Intraoperative frozen section for determining the extent of surgery in papillary thyroid carcinoma: comprehensive risk factor assessment
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SUBMITTER: Jiang C
PROVIDER: S-EPMC10788568 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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Project description:[This corrects the article DOI: 10.21037/gs-23-182.].
| S-EPMC11635564 | biostudies-literature
Project description:Paraganglioma (PGL) is a neuroendocrine tumor that arises from the sympathetic or parasympathetic paraganglia. Primary thyroid PGL is extremely rare. PGL may be difficult to diagnose on frozen sections because its histopathological features, such as polygonal tumor cells with eosinophilic cytoplasm arranged irregularly, overlap with those of thyroid follicular adenoma. We present a case of thyroid PGL in a female patient and provide a detailed description of the patient's clinicopathologic characteristics. Cervical computed tomography showed a left thyroid mass with uneven density. Intraoperative frozen section analysis showed an uneven fibrous septa and rich networks of delicate vessels surrounding tumor cell nests. The tumor cells were polygonal or epithelioid with eosinophilic cytoplasm, arranged in a nest, trabecular, or organoid pattern were and diagnosed as thyroid follicular adenoma. However, in postoperative immunohistochemistry, these were diagnosed as thyroid PGL. The postoperative recovery was uneventful. The patient showed no signs of tumor recurrence or metastasis until 16 months of follow-up. Herein, we summarize the characteristic features of thyroid PGL based on frozen section analysis. In the appropriate clinical context, its proper use as diagnostic and differential diagnostic management strategies is recommended.
| S-EPMC9664199 | biostudies-literature
Project description:BackgroundLymph node metastasis (LNM) assessment in patients with papillary thyroid carcinoma (PTC) is of great value. This study aimed to develop a deep learning model applied to intraoperative frozen section for prediction of LNM in PTC patients.MethodsWe established a deep-learning model (ThyNet-LNM) with the multiple-instance learning framework to predict LNM using whole slide images (WSIs) from intraoperative frozen sections of PTC. Data for the development and validation of ThyNet-LNM were retrospectively derived from four hospitals from January 2018 to December 2021. The ThyNet-LNM was trained using 1987 WSIs from 1120 patients obtained at the First Affiliated Hospital of Sun Yat-sen University. The ThyNet-LNM was then validated in the independent internal test set (479 WSIs from 280 patients) as well as three external test sets (1335 WSIs from 692 patients). The performance of ThyNet-LNM was further compared with preoperative ultrasound and computed tomography (CT).FindingsThe area under the receiver operating characteristic curves (AUCs) of ThyNet-LNM were 0.80 (95% CI 0.74-0.84), 0.81 (95% CI 0.77-0.86), 0.76 (95% CI 0.68-0.83), and 0.81 (95% CI 0.75-0.85) in internal test set and three external test sets, respectively. The AUCs of ThyNet-LNM were significantly higher than those of ultrasound and CT or their combination in all four test sets (all P < 0.01). Of 397 clinically node-negative (cN0) patients, the rate of unnecessary lymph node dissection decreased from 56.4% to 14.9% by ThyNet-LNM.InterpretationThe ThyNet-LNM showed promising efficacy as a potential novel method in evaluating intraoperative LNM status, providing real-time guidance for decision. Furthermore, this led to a reduction of unnecessary lymph node dissection in cN0 patients.FundingNational Natural Science Foundation of China, Guangzhou Science and Technology Project, and Guangxi Medical High-level Key Talents Training "139" Program.
| S-EPMC10209138 | biostudies-literature
Project description:Background and objectivesIt is well established that tumor-free margin is an important factor for reducing local recurrence and reoperation rates. This systematic review with meta-analysis of frozen section intraoperative margin assessment aims to evaluate the accuracy, and reoperation and survival rates, and to establish its importance in breast-conserving surgery.MethodsA thorough review was conducted in all online publication-databases for the related literature up to March 2020. MeSH terms used: "Breast Cancer", "Segmental Mastectomy" and "Frozen Section". We included the studies that evaluated accuracy of frozen section, reoperation and survival rates. To ensure quality of the included articles, the QUADAS-2 tool (adapted) was employed. The assessment of publication bias by graphical and statistical methods was performed using the funnel plot and the Egger's test. The review protocol was registered in PROSPERO (CRD42019125682).ResultsNineteen studies were deemed suitable, with a total of 6,769 cases. The reoperation rate on average was 5.9%. Sensitivity was 0.81, with a Confidence Interval of 0.79-0.83, p = 0.0000, I2 = 95.1%, and specificity was 0.97, with a Confidence Interval of 0.97-0.98, p = 0.0000, I-2 = 90.8%, for 17 studies and 5,615 cases. Accuracy was 0.98. Twelve studies described local recurrence and the highest cumulative recurrence rate in 3 years was 7.5%. The quality of the included studies based on the QUADAS-2 tool showed a low risk of bias. There is no publication bias (p = 0.32) and the funnel plot showed symmetry.ConclusionFrozen section is a reliable procedure with high accuracy, sensitivity and specificity in intraoperative margin assessment of breast-conserving surgery. Therefore, this modality of margin assessment could be useful in reducing reoperation rates.
