Document Type : Original Research
Dept. of Pathology Pratima Institute Medical Sciences, Karimnagar, A.P , India
Dept. of Pathology, BLDE University’s Shri BM Patil Medical College, Bijapur , Karimnagar, India
Background and Objectives: Thyroid gland because of its superficial location is amenable to direct physical examination. Clinical assessment of thyroid lesions by means of physical examination, thyroid scans and ultrasonography is not completely reliable. Fine needle aspiration cytology (FNAC) is the most cost-effective, safe and an initial diagnostic test in the pre-operative evaluation of thyroid lesions. Many surgeons use intraoperative frozen section biopsies to confirm the diagnosis of FNAC and guide the extent of thyroidectomy. Therefore, the objective of the present study was to assess the diagnostic accuracy of frozen section in comparison with fine needle aspiration cytology and histopathology in thyroid lesions.
Materials & Methods: Fine needle aspiration cytology and frozen section (FS) were evaluated in 59 patients. FNAC was classified as benign, malignant and suspicious, and FS was classified as benign, deferred and malignant. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for both FS and FNAC.
Results: Out of 59 patients, 3 were positive for malignancy, 51 were benign, and five were suspicious on FNAC. Over all accuracy of fine needle aspiration cytology was 93%. Five were positive for malignancy, 50 were benign and 4 were “deferred” in frozen section. Over all accuracy of frozen section was 96%.
Discussion: Fine needle aspiration cytology can be used primarily to select patient for surgery and frozen section can be employed to plan the extent of surgery. Frozen section had a good accuracy, sensitivity and negative predictive value compared to fine needle aspiration cytology.
- El-Kayali A, El-Bakry A. Accuracy of fine needle aspiration and frozen section in the management of thyroid nodules. Kuwait Med J 2001; 33(2):116-9.
- McHenry CR, Raeburn C, Strickland T, Marty JJ. The utility of routine frozen section examination for intraoperative diagnosis of thyroid cancer. Am J Surg 1996; 172:658-61.
- Rosen Y, Rosenblatt P, Saltzman E. Intraoperative pathologic diagnosis of thyroid neoplasms. Cancer 1990; 66:2001-6.
- Chang HY, Lin JD , Chen JF, Huang BY, Hsueh C, Jeng LB, Tsai JS. Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol 1997; 50(12):1005-9.
- Sadler TW. Langman’s medical embryology. 9th ed. Maryland: Lippincott Williams & Wilkins;2004.
- Roach JC, Heller KS, Dubner S, Sznyter LA. The value of frozen section examinations in determining the extent of thyroid surgery in patients with indeterminate fine-needle aspiration cytology. Arch Otolaryngol Head Neck Surg 2002; 128(3):263-7.
- Basharat R, Bukhari MH, Saeed S, Hamid T. Comparison of Fine needle aspiration cytology and Thyroid scan in solitary thyroid nodule. Pathol Res Int 2011. doi:10.4061/2011/754041.
- Lumachi F, Borsato S, Tregnaghi A, Marino F, Polistina F, Basso SM, et al. FNA cytology and frozen section examination in patients with follicular lesions of the thyroid. Anticancer Res 2009;29(12):5255-8.
- Srinivas Pai B, Anand VN, Shenoy KR. Diagnostic Accuracy of Fine-Needle Aspiration Cytology Versus Frozen Section In Solitary Thyroid Nodules: The Internet Journal of Surgery2007; 12(2): DOI: 10.5580/e9a
- C. Batra, S. Singh, R. Katra, N. Marwah, S. Marwah, A. Atreja: Role of Fine Needle Aspiration and Frozen Section in the Diagnosis of Thyroid Lesions. The Internet J Pathology 2010;11(1):doi:10.5580/a77.
- Anton RC, Wheeler TM. Frozen section of thyroid and parathyroid specimens. Arch Pathol Lab Med 2005; 129:1575-84.
- Almeida JPAD, Netto SDDC, Rocha RPD, Pfuetzenreiter Jr EG, Dedivitis RA. The role of intraoperative frozen sections for thyroid nodules. Braz J Otorhinolaryngol 2009; 75(2):256-60.
- Rosai J. Ackerman’s surgical pathology. 9th ed. New Delhi: Elsevier; 2004.
- Makes B. Accuracy of frozen-section combined with imprint and fine needle aspiration biopsy in thyroid nodules. Med J Indones 2007;16(2): 89-93.
- Mandell DL, Genden EM, Mechanick JI, Bergman DA, Biller HF, Urken ML. Diagnostic accuracy of fine-needle aspiration and frozen section in nodular thyroid disease. Otolaryngol Head Neck Surg 2001;124(5):531-6.
- Keller MP, Crabbe MM, Norwood SH. Accuracy and significance of FNAC and frozen section in determining extent of surgery. Surgery 1987; 101:632-5.
- Sabel MS, Staren ED, Gianakakis LM, Dwarakanathan S, Prinz RA. User of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule. Surgery 1997; 122(6):1021-6.
- Gulia SP, Chaudhury M, Sitaramam E, Reddy KP. Diagnostic accuracy of fine needle aspiration cytology in the diagnosis of thyroid lesions. The Internet J Surgery2011; 13(1). doi:10.5580/11d5.