Evaluation of the Role of Intraoperative Cervical Lymph Node Frozen Section in Detection of Cervical Lymph Node Metastasis in Differentiated Thyroid Carcinoma Surgeries
Amr Maher Mohamed Shehata, Mahmoud Ahmed Mohamed El-Shafei, Hanna Habib Hanna, Eman Abdel-Salam Ibrahim, Ayman Magdy Boutros GhalyAbstract
Background
Lymphatic metastases at the time of diagnosis are common in differentiated thyroid cancer. There is still continuing controversy regarding the role of prophylactic cervical lymph node dissection in patients with differentiated thyroid cancer, it is widely accepted that in the presence of cervical lymphadenopathy, cervical lymph node dissection is indicated at the time of initial thyroidectomy. Occasionally, skip metastases can occur, but in general lymphatic dissemination occurs in a stepwise fashion.
Objective
To evaluate the role of intraoperative frozen lymph node biopsy in detection of cervical lymph nodes metastasis to reduce incidence of unnecessary cervical lymph node neck dissection in differentiated thyroid carcinoma surgeries to avoid complications of neck dissection.
Patients and Methods
This is a prospective cross-sectional study to evaluate the role of intra- operative frozen lymph node biopsy in detection of cervical lymph nodes metastasis to reduce incidence of unnecessary cervical lymph node neck dissection in differentiated thyroid carcinoma surgeries to avoid complications of neck dissection. This study wasbe conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Diagnosis and staging examinations were carried out according to the standard protocol being conducted at Ain Shams University Hospitals
Results
In our study about 50 patients with negative FNAC from lymph nodes underwent frozen section intra-operative. About 27 patients were positive malignant lymph nodes with percent 54% and underwent neck dissection and 23 patients with percent 46% were negative for malignant lymph node and aborted neck dissection with sensitivity 87% and specificity 98%. Paraffin section postoperative revealed about 30 patients were positive for malignant lymph nodes and 20 patients were negative for malignant lymph nodes with sensitivity 90% and specificity 97.4% Thus, the main role of the intra-operative Frozen section of the lymph nodes is the triage of patients who require surgery, thus reducing the number of unnecessary neck dissection and possible complications.
Conclusion
To sum up, the main role of the intra-operative Frozen section of the lymph nodes is the triage of patients who require surgery, thus reducing the number of unnecessary neck dissection and possible complications. Besides, frozen section has a high sensitivity and specificity percent that makes if effective to avoid overtreatment. The main drawback of the study is the low number of patients. A study with a bigger sample would throw more light on this comparison.