Comparison of Fine needle aspiration followed by histopathology and sonographic features of thyroid nodule to formulate a diagnosis: A cross-sectional study
Fine needle aspiration followed by histopathology and sonographic features of thyroid nodule in diagnosis
DOI:
https://doi.org/10.54393/pbmj.v5i7.634Keywords:
Thyroid nodules, FNAC, Sonography, DiagnosisAbstract
Thyroid nodules are solid lumps filled with fluid that develop inside the thyroid gland. Due to their small size, the majority of them go undetected and are asymptomatic. However, some of them are cancerous. Objectives: To compare the diagnostic accuracy of Fine needle aspiration followed by histopathology and sonographic features of thyroid nodule Methods: In this study, 274 participants were included. All of them were detected with the solitary euthyroid nodule. All the patients considered in the present study had normal values of T4 and TSH as euthyroid nodules were supposed to be studied. All the participants were subjected to undergo a USG as per the TIRADS system and FNAC wherever it was applicable. The biopsy report of the excised sample was considered a gold standard. Result: The classification of FNAC was more specific than the TIRADS system, however, the sensitivity of both the classification was the same. Micro-calcification was most specific and sensitive in the individuals that underwent a USG. Irregular margins had a specificity of 88% and nodules taller-than-wider in shape were 91% specificity. A total of 7 patients had shown benign features on cytology, whereas, they were suspiciously malignant on USG (TIRADES 4 and 5) and showed malignancy in final evaluation after the surgery. Conclusion: The sensitivity of both FNAC and USG in the diagnosis of malignancy of thyroid nodule is equal, however, the specificity of FNA is more (90%). FNAC is a minimally invasive procedure that can be opted for the differentiation of benign and malignant lesions with an accuracy of 86%. Patients showing high-risk features on sonography are subjected to repeat the FNAC and they should also be referred for a surgical biopsy to make a definitive diagnosis.
References
Fisher SB and Perrier ND. The incidental thyroid nodule. CA: A Cancer Journal for Clinicians. 2018 Mar; 68(2):97-105. doi: 10.3322/caac.21447
Hegedüs L. The thyroid nodule. New England Journal of Medicine. 2004 Oct; 351(17):1764-71. doi: 10.1056/nejmcp031436
Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. European Journal of Clinical Investigation. 2009 Aug; 39(8):699-706. doi: 10.1111/j.1365-2362.2009.02162.x
Haugen BR, Sawka AM, Alexander EK, Bible KC, Caturegli P, Doherty GM, et al. American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid. 2017 Apr; 27(4):481-483. doi: 10.1089/thy.2016.0628
Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. The Journal of Clinical Endocrinology and Metabolism. 2014 Apr; 99(4):1253-63. doi: 10.1210/jc.2013-2928
Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013 Oct; 310(14):1473-81. doi: 10.1001/jama.2013.279201.
Gharib H and Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinology and Metabolism Clinics of North America. 2007 Sep; 36(3):707-35, vi. doi: 10.1016/j.ecl.2007.04.009
Rahbari R, Zhang L, Kebebew E. Thyroid cancer gender disparity. Future Oncology. 2010 Nov; 6(11):1771-9. doi: 10.2217/fon.10.127
Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. Journal of Clinical Endocrinology and Metabolism. 2009 May; 94(5):1748-51. doi: 10.1210/jc.2008-1724
Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011 Sep; 260(3):892-9. doi: 10.1148/radiol.11110206.
Xu L, Port M, Landi S, Gemignani F, Cipollini M, Elisei R, et al. Obesity and the risk of papillary thyroid cancer: a pooled analysis of three case-control studies. Thyroid. 2014 Jun; 24(6):966-74. doi: 10.1089/thy.2013.0566
Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Thyroid Nodules: Nondiagnostic Cytologic Results according to Thyroid Imaging Reporting and Data System before and after Application of the Bethesda System. Radiology. 2015 Aug; 276(2):579-87. doi: 10.1148/radiol.15142308
Singh Ospina N, Brito JP, Maraka S, Espinosa de Ycaza AE, Rodriguez-Gutierrez R, Gionfriddo MR, et al. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for thyroid malignancy: systematic review and meta-analysis. Endocrine. 2016 Sep; 53(3):651-61. doi: 10.1007/s12020-016-0921-x
Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of "follicular neoplasm": a gray zone in thyroid fine-needle aspiration cytology. Diagnosis Cytopathology. 2002 Jan; 26(1):41-4. doi: 10.1002/dc.10043
Ho AS, Sarti EE, Jain KS, Wang H, Nixon IJ, Shaha AR, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid. 2014 May; 24(5):832-9. doi: 10.1089/thy.2013.0317
Taddesse A and Yaqub A. Clinical, sonographic and cytological evaluation of small versus large thyroid nodules. Journal of Pakistan Medical Association. 2011 May; 61(5):466-9
Muthu S and Saravanakumar R. A prospective study of incidence of malignancy in solitary nodule of thyroid. International Journal of Contemporary Medical Research. 2019 May; 6(5): e24-e26doi: 10.21276/ijcmr.2019.6.5.29
Barbosa TLM, Junior COM, Graf H, Cavalvanti T, Trippia MA, da Silveira Ugino RT, et al. ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology. BMC Endocrine Disorders. 2019 Oct; 19(1):112. doi: 10.1186/s12902-019-0429-5.
Handa U, Garg S, Mohan H, Nagarkar N. Role of fine needle aspiration cytology in diagnosis and management of thyroid lesions: A study on 434 patients. Journal of cytology. 2008 Jan; 25(1):13.
Hirachand S, Maharjan M, Lakhey M, Thapa R, Kafle S. Accuracy of fine needle aspiration cytology in diagnosis of thyroid swelling. Journal of pathology of Nepal. 2013 Oct; 3(6):433-6. doi: 10.3126/jpn.v3i6.8988
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Pakistan BioMedical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments editor@pakistanbmj.com