Gern Jesper, Arbogast Michael, Alakus Hakan, Brunner Stefanie, Schmidt Matthias, Faust Michael, Bruns Christiane Josephine, Schultheis Anne Maria, Chiapponi Costanza
Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, Cologne, Germany.
Department of General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal, Cologne, Germany.
Gland Surg. 2024 May 30;13(5):630-639. doi: 10.21037/gs-23-105. Epub 2024 May 23.
Frozen section (FS) analysis is strongly influenced by the experience of surgeons and pathologists. We analyzed its performance in a secondary care hospital with surgical and pathologic experience transferred from a university hospital.
Indications, results, and consequences of all thyroid FS performed between January 1, 2021 and December 31, 2022 were critically reviewed.
FS was performed in 90 (26.5%) of 340 procedures. Indications consisted in a suspicious fine needle biopsy in 28 (31.1%) cases, (99m) Technetium-Methoxy-Isobutyl-Isonitrile (MIBI) retaining hypofunctional nodules in 25 (27.8%), the intraoperative appearance in 18 (20%), the sonographic appearance in 18 (20%) and a positron emission tomography (PET) positive result in 1 case (1.1%). Malignancy was diagnosed in 21 (23.3%) and confirmed by final histology in all cases (100%). In the remaining 69 (76.7%) FS displaying no positive malignancy criteria, final histology delivered benign in 62 (89.8%) and malignant diagnoses in 7 cases (10.1%). 25% of thyroid carcinomas could not be diagnosed by FS. FS sensitivity was consequently 75% (95% CI: 55.1-89.3%). All missed malignancies were papillary thyroid carcinomas of follicular variant (fvPTC). FS sensitivity was lowest in MIBI positive hypofunctional nodules (33%) and Bethesda III (50%) as opposed to Bethesda V (92.9%) and to those cases with suspicious sonographic or intraoperative appearance (71.4%). Two-staged surgery was necessary in 10 (15.8%) of carcinomas.
Sensitivity of FS in a secondary care hospital offering surgical and pathologic experience from a specialized university center is 75% and mainly reduced by the prevalence of fvPTC. Omitting FS in Bethesda III and MIBI positive hypofunctional nodules might improve FS performance.
冰冻切片（FS）分析受外科医生和病理学家经验的影响很大。我们在一家从大学医院转来具有手术和病理经验的二级护理医院分析了其性能。
对2021年1月1日至2022年12月31日期间进行的所有甲状腺FS的指征、结果和后果进行了严格审查。
在340例手术中有90例（26.5%）进行了FS。指征包括28例（31.1%）细针穿刺活检可疑、25例（27.8%）（99m）锝 - 甲氧基 - 异丁基 - 异腈（MIBI）摄取减低的低功能结节、18例（20%）术中表现、18例（20%）超声表现以及1例（1.1%）正电子发射断层扫描（PET）阳性结果。21例（23.3%）诊断为恶性，所有病例（100%）均经最终组织学证实。在其余69例（76.7%）FS未显示恶性阳性标准的病例中，最终组织学显示62例（89.8%）为良性，7例（10.1%）为恶性诊断。25%的甲状腺癌无法通过FS诊断。因此，FS敏感性为75%（95%置信区间：55.1 - 89.3%）。所有漏诊的恶性肿瘤均为滤泡变异型乳头状甲状腺癌（fvPTC）。FS敏感性在MIBI阳性低功能结节（33%）和贝塞斯达III级（50%）中最低，而在贝塞斯达V级（92.9%）以及超声或术中表现可疑的病例中（71.4%）较高。10例（15.8%）癌需要进行二期手术。
在一家提供来自专业大学中心手术和病理经验的二级护理医院中，FS的敏感性为75%，主要因fvPTC的患病率而降低。在贝塞斯达III级和MIBI阳性低功能结节中省略FS可能会提高FS性能。
