Frozen Section

Will a biopsy (Frozen Section) be done in the operating room to look at the tumor?

The number of frozen sections done during an operation has decreased significantly over the last decade. The first reason for this is the improved ability to diagnose papillary thyroid cancer and benign (non-cancerous) lesions pre-operatively. 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 entire nodule. Some tissue must be preserved for additional tests that cannot be performed using frozen tissue.

If you underwent a biopsy before surgery and it revealed definite thyroid cancer, there is no need for another biopsy of the tumor itself during surgery (alhtough sometimes suspicious lymph nodes may be sent for frozen section to guide the extent of lymph node removal in some cases). If you underwent a biopsy before surgery and it was a follicular or Hurthle cell neoplasm, intraoperative consultation is rarely helpful for the reasons mentioned above. Intraoperative consultation is most useful when a biopsy before surgery reveals findings in the suspicious for thyroid cancer’ category (Bethesda V). Since papillary thyroid cancer 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 these 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.