ROLE OF FINE-NEEDLE ASPIRATION BIOPSY AND FROZEN-SECTION EXAMINATION IN DETERMINING THE EXTENT OF THYROIDECTOMY

Traditionally the extent of thyroidectomy in patients with nodular thy roid disease has been based on peroperative frozen section examination (FS). Fine-needle aspiration biopsy (FNAB) and FS were evaluated with regard to the reliability to determine whether an operation for cance r is necessary. Both methods were performed in 240 patients operated f or nodular thyroid disease and compared with the Anal histology on par affin sections. Altogether 72 (30%) patients were found to have a mali gnant lesion on final histology. Only a malignant FNAB diagnosis and a malignant FS diagnosis were considered positive results for determini ng the extent of thyroidectomy. The test characteristics were equal: t he sensitivity of FNAB and FS was 67%, the specificity 99%, and the ac curacy 89%. The positive predictive value was 96% for FNAB and 98% for FS; the negative predictive values were 88% and 87%, respectively. Fu rther analysis of the results indicates that FS is not necessary for p atients with a malignant FNAB result. These patients should undergo a therapeutic operation for malignancy. When the FNAB result is uncertai n, patients should undergo diagnostic surgery, and definitive surgery should be based on the final histology. Routine use of FS can be omitt ed.