Targeted use of intraoperative frozen-section analysis lowers the frequency of completion thyroidectomy
Author:
Staubitz J I1ORCID, Elmrich I1, Musholt P B1, Cámara R J A2, Watzka F1, Dralle H3, Sekulla C4, Lorenz K4, Musholt T J1, Vorländer C, Lorenz K, Blankenburg C, Geffcken C, Steinmüller T, Trupka A, Steinert F, Schabram J, Albrecht L, Marschall C, Orlitsch C, Holzner K, Feller J, Weber T, Kaltofen D, Simon D, Kube R, Schultz K, Sahm M, Obermeier J, Roth C, Janson K, Thomusch O, Meier H, Weinhold A, Müller N, Tonndorf G, Sinn D, Klein E, Henke G, Rampf W, Rendel K, Cupisti K, Holzer K, Grothe D, Axt L, Müller I, Probst W, Guhr C, Schischke F, Schwörig T, Konrad Hospital M, Fielitz J, Stets R, Liese M, Weiss C- L, Zaage J, Bräuer T, Weitz J, Huster A, Kidess E, Lautermann J, Kizilirmak N, Jannasch O, Bittscheidt H, Lehmann D, Kröll K- P, Musholt T J, Sonsnowska C, Lorenc Z, Dudesek B, Smutny S, Brauckhoff M, Bareck E, Köberle-Wührer R,
Affiliation:
1. Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Mainz, Germany 2. Institute for Medical Biometry, Epidemiology and Informatics, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Mainz, Germany 3. Department of General, Visceral and Transplantation Surgery, University Medical Centre Essen, University Duisburg-Essen, Essen, Germany 4. Department of Visceral, Vascular and Endocrine Surgery, University Medical Centre Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
Abstract
Abstract
Background
The impact of intraoperative frozen section (iFS) analysis on the frequency of completion thyroidectomy for the management of thyroid carcinoma is controversial. Although specialized endocrine centres have published their respective results, there are insufficient data from primary and secondary healthcare levels. The aim of this study was to analyse the utility of iFS analysis.
Methods
In the Prospective Evaluation Study Thyroid Surgery (PETS) 2 study, 22 011 operations for benign and malignant thyroid disease were registered prospectively in 68 European hospitals from 1 July 2010 to 31 December 2012. Group 1 consisted of 569 patients from University Medical Centre (UMC) Mainz, and group 2 comprised 21 442 patients from other PETS 2 participating hospitals. UMC Mainz exercised targeted but liberal use of iFS analysis for suspected malignant nodules. iFS analysis was compared with standard histological examination regarding the correct distinction between benign and malignant disease. The percentage of completion thyroidectomies was assessed for the participating hospitals.
Results
iFS analysis was performed in 35.70 per cent of patients in group 1 versus 21.80 per cent of those in group 2 (risk ratio (RR) 1.6, 95 per cent c.i. 1.5 to 1.8; P < 0.001). Sensitivity of iFS analysis was 75.0 per cent in group 1 versus 63.50 per cent in group 2 (RR 1.2, 1.2 to 1.3; P = 0.040). Completion surgery was necessary in 8.10 per cent of patients in group 1 versus 20.8 per cent of those in group 2 (RR 0.4, 0.2 to 0.7; P = 0.001).
Conclusion
iFS analysis is a useful tool in determining the appropriate surgical management of thyroid disease. Targeted use of iFS was associated with a significantly higher sensitivity for the detection of malignancy, and with a significantly reduced necessity for completion surgery.
Funder
PETS 2 study group Wilhelm Roux Foundation of Martin Luther University of Halle Wittenberg
Publisher
Oxford University Press (OUP)
Cited by
8 articles.
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