Frozen section in thyroid gland follicular neoplasms: It's high time to abandon it!

Surg Oncol. 2021 Mar:36:76-81. doi: 10.1016/j.suronc.2020.12.005. Epub 2020 Dec 8.


Thyroid nodules are a very common clinical condition. The 2015 American Thyroid Association (ATA) guidelines recommend surgical excision for Bethesda IV nodules. The use of intraoperative frozen section (FS) has been recommended as a strategy to tailor the extent of the initial surgery. We critically evaluated the literature that discusses the utility and cost-effectiveness of FS to make an intraoperative decision in patients with thyroid nodules classified as follicular neoplasm. FS should not be recommended as a routine intraoperative test to assess for malignancy in thyroid follicular patterned lesions due to its low performance; the high number of deferred results; the inability to adequately assess histologically defining features; the improvements in risk stratification guiding total thyroidectomy; and the low cost-effectiveness of FS.

Keywords: Carcinoma; Follicular neoplasm; Frozen section; Thyroid nodule; Thyroidectomy.

Publication types

  • Review

MeSH terms

  • Carcinoma, Papillary / diagnosis*
  • Diagnosis, Differential
  • Diagnostic Errors / prevention & control*
  • Frozen Sections / standards*
  • Humans
  • Practice Guidelines as Topic / standards*
  • Thyroid Neoplasms / diagnosis*
  • Thyroid Nodule / diagnosis*