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. 1997 Dec;50(12):1005–1009. doi: 10.1136/jcp.50.12.1005

Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.

H Y Chang 1, J D Lin 1, J F Chen 1, B Y Huang 1, C Hsueh 1, L B Jeng 1, J S Tsai 1
PMCID: PMC500381  PMID: 9516882

Abstract

AIMS: To evaluate the correlation of fine needle aspiration (FNA) cytology and frozen section biopsy in the diagnosis of thyroid nodules. METHODS: The medical records of 662 patients who underwent FNA cytology of the thyroid and thyroid surgery were analysed. Frozen section biopsies were taken from 586 of the 662 patients. The diagnostic correlations of FNA cytology, frozen section, and both FNA cytology and frozen section with definitive histological assessment were evaluated. RESULTS: Among the 662 patients who received FNA cytology, there were 356 cases (53.8%) diagnosed as benign, 114 cases (17.2%) as malignant, 148 cases (22.4%) as indeterminate, and 44 cases (6.6%) as unsatisfactory. The positive predictive value for the detection of malignancy by FNA cytology was 92.1% and the negative predictive value was 95.2%. The incidence of malignancy in the indeterminate cytological diagnosis was 23%. The diagnosis from frozen sections was benign in 445 cases (75.9%), malignant in 134 cases (22.9%), and deferred in 7 cases (1.2%). By frozen section, the positive and negative predictive values were 97% and 95.5%, respectively. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses were in agreement. No false positives were observed when FNA cytology and frozen sections were both positive for malignancy. When FNA cytology and frozen section diagnoses were discordant, frozen section showed a higher accuracy (78.9%) than FNA cytology (21.1%). In the face of an indeterminate or unsatisfactory cytological diagnosis, the diagnostic accuracy of frozen sections reached 92.6%. CONCLUSIONS: The results confirm that FNA cytology is a useful tool in the initial evaluation of thyroid nodules. Intraoperative frozen section is a valuable procedure to confirm the cytological diagnosis and identify malignancy in patients with indeterminate or unsatisfactory cytological diagnosis. With reliance on frozen sections as an intraoperative guide of thyroid surgery, the possibility of unnecessary extensive surgery and the need for the second operation are considerably lower.

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Selected References

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  1. Aggarwal S. K., Jayaram G., Kakar A., Goel G. D., Prakash R., Pant C. S. Fine needle aspiration cytologic diagnosis of the solitary cold thyroid nodule. Comparison with ultrasonography, radionuclide perfusion study and xeroradiography. Acta Cytol. 1989 Jan-Feb;33(1):41–47. [PubMed] [Google Scholar]
  2. Altavilla G., Pascale M., Nenci I. Fine needle aspiration cytology of thyroid gland diseases. Acta Cytol. 1990 Mar-Apr;34(2):251–256. [PubMed] [Google Scholar]
  3. Bugis S. P., Young J. E., Archibald S. D., Chen V. S. Diagnostic accuracy of fine-needle aspiration biopsy versus frozen section in solitary thyroid nodules. Am J Surg. 1986 Oct;152(4):411–416. doi: 10.1016/0002-9610(86)90314-4. [DOI] [PubMed] [Google Scholar]
  4. Godinho-Matos L., Kocjan G., Kurtz A. Contribution of fine needle aspiration cytology to diagnosis and management of thyroid disease. J Clin Pathol. 1992 May;45(5):391–395. doi: 10.1136/jcp.45.5.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Griffies W. S., Donegan E., Abel M. E. The role of fine needle aspiration in the management of the thyroid nodule. Laryngoscope. 1985 Sep;95(9 Pt 1):1103–1106. [PubMed] [Google Scholar]
  6. Hall T. L., Layfield L. J., Philippe A., Rosenthal D. L. Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer. 1989 Feb 15;63(4):718–725. doi: 10.1002/1097-0142(19890215)63:4<718::aid-cncr2820630420>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  7. Hamburger J. I., Hamburger S. W. Declining role of frozen section in surgical planning for thyroid nodules. Surgery. 1985 Aug;98(2):307–312. [PubMed] [Google Scholar]
  8. Hsiao Y. L., Chang T. C. Prevalence of goiter in Taiwanese adults: a preliminary study. J Formos Med Assoc. 1995 Apr;94(4):197–199. [PubMed] [Google Scholar]
  9. Keller M. P., Crabbe M. M., Norwood S. H. Accuracy and significance of fine-needle aspiration and frozen section in determining the extent of thyroid resection. Surgery. 1987 May;101(5):632–635. [PubMed] [Google Scholar]
  10. Layfield L. J., Mohrmann R. L., Kopald K. H., Giuliano A. E. Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules. Cancer. 1991 Jul 1;68(1):130–134. doi: 10.1002/1097-0142(19910701)68:1<130::aid-cncr2820680124>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  11. Lin J. D., Weng H. F., Huang M. J., Huang B. Y., Huang H. S., Jeng L. B. Thyroid cancer treated in Chang Gung Memorial Hospital (northern Taiwan) during the period 1979-1992: clinical presentation, pathological finding, analysis of prognostic variables, and results of treatment. J Surg Oncol. 1994 Dec;57(4):252–260. doi: 10.1002/jso.2930570409. [DOI] [PubMed] [Google Scholar]
  12. Löwhagen T., Sprenger E. Cytologic presentation of thyroid tumors in aspiration biopsy smear. A review of 60 cases. Acta Cytol. 1974 May-Jun;18(3):192–197. [PubMed] [Google Scholar]
  13. Mazzaferri E. L. Thyroid cancer in thyroid nodules: finding a needle in the haystack. Am J Med. 1992 Oct;93(4):359–362. doi: 10.1016/0002-9343(92)90163-6. [DOI] [PubMed] [Google Scholar]
  14. Miller J. M., Kini S. R., Hamburger J. I. The diagnosis of malignant follicular neoplasms of the thyroid by needle biopsy. Cancer. 1985 Jun 15;55(12):2812–2817. doi: 10.1002/1097-0142(19850615)55:12<2812::aid-cncr2820551216>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  15. Rodríguez J. M., Parrilla P., Sola J., Bas A., Aguilar J., Moreno A., Soria T. Comparison between preoperative cytology and intraoperative frozen-section biopsy in the diagnosis of thyroid nodules. Br J Surg. 1994 Aug;81(8):1151–1154. doi: 10.1002/bjs.1800810822. [DOI] [PubMed] [Google Scholar]
  16. Schmid K. W., Ladurner D., Zechmann W., Feichtinger H. Clinicopathologic management of tumors of the thyroid gland in an endemic goiter area. Combined use of preoperative fine needle aspiration biopsy and intraoperative frozen section. Acta Cytol. 1989 Jan-Feb;33(1):27–30. [PubMed] [Google Scholar]
  17. Shaha A. R., DiMaio T., Webber C., Jaffe B. M. Intraoperative decision making during thyroid surgery based on the results of preoperative needle biopsy and frozen section. Surgery. 1990 Dec;108(6):964–971. [PubMed] [Google Scholar]
  18. Tielens E. T., Sherman S. I., Hruban R. H., Ladenson P. W. Follicular variant of papillary thyroid carcinoma. A clinicopathologic study. Cancer. 1994 Jan 15;73(2):424–431. doi: 10.1002/1097-0142(19940115)73:2<424::aid-cncr2820730230>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]

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