Cohen Marc A, Patel Krupa R, Gromis Jonathan, Kutler David I, Kuhel William I, Stater Brian J, Schulman Aaron, Hoda Rana S, Scognamiglio Theresa
Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
Weill Cornell Medical College, New York, NY 10065, USA.
World J Otorhinolaryngol Head Neck Surg. 2015 Oct 9;1(1):5-10. doi: 10.1016/j.wjorl.2015.09.002. eCollection 2015 Sep.
To evaluate the Weill Cornell Medical College (WCMC)/New York Presbyterian Hospital (NYPH) experience with intraoperative frozen (IOF) section in the management of thyroid nodules with a fine needle aspiration (FNA) diagnosis of Bethesda II-VI and to analyze the cost and pathology benefit it provides.
The surgical and cytopathology files at WCMC/NYPH were searched within the time period of January 2008 to May 2013. A total of 435 thyroid specimens were identified for which both an FNA and subsequent IOF section was performed. The FNA was correlated with the locations of the resected nodule and the nodule frozen for intraoperative diagnosis. The results of the FNA were compared to the IOF section diagnosis and final diagnosis (FD).
Among 435 cases, the FNA diagnosis was Bethesda II: 149 cases, Bethesda III: 170 cases, Bethesda IV: 91 cases, Bethesda V: 19 cases, and Bethesda VI: 6 cases. There were a total of 83 carcinomas identified on FD, which included 69 papillary thyroid carcinomas (PTCs), 12 follicular carcinomas, and 2 poorly differentiated carcinomas. The preoperative FNA diagnosis for these carcinomas was as follows: Bethesda II, 11/149 (7.4%), Bethesda III, 24/170 (14%), Bethesda IV, 26/91 (29%), Bethesda V, 16/19 (84%), and Bethesda VI, 6/6 (100%). IOF section contributed to the diagnosis of malignancy in 16/429 (4%) cases: 1/149 (0.7%) Bethesda II, 5/170 (3%) Bethesda III, 2/91 (1.1%) Bethesda IV, and 8/19 (42%) Bethesda V. The diagnosis of malignancy was confirmed in the 6 Bethesda VI cases by IOF section. There were no false positives on IOF section. IOF had a sensitivity and specificity of 26% and 100%, respectively.
The role of IOF section is limited in the evaluation of thyroid nodules. IOF section is most useful for nodules with an FNA diagnosis of Bethesda V lesions. The diagnosis of follicular variant of PTC remains difficult on frozen section.
评估威尔康乃尔医学院（WCMC）/纽约长老会医院（NYPH）在对细针穿刺活检（FNA）诊断为贝塞斯达II - VI级的甲状腺结节进行术中冰冻切片（IOF）检查方面的经验，并分析其成本及病理诊断价值。
检索WCMC/NYPH在2008年1月至2013年5月期间的手术及细胞病理学档案。共识别出435例甲状腺标本，这些标本均进行了FNA及后续的IOF切片检查。将FNA结果与切除结节的位置以及用于术中诊断的冰冻结节相关联。将FNA结果与IOF切片诊断及最终诊断（FD）进行比较。
在435例病例中，FNA诊断为贝塞斯达II级的有149例，贝塞斯达III级的有170例，贝塞斯达IV级的有91例，贝塞斯达V级的有19例，贝塞斯达VI级的有6例。FD共确诊83例癌，其中包括69例乳头状甲状腺癌（PTC）、12例滤泡癌和2例低分化癌。这些癌术前FNA诊断情况如下：贝塞斯达II级，11/149（7.4%）；贝塞斯达III级，24/170（14%）；贝塞斯达IV级，26/91（29%）；贝塞斯达V级，16/19（84%）；贝塞斯达VI级，6/6（100%）。IOF切片在16/429（4%）的病例中有助于恶性肿瘤的诊断：贝塞斯达II级，1/149（0.7%）；贝塞斯达III级，5/170（3%）；贝塞斯达IV级，2/91（1.1%）；贝塞斯达V级，8/19（42%）。6例贝塞斯达VI级病例通过IOF切片确诊为恶性肿瘤。IOF切片无假阳性结果。IOF的敏感性和特异性分别为为26%和100%。
IOF切片在甲状腺结节评估中的作用有限。IOF切片对FNA诊断为贝塞斯达V级病变的结节最有用。PTC滤泡变异型在冰冻切片上的诊断仍然困难。
