Targeted use of intraoperative frozen-section analysis lowers the frequency of completion thyroidectomy

医学 冰冻切片程序 甲状腺切除术 甲状腺 外科 前瞻性队列研究 甲状腺结节 普通外科 内科学
作者
Julia I. Staubitz,I Elmrich,Petra B. Musholt,Rafael J. A. Cámara,Felix Watzka,Henning Dralle,Carsten Sekulla,Kerstin Lorenz,Thomas J. Musholt,Christian Vorländer,Kerstin Lorenz,C Blankenburg,C Geffcken,Thomas M. Gress,A. Trupka,Frank Steinert,J. Schabram,Lindsey Albrecht,C Marschall,C Orlitsch,K Holzner,Julian A. Feller,Theresia Weber,D Kaltofen,Dietmar Simon,Rainer Kube,Kris Ann P. Schultz,M. Sahm,Juliane Obermeier,Carina Roth,Kjell Janson,Oliver Thomusch,Hans Meier,A Weinhold,Élodie Merlot,G Tonndorf,D.H. Sinn,Eric A. Klein,Guido Henke,W. Rampf,Kathleen Rendel,Kenko Cupisti,Katharina Holzer,Dale R. Grothe,Lukas Axt,Ilaria Muller,W Probst,C Guhr,F Schischke,T Schwörig,M.-A. Hospital,Jens Fielitz,Roman Stets,M Liese,C- L Weiss,J Zaage,Thomas Brauer,Jochen Weitz,A Huster,E Kidess,J Lautermann,N Kizilirmak,Costanza Chiapponi,H Bittscheidt,Dirk J. Lehmann,K. Kroll,Thomas J. Musholt,C Sonsnowska,Zbigniew Lorenc,B Dudešek,S Smutný,Michael Brauckhoff,Evelyne Bareck,R Köberle-Wührer
出处
期刊:BJS open [Wiley]
卷期号:5 (2) 被引量:8
标识
DOI:10.1093/bjsopen/zraa058
摘要

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.

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