Freezing the tissues and examining them histologically (frozen examination, frozen section) is an important diagnostic approach that can change the course of the surgery in some cases. In this context, the pathologist's experience and knowledge become important for a quick and accurate decision. When ordering FC, surgeons should ask whether the result will change the operative strategy. If the answer is 'no', there is no need for this procedure.
Application areas of FK examination:
1. Making the correct diagnosis during surgery. Accordingly, determining the appropriate treatment method and reducing the possibility of re-operation,
2. Evaluation of an unexpected finding during surgery
3. In some cases, confirmation of the known diagnosis,
4. Evaluation of surgical margins,
5. Evaluation of the extent of the disease (such as lymph node metastases and invasion of neighboring organs)
6. Identification of tissues (such as nerve, parathyroid, ureter)
Sometimes pathologists may not be able to reach a decision with PK and the definitive diagnosis of the lesion can be left to paraffin sections at a time after surgery.
The most common areas of use of the PK method during thyroidectomy surgeries are; Evaluation of the nodule in the thyroid during surgery, evaluation of the area of spread outside the thyroid in thyroid cancers, determination of lymph node metastasis (spread), and especially identification of normal parathyroid tissue. FNAB diagnosis; PK is useful to confirm the definitive diagnosis in cases suspicious for papillary, medullary and metastatic thyroid carcinoma or lymphoma (Bethesda system, Category V).
Thyroid pathologies that create diagnostic difficulties in PK; non-encapsulated follicular lesion, Follicular/Hurthle) cell neoplasia or suspicion (Bethesda system, Category IV), Papillary Thyroid Cancer subtypes and ectopic thyroid tissue. In such cases, a definitive diagnosis cannot be made using methods such as frozen section and cytological examination. Additionally, frozen surgery is not recommended for nodules smaller than 1 cm. PK procedure is also unnecessary in cases with a cytological diagnosis of Papillary Thyroid Cancer (Bethesda system, Category VI).
The most important benefits of FC include the detection of lymph node metastases and parathyroid tissue.
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