Bronner Mary P, Hamilton Ralph, LiVolsi Virginia A
Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Section of Surgical Pathology, University of Pennsylvania Medical Center, Philadelphia, PA.
Department of Surgery, Division of Plastic Surgery, University of Pennsylvania Medical Center, Philadelphia, PA.
Endocr Pathol. 1994 Sep;5(3):154-161. doi: 10.1007/BF02921471.
The experience of one surgeon (R.H.) with intraoperative frozen sections (FS) performed on thyroid nodules over a 10-year period was studied to assess the utility of FS in follicular thyroid lesions. One hundred and ten patients with dominant or solitary nodules demonstrating a follicular growth pattern were evaluated. The FS slides and subsequently the permanent sections of the nodules were reviewed by the pathologists in the study (M.P.B., VAL.) without knowledge of the original diagnoses. Our results indicate: (1) if the FS was definitively benign (58 patients), the final diagnosis was benign [these lesions consisted of adenomatous nodule, nodular goiter, follicular adenoma, and Hürthle cell adenoma); (2) if an FS diagnosis of malignancy was rendered (4 patients), it was confirmed on permanent sections (follicular variant of papillary carcinoma in all 4); and (3) if the FS diagnosis was deferred (48 patients), the final diagnosis was benign in all but 10 (21 %) (of these 10, 6 had minimally invasive follicular carcinoma [2 of the Hürthle cell type], and 4 had follicular variants of papillary carcinoma). Overall, sensitivity, specificity, and accuracy rates for FS diagnoses were 29, 100, and 91%. Because unilateral lobectomy may be acceptable therapy for well-differentiated thyroid cancers, and because the efficiency of FS evaluation in diagnosing malignancy is low (only 4 malignancies of 110 total patients were diagnosed at FS, or 3.6% overall), we conclude that in this era of cost-containment, FS is not useful in the evaluation of follicular thyroid nodules identified preoperatively as follicular lesions by fine-needle aspiration cytology. Several recommendations concerning the 3 categories of FS diagnosis (i.e., definitively benign, definitively malignant-especially the follicular variant of papillary carcinoma-and deferred) are also put forward.
研究了一位外科医生（R.H.）在10年期间对甲状腺结节进行术中冰冻切片（FS）检查的经验，以评估FS在滤泡性甲状腺病变中的实用性。对110例表现为滤泡性生长模式的优势或孤立性结节患者进行了评估。研究中的病理学家（M.P.B.，VAL.）在不知道原始诊断的情况下复查了FS切片以及随后的结节永久切片。我们的结果表明：（1）如果FS明确为良性（58例患者），最终诊断为良性[这些病变包括腺瘤性结节、结节性甲状腺肿、滤泡性腺瘤和许特莱细胞腺瘤]；（2）如果FS诊断为恶性（4例患者），在永久切片上得到证实（4例均为乳头状癌的滤泡变体）；（3）如果FS诊断延迟（48例患者），除10例（21%）外，最终诊断均为良性（这10例中，6例为微小浸润性滤泡癌[2例为许特莱细胞型]，4例为乳头状癌的滤泡变体）。总体而言，FS诊断的敏感性、特异性和准确率分别为29%、100%和91%。由于单侧甲状腺叶切除术可能是分化型甲状腺癌的可接受治疗方法，并且由于FS评估在诊断恶性肿瘤方面的效率较低（110例患者中只有4例在FS时被诊断为恶性肿瘤，总体为3.6%），我们得出结论，在这个成本控制的时代，FS对于术前经细针穿刺细胞学检查确定为滤泡性病变的滤泡性甲状腺结节的评估没有用处。还针对FS诊断的3种类型（即明确良性、明确恶性——尤其是乳头状癌的滤泡变体——和延迟诊断）提出了一些建议。
