Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm. Study Design. Retrospective case series. Methods. All patients have a fine needle aspirate biopsy, an intraoperative frozen section, and final pathology performed on a thyroid nodule after initiation of the Bethesda System for Reporting Thyroid Cytopathology in 2009 at a single tertiary referral center. Sensitivity, specificity, positive predictive value, and negative predictive value are calculated in order to determine added benefit of frozen section to original fine needle aspirate data. Results. The sensitivity and specificity of the frozen section were 76.9% and 67.9%, respectively, while for the fine needle aspirate were 53.8% and 74.1%, respectively. The positive and negative predictive values for the fine needle aspirates were 25% and 90.9%, respectively, while for the frozen sections were 27.8% and 94.8%, respectively. There were no changes in the operative course as a consequence of the frozen sections. Conclusion. Our data does not support the clinical usefulness of intraoperative frozen section when the fine needle aspirate yields a Bethesda Criteria diagnosis of follicular neoplasm, suspicious for follicular neoplasm, or suspicious for malignancy at our institution. 1. Introduction The incidence of thyroid cancer increased 2.4-fold from 3.6 to 8.7 per 100,000 Americans [1] over a thirty-year period ending in 2002. The annual incidence of palpable thyroid nodules in North America is 0.1% [2] and most of those under 1？cm cannot be detected by physical exam alone [3]. The introduction of high resolution ultrasound technology has increased our ability to diagnose thyroid nodules [4]. A patient of male gender, aged <20 years or >70 years, with a family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia (MEN), rapid nodular growth, a firm or fixed nodule, a history of head and neck irradiation, a nodule that is >4？cm or is partially cystic, or a compressive sensation should raise increased suspicion for thyroid carcinoma [5]. In 2009, the Bethesda Criteria for Reporting Thyroid Cytopathology were published to create a common language by which multidisciplinary teams could accurately discuss the diagnosis and implications of a fine needle aspiration (FNA) biopsy [6]. The six categories found within the Bethesda Criteria each implies a different malignancy risk (Table 1) and treatment approaches ranging from watchful waiting to
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