Table 4. Twelve cases in which diagnosis changed after surgery.
| Alleged adverse event | Alleged violation | Preoperative examination | Diagnosis | Extent of surgery (year) | Court decision† | ||
|---|---|---|---|---|---|---|---|
| Preoperative (size) | FSE result | Final | |||||
| Unnecessary surgery | Not examining FNAC | FNAC‡, CT | PTC (0.4 cm) | – | Nodular hyperplasia | TL (in 2014) | O |
| Unnecessary surgery | Not examining FNAC | CT | Multiple nodule (3.8 cm) | – | Benign nodule | TL (in 2015) | O |
| Unnecessary surgery | Misinterpretation of FNAC result | TFT, US, Scan, FNAC, CT | PTC (2 cm) | Adenomatous hyperplasia | Benign tumor |
TL (in 2006) | X |
| Unnecessary surgery | Misinterpretation of FNAC result | US, FNAC | PTC (0.55 cm) | Follicular adenoma | HTA | TL (in 2012) | X |
| Unnecessary surgery | Disregard for FSE result | TFT, FNAC, CT → after 5 months, US | PTC | Thyroiditis | Hashimoto’s Thyroiditis | TT (in 2009) | O |
| Unnecessary surgery | Disregard for FSE result | FNAC ‡, US | Malignant nodule | Hashimoto’s Thyroiditis | Hashimoto’s Thyroiditis | TT (in 2010) | O |
| Unnecessary surgery | Disregard for FSE result | US, FNAC → after 3 months, FNAC | Indeterminate atypical nodule (1 cm) | Follicular hyperplasia | Follicular adenoma | TT (in 2012) | X |
| Unnecessary surgery | Misinterpretation of FSE result | FNAC → after 1 month, FNAC & CT | Malignant tumor (1.57 cm) | Follicular variant of PTC | Follicular adenoma | TT (in 2005) | X |
| Unnecessary surgery | Not examining FNAC for LN | FNAC, CT | PTC with LN enlargement | – | Tumor without LNM | TT with LN dissection (in 2009) | X |
| Delayed diagnosis | Not examining FNAC | US | Cancer (3–4 cm) | – | Cancer with LNM | TT without LN dissection (in 2004) | O |
| Delayed diagnosis | Failure to detect cancer | US, FNAC | Atypical cell | – | PTC § | – | X |
| Delayed diagnosis | Failure to detect cancer | US, Scan, FNAC → monthly US×3 → FNAC → monthly US×3 → FNAC → monthly US×2 | Atypical nodule | – | PTC § | – | X |
†, O: recognition of defendant’s malpractice; X: dismissal for claim. ‡, examination performed at another hospital before visiting the defendant (about 10 days prior). §, diagnosis in another hospital after visiting the defendant. US, ultrasonography; FNAC, fine-needle aspiration cytology; FSE, frozen section examination; TFT, thyroid function test; PTC, papillary thyroid carcinoma; TT, total thyroidectomy; TL, thyroid lobectomy; HTA, hyalinizing trabecular adenoma; LNM, lymph node metastasis.