Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Mar 5;5(2):zraa058.
doi: 10.1093/bjsopen/zraa058.

Targeted use of intraoperative frozen-section analysis lowers the frequency of completion thyroidectomy

J I Staubitz  1 , I Elmrich  1 , P B Musholt  1 , R J A Cámara  2 , F Watzka  1 , H Dralle  3 , C Sekulla  4 , K Lorenz  4 , T J Musholt  1 ; Prospective Evaluation Study Thyroid Surgery (PETS) 2 study group
Collaborators, Affiliations
Multicenter Study

Targeted use of intraoperative frozen-section analysis lowers the frequency of completion thyroidectomy

J I Staubitz et al. BJS Open. .

Abstract
in English, Spanish

Background: The impact of intraoperative frozen section (iFS) analysis on the frequency of completion thyroidectomy for the management of thyroid carcinoma is controversial. Although specialized endocrine centres have published their respective results, there are insufficient data from primary and secondary healthcare levels. The aim of this study was to analyse the utility of iFS analysis.

Methods: In the Prospective Evaluation Study Thyroid Surgery (PETS) 2 study, 22 011 operations for benign and malignant thyroid disease were registered prospectively in 68 European hospitals from 1 July 2010 to 31 December 2012. Group 1 consisted of 569 patients from University Medical Centre (UMC) Mainz, and group 2 comprised 21 442 patients from other PETS 2 participating hospitals. UMC Mainz exercised targeted but liberal use of iFS analysis for suspected malignant nodules. iFS analysis was compared with standard histological examination regarding the correct distinction between benign and malignant disease. The percentage of completion thyroidectomies was assessed for the participating hospitals.

Results: iFS analysis was performed in 35.70 per cent of patients in group 1 versus 21.80 per cent of those in group 2 (risk ratio (RR) 1.6, 95 per cent c.i. 1.5 to 1.8; P < 0.001). Sensitivity of iFS analysis was 75.0 per cent in group 1 versus 63.50 per cent in group 2 (RR 1.2, 1.2 to 1.3; P = 0.040). Completion surgery was necessary in 8.10 per cent of patients in group 1 versus 20.8 per cent of those in group 2 (RR 0.4, 0.2 to 0.7; P = 0.001).

Conclusion: iFS analysis is a useful tool in determining the appropriate surgical management of thyroid disease. Targeted use of iFS was associated with a significantly higher sensitivity for the detection of malignancy, and with a significantly reduced necessity for completion surgery.

Antecedentes: El impacto de la biopsia intraoperatoria (intraoperative frozen section, iFS) sobre la frecuencia de completar la tiroidectomía en el tratamiento del carcinoma de tiroides es controvertido. Si bien los centros especializados en cirugía endocrina han publicado sus respectivos resultados, no hay datos suficientes para los niveles de atención primaria y secundaria. El objetivo de este estudio fue analizar la utilidad de la iFS.

Métodos: En el estudio PETS 2 (Prospective Evaluation Study Thyroid Surgery 2), se registraron prospectivamente 22.011 operaciones por enfermedad tiroidea benigna y maligna en 68 hospitales europeos desde el 1 de julio de 2010 hasta el 31 de diciembre de 2012. El grupo 1 consistió en 569 pacientes de UMC Mainz; El grupo 2 comprendió 21.442 pacientes de otros hospitales participantes de PETS 2. En Mainz se realizó un uso selectivo, pero liberal, de la iFS para los nódulos malignos sospechosos. La iFS se comparó con la histología como patrón oro para distinguir correctamente entre enfermedad benigna y maligna. Se evaluó el porcentaje de tiroidectomías completadas por los hospitales participantes.

Resultados: La iFS se realizó en el 35,7% en el grupo 1 versus 21,8% en el grupo 2 (riesgo relativo, RR 1,6; P < 0,001). La sensibilidad de la iFS fue del 75,0% en el grupo 1 versus 63,5% en el grupo 2 (RR 1,2; P = 0,040). Fue necesario completar la cirugía en el 8,0% del grupo 1 versus 20,8% del grupo 2 (RR 0,4; P < 0,001).

Conclusión: La iFS es útil para determinar el tratamiento quirúrgico adecuado de la enfermedad tiroidea. El uso selectivo de la iFS se asoció con una sensibilidad significativamente mayor para detectar malignidad y con una necesidad significativamente menor de completar la cirugía.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Funnel plot showing use of methods of analysis and resulting completion surgery rates for individual PETS 2 hospitals. Use of fine-needle aspiration cytology (FNAC) and intraoperative frozen-section (iFS) analysis, and completion surgery (percentage of patients with carcinoma), defined by the total number of operations in each Prospective Evaluation Study Thyroid Surgery (PETS) 2 hospital. UMC, University Medical Centre Mainz.
Fig. 2
Fig. 2
Patient flow diagram illustrating the use and results of intraoperative frozen-section analysis in relation to standard final histological examination UMC, University Medical Centre; PETS, Prospective Evaluation Study Thyroid Surgery; iFS, intraoperative frozen-section analysis.
Fig. 3
Fig. 3
Patient flow diagram illustrating the proportion of patients receiving completion thyroidectomy after incomplete initial surgery in cancer cases UMC, University Medical Centre; PETS, Prospective Evaluation Study Thyroid Surgery; iFS, intraoperative frozen section.
Fig. 4
Fig. 4
Forest plot comparing operative management characteristics at UMC Mainz (group 1) and the remaining PETS 2 hospitals (group 2) Values in parentheses are 95 per cent confidence intervals. RR, risk ratio; UMC, University Medical Centre; FNAC, fine-needle aspiration cytology; iFS, intraoperative frozen-section (analysis); PPV, positive predictive value; NPV, negative predictive value.
See this image and copyright information in PMC

References

    1. Dralle H, Musholt TJ, Schabram J, Steinmuller T, Frilling A, Simon D et al. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013;398:347–375 - PubMed
    1. Treglia G, Caldarella C, Saggiorato E, Ceriani L, Orlandi F, Salvatori M et al. Diagnostic performance of 99mTc-MIBI scan in predicting the malignancy of thyroid nodules: a meta-analysis. Endocrine 2013;44:70–78 - PubMed
    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1–133 - PMC - PubMed
    1. Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE et al.; Leitliniengruppe der CAEK. Update of the S2k guidelines : surgical treatment of benign thyroid diseases. Chirurg 2018;89:699–709 - PubMed
    1. Keller MP, Crabbe MM, Norwood SH. Accuracy and significance of fine-needle aspiration and frozen section in determining the extent of thyroid resection. Surgery 1987;101:632–635 - PubMed

Publication types