OBJECTIVE To assess the value of intraoperative cytology on scrape preparations of thyroid lesions. METHODS We conducted a retrospective review of 73 cases of various thyroid lesions in which ultrafast Papanicolaou-stained scrape preparations were performed. Frozen sections were performed in 19 cases (26%). Fine-needle aspiration diagnosis was available in 65 cases. The correlation between the scrape diagnosis and the final diagnosis was analyzed. RESULTS The agreement rate between the scrape diagnosis and the final diagnosis was 89%. All cases diagnosed as suspicious for papillary thyroid carcinoma on fine-needle aspiration were definite for malignant papillary carcinoma on scrape preparations. Three cases from this category were diagnosed as papillary carcinoma on both frozen section and scrape preparations, leading to total thyroidectomy. CONCLUSION We conclude that intraoperative consultation is useful for thyroid lesions diagnosed as suspicious for papillary thyroid carcinoma on fine-needle aspiration and that ultrafast Papanicolaou-stained scrape preparations can increase the efficacy of thyroid frozen sections and obviate a second procedure for completion thyroidectomy.