In Thyroid Cancer Patients, Is Preoperative FNAB-C Reliable for Prediction of Lateral Cervical LN Metastasis? / 대한내분비외과학회지

PURPOSE: The goal of this study was to evaluate the diagnostic accuracy of preoperative fine needle aspiration biopsy cytology (FNAB-C) in predicting lateral lymph node metastasis in papillary thyroid cancer patients. METHODS: A total of 592 patients who underwent thyroid cancer surgery and intra-operative lateral cervical LN frozen section or RND, from January 2002 to December 2011, were evaluated retrospectively. Among them, 228 cases had suspicious findings in FNAB-C of lateral nodes. We reviewed their radiological and pathological reports. RESULTS: Intra-operative frozen section examination was performed in 540 cases and RND was performed in 314 cases. This study included 534 women (83.4%) and 106 men (16.6%). Patients' ranged in age from 9 to 83 years (mean, 45.65 years). FNAB-C was performed in 228 cases. The sensitivity and specificity of FNAB-C was 71.5% and 78.6%, respectively; 35.9% of cases had a false negative result. The combination of FNAB-C and intra-operative frozen section test sensitivity and specificity was 87.2% and 93.6%, respectively. CONCLUSION: The results for sensitivity in FNAB-C actually appear low, and false negative results were very high. In papillary thyroid cancer in patients with FNAB-C, even if the result is negative, if lymph node metastasis is suspected based on radiologic evidence, frozen section examination should be performed for determination of metastasis.

La biopsia por congelación en las afecciones quirúrgicas de la glándula tiroides / Frozen section biopsy in surgical disorders of the thyroid gland

La presencia de un nódulo en la glándula tiroides continúa siendo un reto para los cirujanos. El riesgo de no detectar una neoplasia maligna persiste, incluso con la biopsia intraoperatoria por congelación. Varios autores opinan que esta produce un elevado número de resultados no concluyentes. La ecografía tiroidea y la citología con aguja fina, sumadas a la correcta evaluación clínica se han convertido en los pilares fundamentales que permiten un manejo más racional de los nódulos tiroideos. Objetivo: comparar los resultados de la biopsia intraoperatoria por congelación con la citología con aguja fina guiada por ecografía con la biopsia por parafina. Métodos: se realizó un estudio de corte transversal, de 331 pacientes operados por presentar afecciones de la glándula tiroides. Para el análisis se tomaron en cuenta los resultados verdaderos positivos, falsos positivos, verdaderos negativos, falsos negativos y los sospechosos o dudosos. A estos resultados se le aplicó la prueba de Galem y Gambino para obtener la sensibilidad, especificidad, valores predictivos y eficiencia de ambos procederes. Resultados: el 58 % de la serie correspondió a afecciones benignas y el 42 % a las malignas. La citología con aguja fina guiada por ecografía mostró especificidad (99,1 %), sensibilidad (99,2 %), valor predictivo negativo (99,2 %), eficiencia (97,1 %), y sensibilidad completa (99,2 %). Conclusiones: la citología con aguja fina guiada por ecografía resulta ser un proceder confiable para establecer el diagnóstico preoperatorio en los nódulos tiroideos...

"Thyroid nodules continue to pose a challenge to surgeons. The risk of not detecting a malignant neoplasia persists, even when an intraoperative frozen section biopsy is performed. Several authors are of the opinion that this test yields a large number of inconclusive results. Thyroid echography and fine-needle cytology, in combination with an appropriate clinical evaluation, have become the main pillars of a more rational management of thyroid nodules. Objective: compare the results of intraoperative frozen section biopsy with echography-guided fine-needle cytology with paraffin biopsy (PB). Methods: across-sectional study was conducted of 331 patients operated on for thyroid gland disorders. True positive, false positive, true negative, false negative and suspicious or doubtful results, were all taken into account in the analysis. The Galen and Gambino test was applied to these results to obtain the sensitivity, specificity, predictive values and efficiency of both procedures. Results: 58 % of the series corresponded to benign disorders and 42 % to malignant disorders. Echography-guided fine-needle cytology showed specificity (99.1 %), sensitivity (99.2 %), negative predictive value (99.2 %), efficiency (97.1 %), and full sensitivity (99.2 %). Conclusions: echography-guided fine-needle cytology is a reliable procedure to establish the preoperative diagnosis of thyroid nodules...

Frozen Section Biopsy to Evaluation of Obscure Lateral Resection Margins during Gastric Endoscopic Submucosal Dissection for Early Gastric Cancer

PURPOSE: To determine the diagnostic utility of a frozen section biopsy in patients undergoing endoscopic submucosal dissection (ESD) for early gastric neoplasms with obscure margins even with chromoendoscopy using acetic acid and indigo carmine (AI chromoendoscopy). MATERIALS AND METHODS: The lateral spread of early gastric neoplasms was unclear even following AI chromoendoscopy in 38 patients who underwent ESD between June 2007 and May 2011. Frozen section biopsies were obtained by agreement of the degree of lateral spread between two endoscopists. Thus, frozen section biopsies were obtained from 23 patients (FBx group) and not in the other 15 patients (AI group). RESULTS: No significant differences were observed for size, histology, invasive depth, and location of lesions between the AI and FBx groups. No false positive or false negative results were observed in the frozen section diagnoses. Adenocarcinoma was revealed in three patients and tubular adenoma in one, thereby changing the delineation of lesion extent and achieving free lateral margins. The rates of free lateral resection margins and curative resection were significantly higher in the FBx group than those in the AI group. CONCLUSIONS: Frozen section biopsy can help endoscopists perform more safe and accurate ESD in patients with early gastric neoplasm.

