Role of fine-needle aspiration biopsy and frozen section analysis in the surgical management of thyroid tumors

Introduction: The role of fine-needle aspiration (FNA) and frozen section ( FS) in the management of thyroid neoplasms continues to generate considerab le controversy. We reviewed our recent experience to determine the clinical utility of FNA and FS in our surgical management and intraoperative decisi on-making. Methods: All patients who had operations for thyroid disease between Januar y 1996 and June 1999 were identified in our prospective database. Completio n and incidental thyroidectomies were excluded. Data obtained from the path ology files included FNA, FS, and the final histologic diagnosis. Results: Five hundred sixty-four patients, including 409 women (73%), with a median age of 50 years (range, 6-94) were identified, of whom 293 (52%) h ad cancer diagnosed on permanent sections. Three hundred twenty-nine patien ts (58%) had evaluable FNA, of which 91 (28%) were benign, 94 were malignan t (28%), and 144 (44%) were suspicious (46% of these were malignant on fina l). Frozen section was performed in 397 (70%) patients; of these samples, 1 70 (43%) were found to be benign, 106 (27%) were malignant, and 121 (30%) w ere deferred (46% malignant on final). Fine-needle aspiration positively id entified 51% of confirmed malignancies; 13% of patients with malignancy had a benign FNA result. Total thyroidectomy was performed in 64% of malignant tumors and 29% of benign thyroid disease (P < .001). Logistic regression r evealed no association of extent of surgery with FNA results. A frozen sect ion positive for malignancy was associated with total thyroidectomy (P < .0 01, RR 6 [CI 3-10]), and a negative frozen section report was associated wi th lobectomy (P < .05, RR 0.5 [CI 0.3-0.96]). Frozen sections results alter ed the preoperative plan in only 29 patients (5%). Conclusion: Results of preoperative FNA had no direct impact on the selecti on of the surgical procedure in this selected cohort. Intraoperative FS add ed very little to surgical management. The majority of thyroid operations a t this institution are planned and performed based on known prognostic fact ors and intraoperative findings.