| S-EPMC7971883 | biostudies-literature
Project description:BackgroundMost patients with papillary thyroid carcinoma have a good prognosis. Excessive resection of thyroid and cervical lymph nodes is an important reason for affecting the quality of life of patients after surgery. Intraoperative rapid frozen pathological examination is an important step in the development of a surgical plan for thyroid cancer (especially micropapillary carcinoma); however, whether it affects the treatment outcome remains unclear.MethodsThe clinicopathological data of papillary thyroid microcarcinoma (PTMC) patients who underwent surgery in our center from 1 January 2021 to 31 December 2021 were retrospectively analyzed. Patients with unilateral low-risk PTMC who underwent radical surgery were selected as the main research subjects. The negative results of intraoperative frozen section of the central lymph node (CLN) of the affected side were the experimental group, and the positive results were the control group. Subjects with lesions larger than 10 mm and those who did not undergo intraoperative frozen section pathological examination were excluded. After excluding other risk factors for recurrence, we calculated the proportion of patients requiring radioactive iodine (RAI) treatment among those with metastases detected by intraoperative rapid frozen section pathology and its influencing factors. Patient data were analysed using SPSS version 20. Continuous variables were presented as means when symmetrical or as medians and ranges when asymmetrical. Categorical variables were presented as proportions. A P value <0.05 was considered significant.ResultsA total of 564 PTMC patients were included, among whom 122 patients (21.6%) underwent total thyroidectomy due to the presence of metastases in the ipsilateral CLNs. Compared with the experimental group, the patients with male, young age and tumor located in the middle and lower pole in the control group had higher lymph node metastasis (P<0.05).ConclusionsThe proportion of patients requiring postoperative RAI treatment for unilateral low-risk PTMC is relatively low, and the possibility that an intraoperative frozen pathological finding will change the treatment outcome is low. However, the need for postoperative RAI therapy notably increases when the intraoperative frozen pathological analysis reveals ipsilateral CLN metastases, especially in males, younger patients, and/or patients with lesions located in the middle and lower poles.
| S-EPMC9638794 | biostudies-literature
Project description: Not available
| S-EPMC9906101 | biostudies-literature
Project description:It remains controversial whether patients with papillary thyroid microcarcinoma (PTMC) benefit from total thyroidectomy (TT) or thyroid lobectomy (TL). We aimed to investigate the impact of extent of surgery on the prognosis of patients with unilateral PTMC. Patients were obtained from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Cancer-specific survival (CSS) and overall survival (OS) were evaluated by Cox regression and Kaplan-Meier curves with propensity score matching. Of 31167 PTMC patients enrolled, 22.2% and 77.8% of which underwent TL and TT, respectively. Patients with TT were more likely to be younger, females, present tumors of multifocality, extrathyroidal extension, cervical lymph node metastasis (CLNM), distant metastasis, and receive radioactive iodine (RAI) compared with those receiving TL. The multivariate Cox regression model showed that TT was not associated with an improved CSS and OS compared with TL with hazard ratio (HR) and 95% confidence interval (CI) of 0.53 (0.25-1.12) and 0.86 (0.72-1.04), respectively. In addition, the Kaplan-Meier curves further confirmed the similar survival between TL and TT after propensity score matching. The subgroup analysis showed that TT was associated with better CSS for patients < 55 years, those with tumors of gross extrathyroidal extension, CLNM (N1b), and cases not receiving RAI with HR 95% CI of 0.13 (0.02-0.81), 0.12 (0.02-0.66), 0.11 (0.02-0.64) and 0.36 (0.13-0.90), respectively. TT predicted a trend of better OS for patients with N1b and distant metastasis after adjustment. In addition, TT was associated with better CSS than TL for patients with risk factors like N1b combined with gross extrathyroidal extension, and/or multifocality after matching. In conclusion, TL may be enough for low-risk PTMC patients. TT may improve the prognosis of unilateral PTMC patients with 2 or more risk clinicopathologic factors like CLNM, multifocality, extrathyroidal extension and a younger age compared with TL.
| S-EPMC8242954 | biostudies-literature
Project description:In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen sections for diagnosis of infection in hip and knee revisions. Between 1996 and 2002 we examined sections and cultured periprosthetic tissues in prosthetic revision in 170 cases, including 146 cases (83 hips and 63 knees). We assessed sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared intraoperative findings and paraffin-embedded samples. The results in the knee group were SE=66.7%, SP=89.7% [95% confidence interval (CI)], PPV=81% (95% CI), NPV=81.4% (95% CI), Youden index=0.56, PLR=6.5 (95% CI) and NLR=0.4 (95% CI). In the paraffin-embedded samples the results were SE=91%, SP=87% (95% CI), PPV=81% (95% CI), NPV=94% (95% CI), PLR=7 (95% CI) and NLR=8.7 (95% CI). We found a significant difference. The results in the hip group were SE=50%, SP=100% (95% CI), PPV=100% (95% CI), NPV=94.9% (95% CI), Youden index=0.5 and PLR=0.5 (95% CI). In hip and knee prosthetic revision surgery the presence of polymorphonuclear cells correlates with infection, but their absence does not exclude it. It is a quick and inexpensive test that should be included in the diagnostic protocol in revision surgery.diagnostic Study (investigating a diagnostic test), level I. See instructions to authors for a complete description of levels of evidence.