Significance of Fine-Needle Aspiration Cytology and Frozen Section Biopsy of Thyroid Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although fine needle aspiration (FNA) cytology is a safe, simple and relatively accurate procedure, satisfactory samples cannot be obtained in about 10-20% of cases and there is also difficulty in differentiating between benign and malignant lesions in follicular neoplasm. Authors have compared preoperative FNA results and frozen section biopsy with permanent histologic findings and evaluated the significance of FNA cytology and frozen section biopsy in the diagnosis of thyroid nodules. MATERIALS AND METHODS: The medical records of 136 patients who underwent FNA cytology and thyroidectomy from October 1, 1993 to September 30, 1998 at the department of Otolaryngology and General Surgery of Ewha Womans University Mokdong Hospital were retrospectively analyzed. RESULTS: Among the 136 patients who received FNA, there were 75 cases (55.1%) diagnosed as benign, 30(22.1%) as malignant, 13(9.6%) as suspicion of malignant and 18(13.2%) as unsatisfactory. Sensitivity of FNA was 77.1%, the specificity 91.4%, and the accuracy 85.6%. Frozen section biopsy was performed in 118 patients and the sensitivity and specificity rate was 78.3% and 100%, respectively. CONCLUSION: FNA cytology has a high sensitivity (77.1%) and specificity (91.4%) rate. It is therefore a valuable initial procedure for diagnosing thyroid nodules and reducing unnecessary extensive surgery. When FNA yields a diagnosis of follicular neoplasm, frozen section biopsy having a specificity rate of 100% is an important step in determining the extent of operation.

The Accuracy of Frozen Section Biopsy in the Diagnosis of Gynecologic Tumors / 대한산부인과학회잡지

OBJECTIVE: Frozen-section evaluation of gynecologic tumors has historically been used to establish a histopatholgic diagnosis and to guide surgeons in appropriate surgical procedure. this study is to assess the clinical appropriation and accuracy of frozen-section biopsy in gynecologic tumors. METHODS: This is a retrospective quality assurance study all of frozen-section biopsy done at Chungnam National University Hospital during a three year period (1995 to 1997). There were 125 cases out of 2310 surgical specimens for gynecologic tumors, and the results were compared with final diagnoses based on fixed tissue specimens. RESULTS: Frozen section biopsy was accurate in 95.2% of all cases, in 96.3% (104/108) of ovarian tumor cases, and in 88.2% (15/17) of uterine tumor cases. Analysis of 6 inaccuracy cases revealed that most cases were sampling errors and occurred in mucinous tumor, belonging to all cases of ovarian tumors. Sensitivity, specificity, positive predictive value, and negative predictive value of frozen-section biopsy in ovarian tumors were 0.94, 1.00, 1, 00, 0.97. CONCLUSION: Frozen section biopsy is an appropriate method as a basic guideline during operations of gynecologic tumors and this method can obtains the highest accuracy when there is cooperation between experienced surgeons and reliable and careful pathologists. The accuracy of frozen section diagnosis has important implications regarding the type and extent of the primary surgery for gynecologic tumors.

Efficacy of Frozen Section Biopsy in the Diagnosis of Adnexal Neoplasms / 대한산부인과학회잡지

Recently, the possibility of inappropriate management of undiagnosed early cancers increased with spreading laparoscopic approach of adnexal tumors. The pathologic diagnosis of frozen section biopsy(FBx) guide the surgeon to perform the appropriate surgical procedure of adnexal tumors. This study was conducted to verify preliminarily the criteria for the laparoscopic management and determine the accuracy and efficacy of conditioned FBx according to the criteria. The inclusive criteria of FBx results in this study was designed by means of the preoperative transvaginal sonography(morphologic score >or=10) or tumor marker level of serum(CA-125 level>or=35 U/ml in postmenopause and >or=65 U/ml in postmenopause) or suspected gross findings of the malignancy during operation. On the other hand, cases which were convinced as dermoid cysts, endometriomas and advanced(>or=IIIb) ovarian cancers on the basis of gross findings were excluded in this study. Two hundred seventy-six operations of adnexal tumors were performed between January 1995 and June 1996 and 74 results of FBx were picked up in this study. The overall rate of conditioned FBx was 26.8%(74/276). The applied criterion in this study had the sensitivity of 0.97, specificity of 0.78, negative predictive value of 0.99, positive predictive value of 0.36. The accuracy of frozen sectional biopsy were 87.8% in the histopathologic diagnosis and 97.3% in the clinicopathologic diagnosis. The sensitivity, specificity, negative predictive value and positive predictive value for ovarian cancers(borderline+malignant) were 1 in all. It was thought that frozen sectional biopsy was a appropriate guide for the decision of methods during operation of adnexal tumors and that the criteria in this study could be used as a guideline for frozen section biopsy in the laparoscopic surgery of adnexal tumors.

An evaluation of frozen section biopsy in 4434 cases

Frozen section diagnosis is a highly useful method of diagnosis. There were 4434 frozen sections, 24 false positive diagnosis, 65 false negative diagnosis and 30 deferred diagnosis. This method achieves the highest accuracy when there is a cooperation between experienced surgeon and reliable and careful pathologist. It is wise to defer the diagnosis of consult to other pathologist in difficult situation.