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10.1245/s10434-006-9083-z
Annals of Surgical Oncology 14:712-718 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis

Tzu-Chieh Chao, MD, PhD1,4, Jen-Der Lin, MD2,5, Hsiao-Hsiang Chao, MD1, Chuen Hsueh, MD3,6 and Miin-Fu Chen, MD1,4

1 Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan
2 Department of Internal Medicine, Division of Metabolism and Endocrinology, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan
3 Department of Pathology, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan
4 Department of Surgery, Chang Gung University College of Medicine, 259 Wenhwa 1st Road, Kweishan, Taoyuan, Taiwan
5 Department of Internal Medicine, Chang Gung University College of Medicine, 59 Wenhwa 1st Road, Kweishan, Taoyuan, Taiwan
6 Department of Pathology, Chang Gung University College of Medicine, 59 Wenhwa 1st Road, Kweishan, Taoyuan, Taiwan

Correspondence: Address correspondence and reprint requests to: Tzu-Chieh Chao, MD, PhD; E-mail: tcchao{at}adm.cgmh.org.tw

Background: Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy.

Methods: This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy.

Results: Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively.

Conclusions: FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.

Key Words: Nodule • Fine-needle biopsy • Frozen section • Thyroid






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