中国普通外科杂志2025，Vol.34Issue(11)：2454-2461,8.DOI:10.7659/j.issn.1005-6947.250281
后贝塞斯达时代术中冷冻切片在甲状腺结节手术决策中的应用价值与争议
Application value and controversies of intraoperative frozen section in surgical decision-making for thyroid nodules in the post-Bethesda era
摘要
Abstract
With the widespread adoption of fine-needle aspiration(FNA)in the diagnostic workup of thyroid nodules,the role of intraoperative frozen section(FS)in surgical decision-making has been increasingly re-evaluated in the post-Bethesda era.This review systematically summarizes the clinical value of FS across different Bethesda categories,with particular focus on its role in preventing overtreatment and avoiding insufficient surgery,as well as the notable differences between Western and Asian clinical practices.Current evidence indicates that for Bethesda Ⅵ nodules,the positive predictive value of FNA is extremely high,and routine FS rarely alters surgical management while potentially increasing the risk of under-treatment due to false-negative results.For Bethesda Ⅴ nodules,the utility of FS largely depends on the population-specific risk of malignancy(ROM):in Western countries with relatively lower ROM,FS may reduce overtreatment caused by FNA false positives,whereas in China and other Asian populations with significantly higher ROM,routine FS provides limited additional benefit.For Bethesda Ⅱ nodules,routine FS is not cost-effective and should be reserved for selected high-risk cases.FS is beneficial in Bethesda I and some Bethesda Ⅲ nodules for clarifying diagnosis and optimizing the extent of initial surgery,but it is not recommended for routine use in Bethesda Ⅳ nodules due to low diagnostic sensitivity.Molecular testing offers new tools for risk stratification in indeterminate nodules,although its application remains limited in China.In conclusion,FS should not be applied uniformly across all patients but rather tailored according to Bethesda category,population-specific ROM,and institutional diagnostic performance of FS.关键词
甲状腺结节/活组织检查,细针/Bethesda系统/冷冻切片/综述Key words
Thyroid Nodule/Biopsy,Fine-Needle/Bethesda System/Frozen Sections/Review分类
医药卫生引用本文复制引用
骆鹏飞,马伟..后贝塞斯达时代术中冷冻切片在甲状腺结节手术决策中的应用价值与争议[J].中国普通外科杂志,2025,34(11):2454-2461,8.基金项目
安徽省卫生健康科研计划基金资助项目(AHWJ2024Ab0145). （AHWJ2024Ab0145）
