The Role of Fine-Needle Aspiration Cytology and Frozen Section in the Operative Management of Thyroid Nodule / 대한내분비외과학회지

PURPOSE: Traditionally the extent of thyroidectomy in patients with nodular thyroid disease has been based on fine needle aspiration cytology and intraoperative frozen section examination. The value of routine frozen section examination for intraoperative diagnosis of thyroid cancer and determination of extent of thyroidectomy is controversial and needs to be evaluated. METHODS: We reviewed the fine needle aspiration cytology, frozen section examination, and final pathology of 142 consecutive patients who underwent thyroidectomy for nodular thyroid mass in an 3-year period. The diagnosis were classified as indeterminant, benign, or malignant. The utility and impact of the diagnosis from fine needle aspiration or frozen section on the operative procedure performed was analyzed. RESULTS: Fine needle aspiration cytology (FNA) as a diagnostic test for thyroid nodules demonstrated an indeterminant rate of 23.9% (34 patients), with diagnostic accuracy of 93.9% for malignant disease. In frozen section (FS) results, the indeterminant rate was 19.7%, and the diagnostic accuracy 98.3% for malignant disease. Of the 50 patients with the benign results on FNA, 3 patients was diagnosed as malignancy on FS. Of the 34 patients with indeterminant results on FNA, the intraoperative FS diagnosis showed 16 patients of benign, 3 patients of malignancy, and diagnosis on 15 patients was deferred to permanent section; in 15 patients, benign disease was diagnosed in 12 patients, and 3 patients were diagnosed as malignancy. And one of 10 patients with inadequate result on FNA was diagnosed as malignancy on FS. Therefore the decision about the extent of surgical thyroid resection was changed in 7 patients (4.9%) based on the FS results, and including the 16 patients diagnosed as benign on FS with indeterminant results on FNA, overall, in 23 patients (16.2%) the intraoperative surgical decision was affected by FS. CONCLUSION: The fine needle aspiration cytology and intraoperative frozen section examination showed the limitation on diagnosis of follicular neoplasm, but intraoperative frozen section examination proved useful in determining the extent of operation and affected intraoperative decision making in thyroid surgery.

Clinical Analysis of Right Colonic Diverticulitis That was Operated under the Impression of Acute Appendicitis

PURPOSE: Because there are no significant differences of the clinical findings between the appendicitis and cecal diverticulitis, it is very difficult to make a correct diagnosis preoperatively and to choose a appropriate management intraoperatively. The purpose of this study is to investigate the clinical charateristics of right diveticulitis and to evaluate the appropriateness of surgical management. METHODS: We reviewed 45 cases of right colonic diverticulitis which underwent emergency operation under the impression of acute appendicitis during 10 years from January 1988 to December 1997. RESULTS: Of them, 38 cases were treated by diverticulectomy with appendectomy (Group I), and 7 cases were treated by resection (ileocecal resection or right hemicolectomy) (Group II). The male to female ratio was 4:1, and the mean age was 38.2 years. In Group I, all cases had a solitary inflamed cecal diverticulum. In group II, two cases had a solitary cecal diverticulitis, whereas five cases had multiple ones. Postoperative complications were found in 14 cases, but all of them were not significant. Postoperative Barium enema was performed in 22 cases of Group I, in two cases of Group II. In Group I, 8 cases had a residual diverticulum at postoperative Barium enema. In Group II, no residual diverticulum was shown. Follow-up study by Telephone was done at 16 cases, there were no symptomatic recurrences. CONCLUSIONS: In conclusion, when right colonic diverticulitis is found at the time of operation, surgical management is a safe treatment with low morbidity and low recurrence rate. Diverticulectomy with appendectomy is a safe surgical procedure for the uncomplicated diverticulitis. If diverticulitis is complicating, multiple or undistinguishable with malignancy, resection (ileocecal resection, right hemicolectomy) should be considered as a primary surgical treatment. Postoperative colon study is helpful, due to high incidence of residual diverticulum.