Vuong Christopher D, Watson WayAnne B, Kwon Daniel I, Mohan Sonia S, Perez Mia N, Lee Steve C, Simental Alfred A
Department of Otolaryngology- Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, United States.
Loma Linda School of Medicine, Loma Linda University Medical Center, Loma Linda, California, United States.
Arch Endocrinol Metab. 2020 Aug;64(4):356-361. doi: 10.20945/2359-3997000000263. Epub 2020 Jun 29.
Objective This study aims to determine the cost effectiveness of rapid frozen section (RFS) for indeterminate thyroid nodules. Materials and methods A retrospective chart review was conducted between January 2009 and June 2013 at a tertiary care institution. Main outcomes were number needed to treat, RFS efficacy, and cost-savings of avoiding second completion thyroidectomy. Cost-effectiveness was estimated using 2015 Medicare reimbursement rate. Results Out of 1,114 patients undergoing thyroid surgery, 314 had preoperative AUS/FLUS cytopathology and subsequent thyroid lobectomy with RFS. RFS identified 13 of the 32 patients with malignancy resulting in a total thyroidectomy. 19 of the 29 malignancies not detected by RFS were papillary microcarcinomas. Conclusions Completion thyroidectomy was avoided in 1 out of every 24 patients resulting in cost-savings of $ 80.04 per patient. In the era of outpatient thyroid surgery, intraoperative RFS for indeterminate thyroid nodules is cost-effective.
目的 本研究旨在确定快速冰冻切片（RFS）对甲状腺结节性质不确定患者的成本效益。材料与方法 2009年1月至2013年6月在一家三级医疗机构进行了一项回顾性病历审查。主要结局指标为治疗所需人数、RFS疗效以及避免二次甲状腺全切术的成本节约情况。使用2015年医疗保险报销率估算成本效益。结果 在1114例接受甲状腺手术的患者中，314例术前甲状腺细针穿刺活检结果为意义不明确的非典型细胞/滤泡性病变不明意义（AUS/FLUS），随后接受了甲状腺叶切除术及RFS。RFS在32例恶性肿瘤患者中识别出13例，从而进行了甲状腺全切术。RFS未检测出的29例恶性肿瘤中有19例为微小乳头状癌。结论 每24例患者中有1例避免了甲状腺全切术，每位患者节约成本80.04美元。在门诊甲状腺手术时代，对甲状腺结节性质不确定患者进行术中RFS具有成本效益。
