Frozen section in thyroid gland follicular neoplasms: It's high time to abandon it!

Alvaro Sanabria; Mark Zafereo; Lester D R Thompson; Juan C Hernandez-Prera; Luiz P Kowalski; Iain J Nixon; Ashok Shaha; Juan P Rodrigo; Antti Mäkitie; Vincent Vander Poorten; Carlos Suarez; Peter Zbären; Alessandra Rinaldo; Alfio Ferlito

doi:10.1016/j.suronc.2020.12.005

Frozen section in thyroid gland follicular neoplasms: It's high time to abandon it!

Surg Oncol. 2021 Mar:36:76-81. doi: 10.1016/j.suronc.2020.12.005. Epub 2020 Dec 8.

Authors

Affiliations

¹ Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello. Medellín, Colombia. Electronic address: alvaro.sanabria@udea.edu.co.
² Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA.
³ Department of Pathology. Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA.
⁴ Department of Pathology. Moffit Cancer Center. Tampa, FL, USA.
⁵ Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Department of Head and Neck Surgery University of Sao Paulo Medical School, Sao Paulo, Brazil.
⁶ Ear, Nose and Throat Department, NHS Lothian, University of Edinburgh, Edinburgh, UK.
⁷ Head and Neck Service, Memorial Sloan-Kettering Cancer Center, NY, USA.
⁸ Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain.
⁹ Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁰ Department of Oncology, Section Head and Neck Oncology, KU Leuven, and Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven. Leuven, Belgium.
¹¹ Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain.
¹² Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland.
¹³ University of Udine School of Medicine, Udine, Italy.
¹⁴ Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

PMID: 33316682
DOI: 10.1016/j.suronc.2020.12.005

Abstract

Thyroid nodules are a very common clinical condition. The 2015 American Thyroid Association (ATA) guidelines recommend surgical excision for Bethesda IV nodules. The use of intraoperative frozen section (FS) has been recommended as a strategy to tailor the extent of the initial surgery. We critically evaluated the literature that discusses the utility and cost-effectiveness of FS to make an intraoperative decision in patients with thyroid nodules classified as follicular neoplasm. FS should not be recommended as a routine intraoperative test to assess for malignancy in thyroid follicular patterned lesions due to its low performance; the high number of deferred results; the inability to adequately assess histologically defining features; the improvements in risk stratification guiding total thyroidectomy; and the low cost-effectiveness of FS.

Keywords: Carcinoma; Follicular neoplasm; Frozen section; Thyroid nodule; Thyroidectomy.

Publication types

Review

MeSH terms

Carcinoma, Papillary / diagnosis*
Diagnosis, Differential
Diagnostic Errors / prevention & control*
Frozen Sections / standards*
Humans
Practice Guidelines as Topic / standards*
Thyroid Neoplasms / diagnosis*
Thyroid Nodule / diagnosis*