Follicular lesions of the thyroid. Does frozen section evaluation alter operative management
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TL;DR: Until a more definitive diagnostic tool exists for follicular thyroid lesions, FS evaluation could be omitted, resection of the lobe with the nodule could be performed, and the definitive operative management could be based on the final permanent histology.
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Abstract: OBJECTIVE: The authors determined the usefulness of frozen section (FS) evaluation in the operative management of follicular lesions of the thyroid. SUMMARY BACKGROUND DATA: Fine-needle aspiration (FNA) cannot reliably discriminate between benign and malignant follicular lesions of the thyroid. Accordingly, FS evaluation is used routinely to guide intraoperative management. METHODS: One hundred twenty-five consecutive patients with follicular thyroid lesions who underwent surgical exploration at the Johns Hopkins Hospital were reviewed. RESULTS: Frozen sections were categorized in 104 of 120 patients (87%) as "follicular lesion, defer to permanent section," rendering no useful clinical information. In only 4 of 120 patients (3.3%) did FS evaluation correctly modify the operative procedure. Notably, in six cases (5.0%), an incorrect FS evaluation misled the surgeon, resulting in four misguided operations. CONCLUSION: Frozen section evaluation is of minimal diagnostic value for follicular thyroid lesions, rendering no additional information 87% of the time; it prolongs the operation, increases costs, and leads to misguided interventions. Until a more definitive diagnostic tool exists for follicular thyroid lesions, FS evaluation could be omitted, resection of the lobe with the nodule could be performed, and the definitive operative management could be based on the final permanent histology.
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Citations
German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors
Henning Dralle,Thomas J. Musholt,Jochen Schabram,Thomas Steinmüller,A. Frilling,D. Simon,Peter E. Goretzki,Bruno Niederle,Christian Scheuba,Thomas Clerici,M. Hermann,Jochen Kußmann,Kerstin Lorenz,Christoph Nies,P. Schabram,A Trupka,Andreas Zielke,Wolfram Karges,Markus Luster,Kurt Werner Schmid,Dirk Vordermark,Hans-Joachim Schmoll,Reinhard Mühlenberg,Otmar Schober,Harald Rimmele,Andreas Machens,Visceral Surgery,Radiooncology,Oncological Hematology +28 more
TL;DR: These evidence-based recommendations for surgical therapy reflect various “treatment corridors” that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
286
Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules.
TL;DR: Thyroid nodules whose FNA is diagnosed as highly suspicious for malignancy should be resected unless there are significant contraindications to a surgical procedure, and the extremely low rate of invasive follicular cancers among all follicular neoplasms may reflect changing histologic criteria for follicular carcinoma.
264
Follicular Adenoma and Carcinoma of the Thyroid Gland
TL;DR: Patients with a follicular neoplasm should undergo a diagnostic thyroid lobectomy and isthmusectomy, which is definitive treatment for a benign follicular adenoma or a minimally invasive follicular cancer.
Randomized Prospective Evaluation of Frozen-Section Analysis for Follicular Neoplasms of the Thyroid
TL;DR: For the vast majority of patients with follicular neoplasms of the thyroid, frozen section is neither informative nor cost-effective.
186
Hürthle cell neoplasms of the thyroid: are there factors predictive of malignancy?
Herbert Chen,Theresa L. Nicol,Martha A. Zeiger,William C. Dooley,Paul W. Ladenson,David S. Cooper,Matthew D. Ringel,Sara Parkerson,Maria Allo,Robert Udelsman +9 more
TL;DR: It is demonstrated that the size of a Hürthle cell neoplasm is predictive of malignancy, and definitive resection involving both thyroid lobes should be considered because of the higher probability ofmalignancy.
160
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Accuracy and significance of fine-needle aspiration and frozen section in determining the extent of thyroid resection.
Keller Mp,Crabbe Mm,Norwood Sh +2 more
TL;DR: FNA alone provides sufficient information for determining the extent of thyroid resection, but Frozen section may be helpful if FNA results are suspicious, but it does not have sufficient sensitivity for determiningThe extent of resection is deferred until permanent sections have been analyzed.
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Intraoperative pathologic diagnosis of thyroid neoplasms. Report on experience with 504 specimens.
TL;DR: The inability to diagnose follicular carcinoma intraoperatively with FS is the most significant factor accounting for the relatively low sensitivity of FS diagnosis of malignant thyroid neoplasms.
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Clinical parameters predictive of malignancy of thyroid follicular neoplasms.
TL;DR: Clinical parameters that characterize patients with an increased risk of having a thyroid follicular cancer who preoperatively have a "follicular neoplasm" identified by needle aspiration biopsy are identified.
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