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Role of Fine-needle Aspiration Biopsy and Frozen Section in the Management of Papillary Thyroid Carcinoma Subtypes

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Abstract

Since fine-needle aspiration biopsy (FNAB) was introduced, the value of frozen section (FS) has been questioned. This study compares FNAB and FS sensitivities among the usual form of papillary thyroid cancer (uPTC) and variants of PTC such as tall cell (tcPTC), follicular (fPTC), and Hurthle cell (HcPTC). A total of 257 patients who underwent preoperative FNAB, intraoperative FS, and thyroidectomy for PTC were randomly selected from a database of a university teaching hospital in Toronto. There were 218 females (84.8%) and 39 males (15.2%), from 19 to 89 years of age (mean of 44 years), having uPTC (n = 212), fPTC (n = 24), HcPTC (n = 14), and tcPTC (n = 7). Data were analyzed using χ2 test. Sensitivities were calculated by division of true positives and by the sum of true positives and false negatives. True positives had to reflect a conclusive diagnosis of cancer. The FNAB sensitivities were uPTC (39.2%), fPTC (25%), HcPTC (42.9%), tcPTC (85.7%), similar to FS sensitivities (p = 0.497) for uPTC (44.3%), fPTC (16.7%), HcPTC (42.9%), and tcPTC (71.4%). Use of FS following FNAB increased sensitivities for uPTC to 56.1%, fPTC to 29.2%, and tcPTC to 100%. In addition, FS did not increase FNAB sensitivity in HcPTC. Combination FNAB plus FS failed in 43.9% of uPTC, 70.8% of fPTC, and 57.1% of HcPTC. We concluded that FNAB and FS sensitivity vary with PTC subtype and are still necessary for selection and treatment. The recognition of morphologic subtypes of PTC from the FNAB could optimize the selection of patients for intraoperative FS, enhance the preoperative assessment of prognosis, facilitate the surgical planning, and simplify the preparation of postoperative adjuvant therapy.

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Acknowledgment

The authors thank Margaret Allen for her assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1521, Toronto, Ontario M5G 1X5, Canada

    Julio C. Furlan M.D., Ph.D. & Irving B. Rosen M.D.

  2. Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, McL 12-407, Toronto, Ontario M5T 2S8, Canada

    Julio C. Furlan M.D., Ph.D.

  3. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, 600 University Avenue, 6th Floor, Toronto, Ontario M5G 1X5, Canada

    Yvan C. Bedard M.D., Ph.D.

Authors
  1. Julio C. Furlan M.D., Ph.D.
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  2. Yvan C. Bedard M.D., Ph.D.
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  3. Irving B. Rosen M.D.
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Correspondence to Julio C. Furlan M.D., Ph.D..

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Furlan, J., Bedard, Y. & Rosen, I. Role of Fine-needle Aspiration Biopsy and Frozen Section in the Management of Papillary Thyroid Carcinoma Subtypes. World J. Surg. 28, 880–885 (2004). https://doi.org/10.1007/s00268-004-6953-z

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