Roychoudhury Sudarshana, Souza Fabiola, Gimenez Cecilia, Glass Ryan, Cocker Rubina, Chau Karen, Kohn Nina, Das Kasturi
Department of Pathology, Hofstra Northwell Health School of Medicine, Lake Success, New York.
Department of Biostatistics Manhasset, The Feinstein Institute for Medical Research, New York.
Diagn Cytopathol. 2017 Sep;45(9):789-794. doi: 10.1002/dc.23765. Epub 2017 Jun 11.
The objective of this study was to evaluate the role of intraoperative frozen section (IFS) in determining the course of surgery in thyroid nodules with a prior fine needle aspiration (FNA) biopsy diagnosis. In addition, reliability of FNA interpretation to guide surgical management without IFS was investigated.
This is a retrospective study of all patients who had a FNA biopsy, IFS, and final pathology performed on a thyroid nodule over a 9 month period. The extent of surgery at the time of the IFS was recorded. Subsequent change in surgical procedure following the IFS diagnosis was noted in each of the Bethesda diagnostic categories.
55% of the cases were deferred at IFS overall, with 68 and 86% in Bethesda III and IV categories, respectively. Overall, there was a change in management in 6% of cases.
Our study does not support the use of IFS for nodules with prior FNA interpretation of Bethesda II, III, IV and VI as management was not significantly changed. IFS is of value for nodules with prior FNA diagnosis of Bethesda I for interpretation of nodule, and Bethesda V for planning surgery. A confirmatory diagnosis could not be rendered at IFS for lesions with follicular architecture, which comprised most of the cases in Bethesda III and IV.
本研究的目的是评估术中冰冻切片（IFS）在确定经细针穿刺抽吸（FNA）活检诊断的甲状腺结节手术进程中的作用。此外，还研究了在无IFS情况下FNA解读对指导手术管理的可靠性。
这是一项对在9个月期间对甲状腺结节进行FNA活检、IFS及最终病理检查的所有患者的回顾性研究。记录IFS时的手术范围。在每个贝塞斯达诊断类别中，记录IFS诊断后手术程序的后续变化。
总体而言，55%的病例在IFS时被推迟，贝塞斯达III类和IV类分别为68%和86%。总体而言，6%的病例管理方式发生了变化。
我们的研究不支持对先前FNA解读为贝塞斯达II、III、IV和VI类的结节使用IFS，因为管理方式没有显著改变。IFS对于先前FNA诊断为贝塞斯达I类的结节用于解读结节以及贝塞斯达V类的结节用于规划手术具有价值。对于具有滤泡结构的病变，IFS无法做出确诊，这类病变在贝塞斯达III类和IV类中占大多数。
