THE UTILITY OF ROUTINE FROZEN-SECTION EXAMINATION FOR INTRAOPERATIVE DIAGNOSIS OF THYROID-CANCER

BACKGROUND: The value of routine frozen section examination for intrao perative diagnosis of thyroid cancer and determination of extent of th yroidectomy is controversial and needs to be evaluated on an instituti on to institution basis.METHODS: A prospective evaluation of 76 patien ts with nodular thyroid disease who had an adequate fine needle aspira tion biopsy (FNAB) underwent thyroidectomy with routine thyroid frozen section examination, A direct comparison of FNAB and frozen section e xamination, along with a cost benefit analysis of frozen section exami nation, was completed. RESULTS: The thyroid pathology was carcinoma in 24, follicular adenoma in 24, multinodular goiter in 24, thyroiditis in 3, and a cyst in 1 patient, The sensitivity, specificity, and accur acy of frozen section examination were 93%, 100%, and 97%, respectivel y, compared with 88%, 89%, and 91% for FNAB (P >0.05), Diagnosis was d eferred in 38 patients (50%) in whom frozen section examination showed a follicular neoplasm, One to 6 frozen section examinations were obta ined per patient with alteration in intraoperative management in only 2 patients (3%) at a charge of $246 to $606 pet patient and a total ch arge of $26,040. CONCLUSION: In patients with an adequate FNAB, frozen section examination rarely affected intraoperative decision making in thyroid surgery and its routine use was not cost effective, (C) 1996 by Excerpta Medica, Inc.