| S-EPMC2267549 | biostudies-other
Project description:BACKGROUND:Molecular testing of thyroid nodules is a diagnostic tool used to better understand the nature of thyroid nodules. The aim of this study is to better comprehend the relationship between specific mutations and aggressive behavior of the tumour as demonstrated on postoperative pathological analysis. METHODS:A retrospective chart review of 103 cases was performed. Included were patients who had undergone molecular testing using a panel that tests for 9 mutations (ThyGenX®) and were found to have malignant tumours. The following gene alterations were found pre-operatively in the nodules: BRAF V600E (n = 32), BRAF K601E (n = 4), NRAS (n = 11), HRAS (n = 4), KRAS (n = 3), RET/PTC1 rearrangement (n = 1), TERT promoter (n = 2), PAX8-PPARγ rearrangement (n = 1), and 45 cases where no mutation was detected. Aggressive behavior was defined by extra-thyroidal extension (ETE), lymph node metastasis (LN+), and the following variants of papillary thyroid carcinoma: tall cell, solid, diffuse sclerosing, columnar cell and hobnail. Chi-squared testing was performed to compare groups. RESULTS:The group with BRAF V600E, RET/PTC1 rearrangement, and TERT promoter mutations was associated with ETE 37.1%, and LN+ 45.7% of the time compared to 4.3 and 13.0% in the group with other mutations, and 4.4 and 4.4% in the group with no mutations (p-value 0.02, p-value < 0.001, p-value 0.006). In addition, the BRAF V600E, RET/PTC1 rearrangement, and TERT mutations group demonstrated tall cell variants (17.1%), columnar cell variants (5.7%), and hobnail variants (3%). The other mutations group demonstrated columnar cell variants (4.3%), and the no mutations group demonstrated solid variants (2.2%). CONCLUSIONS:In this study, BRAF V600E, RET/PTC1 rearrangement, and TERT mutations were associated with aggressive behaving thyroid malignancies as defined above. Molecular testing may be a useful method to anticipate aggressive tumour types and therefore assist in planning the extent and timing of surgery.
| S-EPMC6796357 | biostudies-literature
Project description:ImportanceIntraoperative margin assessment is an important technique for ensuring complete tumor resection in malignant cancers. However, in patients undergoing transoral robotic surgery (TORS) for oropharyngeal carcinomas, tissue artifact may provide pathologic uncertainty.ObjectiveTo assess the benefit of providing frozen section control samples ("positive tumor biopsies") for use during intraoperative margin assessment for patients undergoing TORS for human papillomavirus (HPV)-16-positive oropharyngeal squamous cell carcinoma (OPSCC).Design, setting, and participantsIn this cohort study, patients receiving curative-intent TORS for biopsy-proven HPV-16-positive OPSCC performed by a single attending surgeon (A.H.M.) at Ronald Reagan UCLA Medical Center from 2017 to 2021 were included in a retrospective data analysis. Exclusion criteria included HPV-negative status, participation in clinical trials, and tumors of unknown primary origin.Main outcomes and measuresSurvival outcomes investigated included overall and disease-free survival. Adverse pathologic outcomes measured included occurrence of nondiagnostic margins and margin reversal from frozen to fixed pathology.ResultsOf the 170 patients included (mean [SD] age, 61.8 [9.9] years; 140 [82%] male), 50% of patients (n = 85) received a frozen section control. Use of a frozen section control was associated with statistically significantly improved sensitivity of intraoperative margin assessment, from 82.8% to 88.9% (difference, 6.1%; 95% CI, 3.9%-8.3%). Eleven percent (n = 18) of all tumors evaluated exhibited at least 1 nondiagnostic intraoperative margin, and 11% (n = 18) experienced margin reversal from frozen to fixed pathology. In patients with nondiagnostic margins, use of frozen section controls was associated with statistically significantly reduced time spent in the operating room (Cohen d, 1.14; 95% CI, 0.12-2.14).Conclusions and relevanceIn this cohort study, frozen intraoperative margins assessed during TORS resections of HPV-16-positive OPSCC were diagnostically challenging. Adverse pathologic outcomes, such as margin status reversal from positive on frozen pathology to negative on formal analysis, were common. Providing intraoperative frozen section control biopsies may offer clarity in cases with nondiagnostic margins, reducing the need for additional sampling and time spent in the operating room.
| S-EPMC9501795 | biostudies-literature