Thyroid gland
Miscellaneous
Frozen section

Author: Shahidul Islam, M.D., Ph.D. (see Authors page)

Revised: 23 February 2017, last major update March 2009

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: frozen section thyroid

Cite this page: Frozen section. PathologyOutlines.com website. http://pathologyoutlines.com/topic/thyroidfrozen.html. Accessed November 21st, 2017.
Definition / general
  • Not indicated for most thyroid nodules due to low sensitivity; frequency has been decreasing (Virchows Arch 2008;453:433)
  • Results may conflict with FNA (Arch Otolaryngol Head Neck Surg 2007;133:874), but see Thyroid 2007;17:557
  • Well differentiated carcinomas often cannot be diagnosed on frozen section, regardless of experience of pathologist
  • Intraoperative cytology may be useful to detect nuclear features of papillary carcinoma (Mod Pathol 2000;13:210)

  • False negatives by frozen section:
    • Minimally invasive follicular carcinoma:

  • False positives by frozen section:
    • Metastatic papillary carcinoma: apparent metastases may actually be Riedel thyroiditis, diffuse hyperplasia of ectopic thyroid tissue or sequestered thyroid tissue
    • Freezing artifact may mimic nuclear features of papillary thyroid carcinoma or parathyroid neoplasms (43% of cases diagnosed as "suspicious for papillary carcinoma" are not papillary carcinoma at permanent section, Thyroid 2008;18:419)
    • Post FNA alterations can mimic capsular or vascular invasion
Microscopic (histologic) images

Images hosted on PathOut server:

Frozen section lacks nuclear features (left),
nuclear features present in permanent section (right)



Images hosted on other servers:

Follicular variant of papillary carcinoma:

Comparison of frozen section and permanent section

Nuclear features are not evident in frozen section

Nuclear features identifiable with scrape cytology

Additional references