442PubMedGoogle Scholar
  18. 18.
    Rosen IB, Young JE, Archibald SD, Walfish PG, Vale J (1994) Parathyroid cancer: clinical variations and relationship to autotransplantation. Can J Surg 37:465–469PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of PathologyTokai University School of MedicineIsehara CityJapan
  2. 2.Department of Anatomic PathologyCleveland ClinicClevelandUSA

Personalised recommendations