Uludag Mehmet, Cetinoglu Isik, Unlu Mehmet Taner, Kostek Mehmet, Caliskan Ozan, Aygun Nurcihan
Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
Sisli Etfal Hastan Tip Bul. 2023 Dec 29;57(4):441-450. doi: 10.14744/SEMB.2023.91129. eCollection 2023.
In endocrine pathology, frozen section (FS) examination is most commonly used for the intraoperative evaluation of thyroid and parathyroid tumors, as well as cervical lymph nodes. In the past, frozen section was considered a fundamental tool in thyroid surgery. However, with advancements in preoperative ultrasound and fine-needle aspiration biopsy (FNAB), there have been increasing queries about its routine use due to the improved preoperative diagnosis. Nowadays, while the use of FS during thyroidectomy has decreased, it is still used as an additional method for different purposes intraoperatively. FS may not always provide definitive results. If FS will alter the surgical plan or extent, it should be applied. Routine FS is not recommended for evaluating thyroid nodules. But in addition to FNAB, if FS results may change the operation plan or extent, they can be utilized. FS should not be applied for thyroid lesions smaller than 1 cm, and the entire lesion should not be frozen for FS. For the assessment of thyroid nodules, the use of FS is recommended based on the Bethesda categories of FNAB. In Bethesda I category nodules, FS may contribute to distinguishing between malignant and benign lesions and guide surgical treatment. In Bethesda II nodules, where the malignancy rate is low, the performance of FNAB and FS can be compared, but it's not recommended due to the lack of a significant contribution to the surgical strategy. The sensitivity of FS in Bethesda III and IV nodules is low; its contribution to the diagnosis is limited, and it does not provide an apparent benefit to treatment; therefore, it is not recommended. In Bethesda V nodules, FS can effectively confirm the malignancy diagnosis, contribute to the surgical strategy, and reduce the possibility of completion thyroidectomy, and accordingly, it is recommended for use. Nonetheless, in Bethesda V nodules with a benign FS report, the malignancy rate remains high, so it should not be used to rule out malignancy. In Bethesda VI nodules, the performance of FS is lower or comparable to FNAB and does not significantly contribute to the treatment strategy; hence, it is not recommended. Particularly in patients with papillary thyroid cancer, intraoperative FS can be effective in detecting extrathyroidal extension and can assist the surgeon in determining the extent of thyroid surgery and central neck dissection. FS has high sensitivity and specificity in evaluating the lymphatic status of the central region intraoperatively and can be used to determine the extent of central compartment node dissection. During thyroidectomy, FS examination can be used in recognizing parathyroid tissue and distinguishing it from fatty tissue, thymus, thyroid, lymph nodes, especially in differentiating metastatic lymph nodes.
在内分泌病理学中，冰冻切片（FS）检查最常用于甲状腺和甲状旁腺肿瘤以及颈部淋巴结的术中评估。过去，冰冻切片被认为是甲状腺手术的一项基本工具。然而，随着术前超声和细针穿刺活检（FNAB）技术的进步，由于术前诊断的改善，人们对其常规使用的质疑越来越多。如今，虽然甲状腺切除术中FS的使用有所减少，但它仍作为术中用于不同目的的辅助方法。FS可能并不总是能提供明确的结果。如果FS会改变手术计划或范围，则应应用。不建议常规使用FS来评估甲状腺结节。但除FNAB外，如果FS结果可能改变手术计划或范围，则可以采用。对于小于1 cm的甲状腺病变不应应用FS，且不应将整个病变进行冰冻以作FS检查。对于甲状腺结节的评估，建议根据FNAB的贝塞斯达分类来使用FS。在贝塞斯达I类结节中，FS可能有助于区分恶性和良性病变并指导手术治疗。在恶性率较低的贝塞斯达II类结节中，可以比较FNAB和FS的表现，但由于对手术策略没有显著贡献，不建议使用。FS在贝塞斯达III类和IV类结节中的敏感性较低；其对诊断的贡献有限，对治疗没有明显益处；因此，不建议使用。在贝塞斯达V类结节中，FS可以有效地确认恶性诊断，有助于手术策略制定，并降低甲状腺全切术的可能性，因此，建议使用。尽管如此，在FS报告为良性的贝塞斯达V类结节中，恶性率仍然很高，所以不应使用它来排除恶性。在贝塞斯达VI类结节中，FS的表现低于或与FNAB相当，对治疗策略没有显著贡献；因此，不建议使用。特别是在甲状腺乳头状癌患者中，术中FS可有效检测甲状腺外侵犯，并可协助外科医生确定甲状腺手术和中央区淋巴结清扫的范围。FS在术中评估中央区淋巴结状态方面具有较高的敏感性和特异性，可用于确定中央区淋巴结清扫的范围。在甲状腺切除术中，FS检查可用于识别甲状旁腺组织，并将其与脂肪组织、胸腺、甲状腺、淋巴结区分开来，尤其是在鉴别转移性淋巴结方面。
