Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello. Medellín, Colombia.
Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Surg Oncol. 2021 Mar;36:76-81. doi: 10.1016/j.suronc.2020.12.005. Epub 2020 Dec 8.
Thyroid nodules are a very common clinical condition. The 2015 American Thyroid Association (ATA) guidelines recommend surgical excision for Bethesda IV nodules. The use of intraoperative frozen section (FS) has been recommended as a strategy to tailor the extent of the initial surgery. We critically evaluated the literature that discusses the utility and cost-effectiveness of FS to make an intraoperative decision in patients with thyroid nodules classified as follicular neoplasm. FS should not be recommended as a routine intraoperative test to assess for malignancy in thyroid follicular patterned lesions due to its low performance; the high number of deferred results; the inability to adequately assess histologically defining features; the improvements in risk stratification guiding total thyroidectomy; and the low cost-effectiveness of FS.
甲状腺结节是一种非常常见的临床病症。2015 年美国甲状腺协会（ATA）指南建议对 Bethesda IV 结节进行手术切除。术中冷冻切片（FS）的使用被推荐作为一种策略，以调整初始手术的范围。我们对讨论 FS 在术中决策中的效用和成本效益的文献进行了批判性评估，这些决策是针对甲状腺滤泡性肿瘤患者的。由于其性能较低、大量的延迟结果、无法充分评估组织学定义特征、改善指导全甲状腺切除术的风险分层以及 FS 的低成本效益，FS 不应该被推荐作为评估甲状腺滤泡性病变恶性肿瘤的常规术中检查。
