LiVolsi Virginia A, Baloch Zubair W
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Endocr Pathol. 2005 Winter;16(4):285-93. doi: 10.1385/ep:16:4:285.
The role of intraoperative frozen section in certain organ systems such as the thyroid continues to be problematic. In many cases, diagnoses are deferred or nonhelpful--"follicular lesion." In the modern era, the widespread use of preoperative aspiration biopsy has allowed for more careful selection of patients who undergo thyroid surgery. In many cases, the fine-needle-aspiration (FNA) biopsy diagnosis can be definitive or can guide the specific surgical procedure. The literature supports our approach, which is summarized as follows: Intraoperative consultation is not needed on the intrathyroidal nodule if a preoperative FNA was definitive for papillary carcinoma. Frozen section is of no value in the intraoperative diagnosis of lesions diagnosed on FNA as "follicular neoplasm" or "Hürthle cell neoplasm" because the characterization of these lesions requires detailed analysis of the tumor capsule for the demonstration of capsular and/or vascular invasion--an analysis that is not practical in the intraoperative setting. Finally, intraoperative consultation including frozen section and intraoperative cytologic examination is most useful in those cases that are diagnosed as suspicious for papillary carcinoma by FNA, because the assessment of nuclear features needed for the definitive diagnosis is possible with intraoperative techniques in a significant number of cases.
术中冰冻切片在某些器官系统（如甲状腺）中的作用仍然存在问题。在许多情况下，诊断被推迟或没有帮助——“滤泡性病变”。在现代，术前细针穿刺活检的广泛应用使得接受甲状腺手术的患者选择更加谨慎。在许多情况下，细针穿刺（FNA）活检诊断可以是明确的，或者可以指导具体的手术操作。文献支持我们的方法，总结如下：如果术前FNA对乳头状癌诊断明确，则甲状腺内结节无需术中会诊。冰冻切片对FNA诊断为“滤泡性肿瘤”或“许特莱细胞肿瘤”的病变的术中诊断没有价值，因为这些病变的特征需要详细分析肿瘤包膜以证明包膜和/或血管侵犯——这种分析在术中环境中不实用。最后，术中会诊包括冰冻切片和术中细胞学检查在那些FNA诊断为可疑乳头状癌的病例中最有用，因为在大量病例中，术中技术可以对明确诊断所需的核特征进行评估。
