Aim: To assess diagnostic accuracy of preoperative fine-needle aspiration (FNA) compared to that of frozen-section 
examination (FSE) in the management of thyroid surgery. 
Methods: This is a retrospective review of 34 patients who underwent thyroid surgery between 2003-2005 at King Abdulaziz University Hospital. FNA and FSE were taken form all patients. FNA and FS sensitivity, specificity, positive and negative predictive values, accuracy were calculated versus permanent section. 
Results: FNA results were 29 (85.3%) benign, 3 (8.8%) malignant, and 2 (5.9%) suspicious. FSE diagnosis was benign in 28 
(82.4%), deferred in 2 (5.9%), and malignant in 4 (11.8%). Diagnosis of malignancy in suspicious deferred cases was 50%. 
Sensitivity, specificity, positive, negative predictive values, and accuracy for FNA versus FSE were 33.3% versus 50.0%; 89.7% versus 92.9%, 25.0% versus 50.0%; 92.9% versus 92.9%; 84.4% versus 87.5%.. 
Conclusion: FSE showed higher sensitivity, specificity, positive predictive value, and accuracy when compared to FNA. In 
patients with FNA revealing thyroid pathology, the extent of thyroidectomy must be established by FSE. Reliance on FSE 
lowers the possibility of unnecessary surgery and the need for additional surgery. However, increased costs for operative time and the pathologist needed for routine FSE negate any substantial benefit in patients' outcome.