The American Association of Endocrine Surgeons, Patient Education Site

Thyroid surgery: Frozen section biopsy

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Will a biopsy (Frozen Section) be performed in the operating room?

The reason to perform a frozen sectionFrozen section - tissue taken during an operation that is given to the pathologist to evaluate the thyroid lobe and make a preliminary diagnosis while the patient is still on the operating room table biopsy of the thyroid gland during an operation is to provide a rapid diagnosis that will determine the extent of surgery being performed at that time. After the thyroid is removed, while the patient is still asleep, the surgeon sends it to the pathology to be examined under the microscope. The decision to perform a frozen section lies with the surgeon. The number of frozen sections done during an operation has decreased significantly over the last few years. The first reason for this is the ability of FNAFNA - fine needle aspiration biopsy biopsy to diagnose papillary thyroid cancer and benign (non-cancerous) lesions pre-operatively, is excellent. Secondly, it is known that frozen section biopsies performed for certain types of thyroid nodules (follicular or Hurthle cell neoplasms) is of limited value because the pathologist needs to examine the entire nodule to see if there is growth (i.e. invasion) of cells outside the nodule. Typically a frozen section will only look at one or two slices of the nodule and not the whole thing.

If you underwent a biopsy before surgery and it showed definite thyroid cancer, there is no need for another biopsy during surgery. You already know that you have cancer and the extent of surgery for your thyroid cancer has been decided preoperatively. If you underwent a biopsy before surgery and it was a follicular or Hurthle cell neoplasmHurthle cell neoplasm - variant of follicular neoplasm, intraoperative consultation is rarely helpful for the reasons mentioned above. Intraoperative consultation is most useful when a biopsy before surgery reveals findings suspicious for papillary thyroid cancer or findings that are indeterminate. Up to 50-75% of patients with a preoperative biopsy, suspicious for papillary thyroid cancer, are found to have cancer in their surgical specimen. Since papillary carcinoma has distinct findings that can be evaluated adequately under the microscope during surgery, the diagnosis of papillary carcinoma can be made in the majority of cases with a frozen section. If there is no evidence of cancer, no additional thyroid surgery is performed at that time. On the other hand, if the diagnosis of cancer is made during intraoperative consultation, additional surgery involving the removal of the remainder of the thyroid gland and possibly the surrounding lymph nodes will be performed while you are still in the operating room.

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