PREOPERATIVE EVALUATION AND PREDICTIVE VALUE OF FINE-NEEDLE ASPIRATION AND FROZEN-SECTION OF THYROID-NODULES

Background: We sought to evaluate the predictive value of preoperative fine-needle aspiration (FNA) on surgical decision making by evaluatin g the final pathologic diagnosis and comparing it to the preoperative diagnosis. Further, we wished to calculate the predictive accuracy of each of several types of preoperative FNA diagnosis. Study Design: A r etrospective chart review of 151 thyroid resections between July 1990 and April 1996 at the University of Virginia was undertaken. The mean age was 45 years (range, 11 to 85 years). Preoperative laboratory valu es, presenting symptoms, imaging studies, and predictive values of pre operative FNA and intraoperative frozen section were analyzed. Results : Symptomatology was poorly predictive of a benign versus malignant po stoperative final pathologic diagnosis. Sensitivity, specificity, and accuracy of frozen section versus FNA was 86% versus 86%; 99% versus 9 3%, and 96% versus 92%, respectively, if the reading ''cancer'' or ''s uspicious'' were predicted as positive for malignancy and ''benign'' o r ''follicular'' were predicted as negative for malignancy. If only th e reading ''cancer'' was predicted as positive for malignancy and only ''benign'' was predicted as negative for malignancy sensitivity and s pecificity for FNA were 100% and 96%, respectively, and 100% and 99%, respectively, for frozen section. Forty-nine ''follicular'' lesions ob tained by preoperative FNA resulted in 46 benign diagnoses after surgi cal resection. Conclusions: The use of preoperative FNA is a powerful diagnostic tool in the hands of skilled pathologists. There is increas ing evidence that intraoperative frozen section adds little to intraop erative decision making in patients diagnosed with thyroid cancer by p reoperative FNA. Less definitive interpretations decrease the sensitiv ity, specificity, and accuracy of the FNA diagnosis. (J Am Cell Surg 1 998;187:494-502. (C) 1998 by the American College of Surgeons).