Osorio, Marcela1; Roche, Ansley M.2; Griffin, Martha J.1; Kiplagat, Kimberly J.1; Machado, Rosalie A.1; Pecoriello, Jillian M.1; Moubayed, Sami P.2; Urken, Mark L.1,2
1 Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
2 Department of Otolaryngology – Head and Neck Surgery, Mount Sinai Downtown, New York, NY, USA
Background/Purpose: The latest American Thyroid Association (ATA) guidelines for papillary thyroid cancer (PTC) recommend that low-risk patients may be successfully treated with a hemithyroidectomy.1 Patients that are low-risk before surgery may be upstaged after pathologic analysis. These patients are often advised to undergo secondary completion thyroidectomy. We aim to determine whether intraoperative frozen section is useful in identifying high-risk features that would avoid the need for secondary surgery.
Methods: We prospectively recruited patients with unifocal PTC, < 4cm nodule, without evidence of metastasis. Patients with two first degree relatives with PTC, prior head and neck radiation, and aggressive histology were excluded. Pathologists assessed for extrathyroidal extension, aggressive histology, lymphatic invasion, angioinvasion, multifocality, and number of positive lymph nodes on frozen section.
Results: Twenty-six patients were enrolled in the study. Six patients underwent primary completion thyroidectomy based on high-risk features found on frozen section. One patient with a final diagnosis of follicular carcinoma returned for a completion thyroidectomy. The remaining 19 patients were correctly stratified as low-risk PTC on frozen section analysis. There were no false positives. The sensitivity, specificity, and negative predictive value of frozen section analysis of risk stratifying features were 0.87 and 1.0, and 95%, respectively.
Discussion & Conclusion: Among patients without high risk features on frozen section, the probability of having no high-risk features on final pathology was 95%. In this study, we have determined that low-risk and high-risk PTC can be appropriately managed in a single operative setting with the assistance of frozen section analysis.
- Haugen Bryan R., Alexander Erik K., Bible Keith C., Doherty Gerard M., Mandel Susan J., Nikiforov Yuri E., Pacini Furio, Randolph Gregory W., Sawka Anna M., Schlumberger Martin, Schuff Kathryn G., Sherman Steven I., Sosa Julie Ann, Steward David L., Tuttle R. Michael, and Wartofsky Leonard. Thyroid. January 2016, 26(1): 1-133.