Albino Eccher1, Ilaria Girolami1, Antonia D'Errico2, Gianluigi Zaza3, Amedeo Carraro4, Umberto Montin5, Ugo Boggi6, Aldo Scarpa1, Matteo Brunelli1, Guido Martignoni1,7, Dorry Segev8, Esther Diana Rossi9, Liron Pantanowitz10. 1. Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Italy. 2. Pathology Unit, Department of Specialised, Experimental and Diagnostic Medicine, S. Orsola-Malpighi University Hospital of Bologna, Italy. 3. Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Italy. 4. General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Italy. 5. General Surgery Unit, ULSS1 Dolomiti Hospital of Feltre, Italy. 6. Division of General and Transplant Surgery, University of Pisa, Italy. 7. Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Italy. 8. Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. 9. Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Agostino Gemelli School of Medicine, Rome, Italy. 10. Department of Pathology, University of Pittsburgh Medical Center, PA, USA.
Abstract
INTRODUCTION: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. METHODS: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. RESULTS: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. DISCUSSION: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.
INTRODUCTION: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. METHODS: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. RESULTS: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. DISCUSSION: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.