Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Faculdade de Medicina, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil.
Arch Endocrinol Metab. 2022 Mar 8;66(1):50-57. doi: 10.20945/2359-3997000000445.
A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules.
To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard.
In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy.
Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated.
甲状腺结节的主要医学相关性在于排除甲状腺癌，甲状腺癌约占所有甲状腺结节的 5%。细针穿刺活检（FNAB）在鉴别良恶性甲状腺结节方面具有重要作用，这归因于其可用性和诊断性能。然而，术中冷冻切片（iFS）仍然被提倡作为手术计划的有价值工具，特别是对于不确定的结节。
比较 FNAB 和 iFS 在甲状腺癌诊断中的性能，用于贝塞斯达分类（BC）I 至 VI 类的结节。FNAB 和 iFS 检测的性能使用最终组织病理学结果作为金标准进行计算。
共有 316 名患者纳入分析。272 名患者（86.1%）有 FNAB 和 iFS 数据。总的恶性肿瘤发生率为 30.4%（n=96）。FNAB 对良性（BC II）和恶性（BC V 和 VI）的灵敏度、特异性和准确率分别为 89.5%、97.1%和 94.1%。对于所有评估的结节，iFS 的灵敏度、特异性和准确率分别为 80.9%、100%和 94.9%。对于不确定的结节和滤泡性病变（BC III 和 IV），iFS 的灵敏度、特异性和准确率分别为 25%、100%和 88.7%。对于 BC I 结节，iFS 的准确率为 95.2%。
我们的结果不支持对不确定的结节或滤泡性肿瘤（BC III 和 IV）常规进行 iFS，因为其灵敏度较低。在这些类别中，iFS 不足以准确指导甲状腺切除术的术中管理。对 BC I 结节进行 iFS 可能是一种选择，应具体进行研究。
