The utility of frozen section examination for determining the extent of thyroidectomy in patients with a thyroid nodule and “atypia/follicular lesion of undetermined significance”

BackgroundThe purpose of this study was to evaluate the role of frozen section examination (FSE) for determining the extent of thyroidectomy in patients with nodular thyroid disease and fine-needle aspiration categorized as atypia/follicular lesion of undetermined significance (AFLUS).MethodsA retrospective review of all patients operated on for a thyroid nodule and AFLUS was completed to determine the role of clinical examination and FSE in intraoperative decision making.ResultsOne hundred twenty patients with AFLUS underwent thyroidectomy; 18 (15%) had carcinoma. FSE altered management in 36 (62%) of the 58 patients—32 with benign disease and 4 with cancer who underwent lobectomy and total thyroidectomy, respectively. Total thyroidectomy without FSE was performed in 61 (51%) patients with sonographically confirmed bilateral disease. FSE had a 36.4% sensitivity, 100% specificity, 100% positive predictive value, 87% negative predictive value, and 88% accuracy.ConclusionUltrasound in combination with FSE is of value for determining the extent of thyroidectomy in patients with AFLUS.