World J Surg DOI 10.1007/s00268-015-2991-y
REPLY, LETTER TO THE EDITOR
Intraoperative Surgical Decision Using Intraoperative Frozen Section in Papillary Thyroid Cancer: Reply Young Min Park • Byung-Joo Lee
Ó Socie´te´ Internationale de Chirurgie 2015
Thank you for your letter to the editor regarding ‘Intraoperative frozen section for the evaluation of extrathyroidal extension in papillary thyroid cancer,’ by Park et al. [1]. As the corresponding author, I want to reply to your question. The definition of minimal extrathyroidal extension is problematic, subjective, and still controversial, as you mentioned. Our diagnostic criteria for minimal extrathyroid extension include the presence of carcinoma extending into the perithyroidal tissues (adipose tissues, skeletal muscles, and around and into sizable vascular structures and nerves). We did not study the relationship between the variants of papillary thyroid cancer and the rate of extrathyroidal extension. Comparing the results of intraoperative frozen sections with permanent pathology sections, the falsenegative rate of intraoperative frozen sections was 12.62 %, as you mentioned. In the Discussion, we wrote ‘Technically, pathologic section was generally performed only once in the specimen on the frozen biopsy. Based on a pathologic frozen section, pathologists evaluated malignancy and the presence of ETE in this study. If ETE was observed on the frozen biopsy, it was confirmed on the permanent pathologic examination in almost cases. However, as multiple pathologic sections were performed on permanent pathologic examination, ETE could be detected using the other portion of tumor, which was not sectioned on the frozen biopsy. This is why the accuracy of the Y. M. Park Department of Otorhinolaryngology, Pundang Jesaeng Hospital, Deajin Medical Center, Seongnam, Gyeonggi, Korea B.-J. Lee (&) Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea e-mail: [email protected]
frozen biopsy was different from that of permanent pathologic examination in the prediction of ETE.’ Several factors affect the surgical extent in papillary thyroid cancer, including age, sex, the size of the thyroid nodule, the presence of extrathyroidal extension, the presence of lymph node metastasis, the histopathological type of thyroid cancer, distant metastasis, and the surgeon’s and patient’s preferences. Even performing several preoperative imaging studies, including ultrasound, it is difficult to predict the presence of extrathyroidal extension and metastasis to central compartment lymph nodes accurately [2]. An intraoperative frozen section is a popular method for determining the surgical extent in surgery for several cancers, including that of the head and neck. However, few studies have examined the role of intraoperative frozen sections in determining the surgical extent in papillary thyroid cancer. Previously, we reported on the accuracy of intraoperative frozen section for the detection of metastasis to central compartment lymph nodes in papillary thyroid cancer [3]. In this study, we examined the accuracy of the evaluation of extrathyroidal extension using an intraoperative frozen section to determine the surgical extent in papillary thyroid cancer [1]. Although we performed several preoperative imaging studies, predicting the exact extent of thyroid papillary cancer, including extrathyroidal extension and lymph node metastasis, is highly problematic. The intraoperative frozen section was more accurate than the preoperative ultrasound in terms of evaluating extrathyroidal extension and metastasis to central compartment lymph nodes in papillary thyroid cancer [1, 3]. Although the surgeon’s and patient’s preferences are important factors when deciding the extent of surgery, an intraoperative frozen section can be useful for identifying the presence of extrathyroidal extension and metastasis to central compartment lymph nodes, and so
123
World J Surg
help with the decision regarding the surgical extent in papillary thyroid cancer.
