Chen H, Nicol T L, Udelsman R
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ann Surg. 1995 Jul;222(1):101-6. doi: 10.1097/00000658-199507000-00016.
The authors determined the usefulness of frozen section (FS) evaluation in the operative management of follicular lesions of the thyroid.
Fine-needle aspiration (FNA) cannot reliably discriminate between benign and malignant follicular lesions of the thyroid. Accordingly, FS evaluation is used routinely to guide intraoperative management.
One hundred twenty-five consecutive patients with follicular thyroid lesions who underwent surgical exploration at the Johns Hopkins Hospital were reviewed.
Frozen sections were categorized in 104 of 120 patients (87%) as "follicular lesion, defer to permanent section," rendering no useful clinical information. In only 4 of 120 patients (3.3%) did FS evaluation correctly modify the operative procedure. Notably, in six cases (5.0%), an incorrect FS evaluation misled the surgeon, resulting in four misguided operations.
Frozen section evaluation is of minimal diagnostic value for follicular thyroid lesions, rendering no additional information 87% of the time; it prolongs the operation, increases costs, and leads to misguided interventions. Until a more definitive diagnostic tool exists for follicular thyroid lesions, FS evaluation could be omitted, resection of the lobe with the nodule could be performed, and the definitive operative management could be based on the final permanent histology.
作者确定了冰冻切片（FS）评估在甲状腺滤泡性病变手术管理中的作用。
细针穿刺抽吸（FNA）无法可靠地区分甲状腺良性和恶性滤泡性病变。因此，FS评估通常用于指导术中管理。
回顾了约翰霍普金斯医院连续125例接受手术探查的甲状腺滤泡性病变患者。
120例患者中有104例（87%）的冰冻切片分类为“滤泡性病变， defer to permanent section”，未提供有用的临床信息。120例患者中只有4例（3.3%）FS评估正确地改变了手术方式。值得注意的是，在6例（5.0%）中，错误的FS评估误导了外科医生，导致4次错误的手术。
冰冻切片评估对甲状腺滤泡性病变的诊断价值极小，87%的情况下未提供额外信息；它延长了手术时间，增加了成本，并导致错误的干预。在有更明确的甲状腺滤泡性病变诊断工具之前，可以省略FS评估，对有结节的叶进行切除，最终的手术管理可基于最终的永久组织学检查。
