Thyroid Frozen Sections in Patients With Preoperative FNAs:  Review of Surgeons' Preoperative Rationale, Intraoperative Decisions, and Final Outcome

We wished to discover (1) in what circumstances surgeons wished to request frozen sections (FSs) on thyroid nodules having a prior fine needle aspiration (FNA) and the preoperative plan in these cases; (2) what the surgeons did with the information provided by FS and (3) in what types of cases was value added with the FS. A retrospective chart review was performed of 121 consecutive patients receiving an intraoperative FS diagnosis on a thyroid nodule, all of which had been evaluated with a preoperative FNA. The medical record documented rationale for the request in 83% of cases. The most common reason for a FS request of a nodule was whether a planned hemithyroidectomy should proceed to a total thyroidectomy (TT). This scenario led to a TT in 9% of patients with a FNA diagnosed as benign thyroid nodule, 16% diagnosed as follicular neoplasm/suspicious for follicular neoplasm and 69% diagnosed as suspicious for malignancy. The stated rationale for FSs in patients with preoperative FNA was not supported by patient outcome in most cases. There may be some utility for FSs in lesions with a suspicious for malignancy preoperative FNA diagnosis.