Microscopic view of thyroid nodule with superimposed surgeon's hand indicating a frozen section analysis

Is a Frozen Section Right for Your Thyroid Nodule? A Patient-Friendly Guide

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Unlocking the role of intra-operative frozen section analysis in thyroid nodule management: What patients need to know about accuracy, benefits, and personalized care."

Thyroid nodules are a common health concern, affecting a significant portion of the population. While many are benign, the possibility of malignancy requires careful evaluation and a strategic approach to management. This is where intra-operative frozen section (FS) analysis comes into play, offering a real-time assessment during thyroid surgery to guide the extent of the procedure.

FS biopsy involves taking a small sample of the thyroid nodule during surgery and rapidly freezing it for microscopic examination. This allows pathologists to provide surgeons with an immediate diagnosis, helping them determine whether to remove the entire thyroid gland (total thyroidectomy) or only a portion of it (lobectomy). The goal is to ensure complete removal of cancerous nodules while minimizing the extent of surgery for benign conditions.

This article aims to provide a clear and accessible overview of FS in thyroid surgery. By examining the findings of a recent study on the value of FS, we'll explore its accuracy, benefits, and limitations, empowering you to make informed decisions about your thyroid health.

Frozen Section Analysis: What Does the Research Say?

Microscopic view of thyroid nodule with superimposed surgeon's hand indicating a frozen section analysis

A retrospective study analyzed the results of 1110 frozen sections of thyroid specimens over a 10-year period (2003-2012) and compared these to the final, more detailed, histopathological examination. Here's a breakdown of the key findings:

Accuracy: In the study, FS and final diagnoses agreed in 85.4% of cases. There were disagreements in 5.5% of cases, and 9.1% were deferred (meaning a definitive diagnosis couldn't be made on the frozen section alone).

Specificity: FS was highly specific (99.3%), meaning it was very good at correctly identifying benign nodules.
Sensitivity: Sensitivity was lower (64.7%), indicating that FS missed some malignant nodules. The sensitivity varied depending on the type of thyroid cancer, with higher sensitivity for follicular and anaplastic carcinomas than for papillary carcinoma.
False Negatives: A significant portion of the false-negative diagnoses were due to papillary microcarcinomas (very small tumors), which can be challenging to detect on frozen section.
Predictive Value: The positive predictive value (PPV) was 94.4%, meaning that if FS indicated malignancy, it was highly likely to be correct. The negative predictive value (NPV) was 93.9%, meaning that if FS indicated benignity, it was usually accurate.

It is important to note that deferred responses are those that could not be immediately categorised in order to make statistically calculations.

The Bottom Line: Is Frozen Section Right for You?

The study supports the use of intraoperative FS in confirming malignancy in thyroid nodules. Its high specificity means it's reliable for identifying benign cases, potentially allowing for less extensive surgery when appropriate. However, the lower sensitivity and possibility of false negatives highlight the importance of careful interpretation and consideration of other factors.

Ultimately, the decision to use FS should be made in consultation with your surgeon and endocrinologist, taking into account your individual risk factors, the characteristics of your nodule, and the availability of experienced pathologists. Discuss the potential benefits and limitations of FS in your specific case to determine the best approach for your thyroid health.

By staying informed and actively participating in your care, you can work with your medical team to achieve the best possible outcome for your thyroid nodule.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4172/2167-7948.1000222, Alternate LINK

Title: The Value Of Intra-Operative Frozen Section In Thyroid Neoplasm Management: Experience Of One Center

Subject: Psychiatry and Mental health

Journal: Journal of Thyroid Disorders & Therapy

Publisher: OMICS Publishing Group

Authors: Raja Jouini, Nihed Abdessayed, Wafa Koubba Mahjoub, Ehsen Ben Brahim, Achraf Chadli Debbiche

Published: 2017-01-01

Everything You Need To Know

What is intra-operative frozen section analysis, and how does it guide thyroid nodule surgery?

Intra-operative frozen section (FS) analysis is a rapid microscopic examination of a thyroid nodule sample taken during surgery. It helps surgeons determine whether to remove the entire thyroid gland (total thyroidectomy) or only a portion of it (lobectomy). The aim is to completely remove cancerous nodules while minimizing surgery for benign ones. However, FS is not perfect and has limitations like lower sensitivity for certain types of thyroid cancer such as papillary microcarcinomas.

How accurate is frozen section analysis for diagnosing thyroid nodules, according to the research?

According to the study, frozen section (FS) analysis showed agreement with the final diagnoses in 85.4% of cases. Specificity was high (99.3%), meaning it was very good at correctly identifying benign nodules. Sensitivity was lower (64.7%), indicating that FS missed some malignant nodules. The positive predictive value (PPV) was 94.4%, and the negative predictive value (NPV) was 93.9%. Disagreements occurred in 5.5% of cases, and 9.1% were deferred.

How does the high specificity of frozen section analysis benefit patients with thyroid nodules?

The high specificity (99.3%) of frozen section (FS) means it's very reliable at confirming a nodule is benign. This can allow surgeons to perform a less extensive surgery, like a lobectomy instead of a total thyroidectomy, which reduces potential complications such as hypoparathyroidism or recurrent laryngeal nerve injury. But the possibility of false negatives needs to be carefully considered.

What are false negatives in frozen section analysis, and what implications do they have for thyroid cancer management?

False negatives occur when frozen section (FS) analysis indicates a nodule is benign, but it's actually malignant. The study showed that a significant portion of false negatives were due to papillary microcarcinomas, which are small and can be challenging to detect using FS. If a false negative occurs, it might necessitate a second surgery to remove the remaining thyroid tissue, hence a more detailed final histopathological examination is crucial.

What does it mean when a frozen section analysis result is 'deferred,' and how does it influence the surgical approach?

Deferred responses in frozen section (FS) analysis are instances where a definitive diagnosis cannot be made immediately during the procedure. This can be due to various factors, such as the quality of the sample or the presence of unusual cellular features that require more detailed examination. In such cases, the surgeon will likely proceed based on other clinical factors and await the final histopathology report. Deferred responses represented 9.1% of cases in the study. However, deferred results are not useful for immediate decision making during the operation.