The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules

Purpose. We evaluated the role of intraoperative frozen section (FS) in the surgical management of solitary thyroid nodules, as its true value is a subject of some controversy. Methods. We reviewed the records of 206 consecutive patients operated on for solitary thyroid nodules. All patients had undergone both preoperative fine-needle aspiration (FNA) and intraoperative FS. The diagnostic findings of FNA cytology and FS histology were compared with the final histological results. Results. There were 61 patients with cancer and 145 with various benign conditions. The sensitivity and specificity of FNA were 78.1% and 96.5%, respectively, demonstrating an overall accuracy of 91.3%. The sensitivity, specificity, and accuracy rates for FS were 83.3%, 95.2%, and 91.7%, respectively. FS altered the operative decision in 14 patients, but correctly so in only 8 patients. Correlated with FNA cytology, the yield of FS in assisting in the intraoperative decision making was 1.8%, 3.4%, and 5.2% for benign, malignant, and suspicious cytology, respectively. Conclusions. When the results of FNA and FS are interpreted as either benign or malignant, both are highly accurate predictors of the pathological nature of the nodule. However, the findings of the present study do not support the use of FS in the surgical management of solitary thyroid nodules, regardless of FNA cytology.