References 1. Park YM, Wang SG, Goh JY, Shin DH, Kim IJ, Lee BJ (2014) Intraoperative frozen section for the evaluation of extrathyroidal
123
extension in papillary thyroid cancer. World J Surg 39:187–193. doi:10.1007/s00268-014-2795-5 2. Kwak JY, Kim EK, Youk JH et al (2008) Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18:609–614 3. Lim YS, Choi SW, Lee YS et al (2013) Frozen biopsy of central compartment in papillary thyroid cancer: quantitative nodal analysis. Head Neck 35:1319–1322
REPLY, LETTER TO THE EDITOR
Intraoperative Surgical Decision Using Intraoperative Frozen Section in Papillary Thyroid Cancer: Reply Young Min Park • Byung-Joo Lee
Ó Socie´te´ Internationale de Chirurgie 2015
Thank you for your letter to the editor regarding ‘Intraoperative frozen section for the evaluation of extrathyroidal extension in papillary thyroid cancer,’ by Park et al. [1]. As the corresponding author, I want to reply to your question. The definition of minimal extrathyroidal extension is problematic, subjective, and still controversial, as you mentioned. Our diagnostic criteria for minimal extrathyroid extension include the presence of carcinoma extending into the perithyroidal tissues (adipose tissues, skeletal muscles, and around and into sizable vascular structures and nerves). We did not study the relationship between the variants of papillary thyroid cancer and the rate of extrathyroidal extension. Comparing the results of intraoperative frozen sections with permanent pathology sections, the falsenegative rate of intraoperative frozen sections was 12.62 %, as you mentioned. In the Discussion, we wrote ‘Technically, pathologic section was generally performed only once in the specimen on the frozen biopsy. Based on a pathologic frozen section, pathologists evaluated malignancy and the presence of ETE in this study. If ETE was observed on the frozen biopsy, it was confirmed on the permanent pathologic examination in almost cases. However, as multiple pathologic sections were performed on permanent pathologic examination, ETE could be detected using the other portion of tumor, which was not sectioned on the frozen biopsy. This is why the accuracy of the Y. M. Park Department of Otorhinolaryngology, Pundang Jesaeng Hospital, Deajin Medical Center, Seongnam, Gyeonggi, Korea B.-J. Lee (&) Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea e-mail: [email protected]
frozen biopsy was different from that of permanent pathologic examination in the prediction of ETE.’ Several factors affect the surgical extent in papillary thyroid cancer, including age, sex, the size of the thyroid nodule, the presence of extrathyroidal extension, the presence of lymph node metastasis, the histopathological type of thyroid cancer, distant metastasis, and the surgeon’s and patient’s preferences. Even performing several preoperative imaging studies, including ultrasound, it is difficult to predict the presence of extrathyroidal extension and metastasis to central compartment lymph nodes accurately [2]. An intraoperative frozen section is a popular method for determining the surgical extent in surgery for several cancers, including that of the head and neck. However, few studies have examined the role of intraoperative frozen sections in determining the surgical extent in papillary thyroid cancer. Previously, we reported on the accuracy of intraoperative frozen section for the detection of metastasis to central compartment lymph nodes in papillary thyroid cancer [3]. In this study, we examined the accuracy of the evaluation of extrathyroidal extension using an intraoperative frozen section to determine the surgical extent in papillary thyroid cancer [1]. Although we performed several preoperative imaging studies, predicting the exact extent of thyroid papillary cancer, including extrathyroidal extension and lymph node metastasis, is highly problematic. The intraoperative frozen section was more accurate than the preoperative ultrasound in terms of evaluating extrathyroidal extension and metastasis to central compartment lymph nodes in papillary thyroid cancer [1, 3]. Although the surgeon’s and patient’s preferences are important factors when deciding the extent of surgery, an intraoperative frozen section can be useful for identifying the presence of extrathyroidal extension and metastasis to central compartment lymph nodes, and so
123
World J Surg
help with the decision regarding the surgical extent in papillary thyroid cancer.
References 1. Park YM, Wang SG, Goh JY, Shin DH, Kim IJ, Lee BJ (2014) Intraoperative frozen section for the evaluation of extrathyroidal
123
extension in papillary thyroid cancer. World J Surg 39:187–193. doi:10.1007/s00268-014-2795-5 2. Kwak JY, Kim EK, Youk JH et al (2008) Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18:609–614 3. Lim YS, Choi SW, Lee YS et al (2013) Frozen biopsy of central compartment in papillary thyroid cancer: quantitative nodal analysis. Head Neck 35:1319–1322
