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Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis

Annals of Surgical Oncology volume 14, pages 712–718 (2007)Cite this article

Abstract

Background

Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy.

Methods

This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy.

Results

Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively.

Conclusions

FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.

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Acknowledgments

The authors thank Chang Gung Memorial Hospital, Taoyuan, Taiwan, for partially supporting this research under Contract BMRP 072.

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Affiliations

  1. Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan

    Tzu-Chieh Chao MD, PhD, Hsiao-Hsiang Chao MD & Miin-Fu Chen MD

  2. Department of Internal Medicine, Division of Metabolism and Endocrinology, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan

    Jen-Der Lin MD

  3. Department of Pathology, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan

    Chuen Hsueh MD

  4. Department of Surgery, Chang Gung University College of Medicine, 259 Wenhwa 1st Road, Kweishan, Taoyuan, Taiwan

    Tzu-Chieh Chao MD, PhD & Miin-Fu Chen MD

  5. Department of Internal Medicine, Chang Gung University College of Medicine, 59 Wenhwa 1st Road, Kweishan, Taoyuan, Taiwan

    Jen-Der Lin MD

  6. Department of Pathology, Chang Gung University College of Medicine, 59 Wenhwa 1st Road, Kweishan, Taoyuan, Taiwan

    Chuen Hsueh MD

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  1. Tzu-Chieh Chao MD, PhD
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  2. Jen-Der Lin MD
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  3. Hsiao-Hsiang Chao MD
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Correspondence to Tzu-Chieh Chao MD, PhD.

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Chao, TC., Lin, JD., Chao, HH. et al. Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis. Ann Surg Oncol 14, 712–718 (2007). https://doi.org/10.1245/s10434-006-9083-z

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  • DOI: https://doi.org/10.1245/s10434-006-9083-z

Keywords

  • Nodule
  • Fine-needle biopsy
  • Frozen section
  • Thyroid