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Invited Commentary

Ronald H. Nishiyama, MD
Arch Surg. 1997;132(6):680. doi:10.1001/archsurg.1997.01430300122023.
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One of the more difficult tasks for pathologists and surgeons is to establish the preoperative or intraoperative diagnosis of minimally invasive follicular and Hürthle cell thyroid neoplasms. It is well known to experienced surgeons and pathologists that fine-needle aspirates of the thyroid gland are not dependable for the detection of such lesions. The best that a cytopathologist can do with aspirates in such cases is to alert the surgeon that a thyroid nodule may be a follicular or Hürthle cell neoplasm.

Intraoperatively, as the authors have stated, the pathologic diagnosis of minimally invasive follicular or Hürthle cell carcinomas is established by the demonstration of neoplasm invading through their capsules or into a vein. This is where controversy may begin. The authors clearly state that pathologic diagnoses at the Mayo Clinic are predominantly established by the examination of frozen sections. Hence, there are facilities and personnel to accommodate a large number


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