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Intraoperative Frozen Section for the Evaluation of Extrathyroidal Extension in Papillary Thyroid Cancer

World Journal of Surgery volume 39, pages 187–193 (2015)Cite this article

Abstract

Background

We investigated extrathyroidal extension (ETE) through frozen biopsy for intraoperative decision making in patients with papillary thyroid cancer (PTC).

Methods

During the period of the study an operation was performed in 268 patients with PTC and ETE was evaluated using intraoperative frozen biopsies of thyroid tissue.

Results

Extrathyroidal extension was confirmed in 54 patients (20 %) on frozen biopsy. Fifty-three patients among 54 patients showing ETE on frozen biopsy were confirmed on permanent pathologic analysis. Accordingly, frozen biopsy had a sensitivity of 66 %, a specificity of 99 %, a positive predictive value of 98 %, and a negative predictive value of 87 %. Tumor size (OR 4.373; CI 2.257–8.475, p = <0.001) was an independent factor for predicting ETE on frozen biopsy.

Conclusions

Intraoperative frozen biopsy can be an useful tool in identifying the presence of ETE. It can also help the operator decide the extent of surgery and central neck dissection in patients with PTC.

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References

  1. Mazzaferri EL, Young RL (1981) Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 70:511–518

    CAS  PubMed  Article  Google Scholar 

  2. Samaan NA, Schultz PN, Hickey RC et al (1992) The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720

    CAS  PubMed  Google Scholar 

  3. Haigh PI, Urbach DR, Rotstein LE (2005) Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol 12:81–89

    PubMed  Article  Google Scholar 

  4. Hundahl SA, Fleming ID, Fremgen AM et al (1998) A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995 [see comments]. Cancer 83:2638–2648

    CAS  PubMed  Article  Google Scholar 

  5. Wanebo H, Coburn M, Teates D et al (1998) Total thyroidectomy does not enhance disease control or survival even in high-risk patients with differentiated thyroid cancer. Ann Surg 227:912–921

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  6. Sundram F, Robinson BG, Kung A et al (2006) Well-differentiated epithelial thyroid cancer management in the Asia Pacific region: a report and clinical practice guideline. Thyroid 16:461–469

    PubMed  Article  Google Scholar 

  7. Erdem E, Gülçelik MA, Kuru B et al (2003) Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma. Eur J Surg Oncol 29:747–749

    CAS  PubMed  Article  Google Scholar 

  8. Chow SM, Law SC, Chan JK et al (2003) Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40

    PubMed  Article  Google Scholar 

  9. Arora N, Turbendian HK, Kato MA et al (2009) Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid 19:473–477

    PubMed  Article  Google Scholar 

  10. Mercante G, Frasoldati A, Pedroni C et al (2009) Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid 19:707–716

    CAS  PubMed  Article  Google Scholar 

  11. Besic N, Pilko G, Petric R et al (2008) Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol 97:221–225

    PubMed  Article  Google Scholar 

  12. Lim DJ, Baek KH, Lee YS et al (2007) Clinical, histopathological, and molecular characteristics of papillary thyroid microcarcinoma. Thyroid 17:883–888

    CAS  PubMed  Article  Google Scholar 

  13. Lombardi CP, Bellantone R, De Crea C et al (2010) Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 34:1214–1221. doi:10.1007/s00268-009-0375-x

    PubMed  Article  Google Scholar 

  14. Ahn D, Sohn JH, Jeon JH et al (2014) Clinical impact of microscopic extrathyroidal extension in patients with papillary thyroid microcarcinoma treated with hemithyroidectomy. J Endocrinol Invest 37:167–173

    CAS  PubMed  Article  Google Scholar 

  15. Shin JH, Ha TK, Park HK et al (2013) Implication of minimal extrathyroidal extension as a prognostic factor in papillary thyroid carcinoma. Int J Surg 11:944–947

    PubMed  Article  Google Scholar 

  16. Kim WY, Kim HY, Son GS et al (2014) Clinicopathological, immunohistochemical factors and recurrence associated with extrathyroidal extension in papillary thyroid microcarcinoma. J Cancer Res Ther 10:50–55

    PubMed  Article  Google Scholar 

  17. Kim YS, Park WC (2012) Clinical predictors of right upper paraesophageal lymph node metastasis from papillary thyroid carcinoma. World J Surg Oncol 10:164

    PubMed Central  PubMed  Article  Google Scholar 

  18. Kwak JY, Kim EK, Youk JH et al (2008) Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18:609–614

    PubMed  Article  Google Scholar 

  19. Choi JS, Kim J, Kwak JY et al (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878

    PubMed  Article  Google Scholar 

  20. Kim SS, Lee BJ, Lee JC et al (2011) Preoperative ultrasonographic tumor characteristics as a predictive factor of tumor stage in papillary thyroid carcinoma. Head Neck 33:1719–1726

    PubMed  Article  Google Scholar 

  21. Lim YS, Choi SW, Lee YS et al (2013) Frozen biopsy of central compartment in papillary thyroid cancer: quantitative nodal analysis. Head Neck 35:1319–1322

    PubMed  Article  Google Scholar 

  22. Lee YS, Lim YS, Lee JC et al (2010) Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg 34:2558–2563. doi:10.1007/s00268-010-0749-0

    PubMed  Article  Google Scholar 

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Conflict of interest

None.

Author information

Affiliations

  1. Department of Otorhinolaryngology, Pundang Jesaeng Hospital, Deajin Medical Center, Seongnam, Gyeonggi, Korea

    Young Min Park

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, 1-10 Ami-Dong, Seo-Gu, Busan, 602-739, Korea

    Soo-Geun Wang & Byung-Joo Lee

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Yangsan, Kyeongnam, Korea

    Jin Young Goh

  4. Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Yangsan, Kyeongnam, Korea

    Dong Hoon Shin

  5. Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea

    In-Ju Kim

Authors
  1. Young Min Park
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  2. Soo-Geun Wang
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  3. Jin Young Goh
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  4. Dong Hoon Shin
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  5. In-Ju Kim
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  6. Byung-Joo Lee
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Corresponding author

Correspondence to Byung-Joo Lee.

Additional information

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MEST) (No. NRF-2012R1A1A4A01009912).

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Park, Y.M., Wang, SG., Goh, J.Y. et al. Intraoperative Frozen Section for the Evaluation of Extrathyroidal Extension in Papillary Thyroid Cancer. World J Surg 39, 187–193 (2015). https://doi.org/10.1007/s00268-014-2795-5

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  • DOI: https://doi.org/10.1007/s00268-014-2795-5

Keywords

  • Papillary Thyroid Carcinoma
  • Total Thyroidectomy
  • Papillary Thyroid Carcinoma
  • Extrathyroidal Extension
  • Central Neck Dissection