Analysis of an institutional protocol for thyroid lobectomy: Utility of routine intraoperative frozen section and expedited (overnight) pathology. Surgery 2016 Feb;159(2):512-7
Date
09/13/2015Pubmed ID
26361834DOI
10.1016/j.surg.2015.07.031Scopus ID
2-s2.0-84955180458 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Intraoperative frozen section (FS) often is performed in patients who undergo thyroid lobectomy to determine the need for completion thyroidectomy. At our institution, if FS pathology is benign, final pathology is expedited overnight. The aim of this study was to determine the utility of FS and to identify a cost-effective management algorithm for thyroid lobectomy.
METHODS: A retrospective review was performed of patients who underwent thyroid lobectomy between January 2009 and May 2013. Preoperative cytology ranged from "benign" to "suspicious for malignancy." Clinically significant cancers were defined as >1 cm in size, or multifocal microcarcinomas.
RESULTS: Of the 192 patients who underwent thyroid lobectomy with FS, FS was suspicious for malignancy in 5 (3%) patients; 1 (0.5%) underwent immediate completion thyroidectomy. On final pathology, 9 (5%) patients had clinically significant cancers and underwent completion thyroidectomy. FS had a sensitivity and positive predictive value of 22% and 40%, respectively, in identifying clinically significant thyroid cancer. Cost of thyroid lobectomy at varying rates of same-day discharge favored thyroid lobectomy without FS but with expedited pathology for all scenarios.
CONCLUSION: At our institution, there appears to be limited utility of FS at the time of thyroid lobectomy given the low predictive value for diagnosing a clinically significant thyroid cancer. In patients who are admitted overnight, expedited pathology is slightly less costly and may improve patient quality-of-life and decrease costs by avoiding delayed completion thyroidectomy. Overnight pathology for patients who undergo thyroid lobectomy may achieve modest cost-savings depending on institutional FS results and rates of malignancy.
Author List
Berg RW, Yen TW, Evans DB, Hunt B, Quiroz FA, Wilson SD, Wang TSAuthors
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinBryan C. Hunt MD Associate Professor in the Pathology department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Algorithms
Clinical Protocols
Cost-Benefit Analysis
Decision Support Techniques
Female
Frozen Sections
Humans
Intraoperative Care
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Thyroid Gland
Thyroid Neoplasms
Thyroid Nodule
Thyroidectomy
Wisconsin
Young Adult
