Frozen section in thyroid gland follicular neoplasms: It's high time to abandon it!

Sanabria, Alvaro; Zafereo, Mark; Thompson, Lester D R; Hernandez-Prera, Juan C; Kowalski, Luiz P; Nixon, Iain J; Shaha, Ashok; Rodrigo, Juan P; Mäkitie, Antti; Poorten, Vincent Vander; Suarez, Carlos; Zbären, Peter; Rinaldo, Alessandra; Ferlito, Alfio (2021). Frozen section in thyroid gland follicular neoplasms: It's high time to abandon it! Surgical oncology, 36, pp. 76-81. Elsevier 10.1016/j.suronc.2020.12.005

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Thyroid nodules are a very common clinical condition. The 2015 American Thyroid Association (ATA) guidelines recommend surgical excision for Bethesda IV nodules. The use of intraoperative frozen section (FS) has been recommended as a strategy to tailor the extent of the initial surgery. We critically evaluated the literature that discusses the utility and cost-effectiveness of FS to make an intraoperative decision in patients with thyroid nodules classified as follicular neoplasm. FS should not be recommended as a routine intraoperative test to assess for malignancy in thyroid follicular patterned lesions due to its low performance; the high number of deferred results; the inability to adequately assess histologically defining features; the improvements in risk stratification guiding total thyroidectomy; and the low cost-effectiveness of FS.

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