Thyroid frozen sections in patients with preoperative FNAs: Review of surgeons' preoperative rationale, intraoperative decisions, and final outcome

Abstract

Objectives: We wished to discover (1) in what circumstances surgeons wished to request frozen sections (FSs) on thyroid nodules having a prior fine needle aspiration (FNA) and the preoperative plan in these cases; (2) what the surgeons did with the information provided by FS and (3) in what types of cases was value added with the FS. Methods: A retrospective chart review was performed of 121 consecutive patients receiving an intraoperative FS diagnosis on a thyroid nodule, all of which had been evaluated with a preoperative FNA. Results: The medical record documented rationale for the request in 83% of cases. The most common reason for a FS request of a nodule was whether a planned hemithyroidectomy should proceed to a total thyroidectomy (TT). This scenario led to a TT in 9% of patients with a FNA diagnosed as benign thyroid nodule, 16% diagnosed as follicular neoplasm/suspicious for follicular neoplasm and 69% diagnosed as suspicious for malignancy. Conclusions: The stated rationale for FSs in patients with preoperative FNA was not supported by patient outcome in most cases. There may be some utility for FSs in lesions with a suspicious for malignancy preoperative FNA diagnosis.