Utility of Intraoperative Frozen Section in Making the Decision of Lobectomy vs Total Thyroidectomy in Selected Cases of Solitary Thyroid Nodules

Abstract Background Intraoperative frozen section (IFS) had been, historically, the main tool to determine the initial histologic diagnosis of a thyroid nodule and therefore to guide the treatment strategy. Surgery could be limited to a hemi-thyroidectomy in case of a benign nodule, while a malignant IFS diagnosis indicates a total thyroidectomy. Since the advent of preoperative fine needle aspiration (FNA), and its establishment as a mainstay in the preoperative exploration of thyroid nodules, the role of IFS in this setting has been widely questioned. The introduction in 2007 of the Bethesda system for reporting thyroid cytopathology (BSRTC) has improved FNA reporting standards and became a standard of practice. Aim of the Work To determine accuracy and intertest agreement of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen-section analysis (IFS) findings in thyroid surgery, and to assess the influence of intraoperative FS findings on decision making and the utility of IFS in solitary thyroid nodules. Patients and Methods This study is a retrospective and prospective cohort comparative clinical study. This study was conducted at (General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. The period of the study between November 2020 and November 2023. Results The current study results Group A (n = 20) and Group B (n = 20) were assessed for demographic, baseline, hematological, biochemical, and preoperative characteristics to ensure equivalence prior to interventions. Results revealed no statistically significant differences in age distribution (p = 0.868) or gender composition (p = 0.327), indicating matched groups. Thyroid function tests (T3, T4, TSH) showed no significant variations (p = 0.820, p = 0.081, p = 0.567). Hematological and biochemical parameters (hemoglobin, creatinine, ALT, AST, INR) exhibited no significant disparities (p = 0.420, p = 0.811, p = 0.752, p = 0.571, p = 0.862). Preoperative characteristics (family history, TIRADS, nodule size, site) were well-balanced (p = 0.519, p = 0.752, p = 0.625, p = 0.321). Conclusion The comprehensive analysis of the clinical and pathological data comparing two groups reveals several key insights into the management and diagnostic evaluation of thyroid nodules. Firstly, there are no significant differences in baseline characteristics such as family history, TIRADS classification, nodule size, and site between the groups, ensuring a balanced comparison.