Fine Needle Aspiration of Thyroid as a Screening Test- Diagnostic Accuracy, Discrepancies and Pitfalls- Study of 1175 Patients in a Tertiary Care Centre (original) (raw)
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IOSR Journals , 2019
Introduction:. At present FNAC of the thyroid is considered by many as first line procedure and it is fully accepted in the diagnostic work up of patients in conjunction withtraditional methods. FNAC is widely accepted the most accurate, non-invasive, sensitive, specific and cost effective diagnostic procedure in the assessment of thyroid nodules andhelps to select people pre operatively for surgery.The main purpose of FNAC thyroid is to distinguish patients with malignantnodules and those with benign nodules. It is the procedure of choice in the initialscreening of thyroid nodules. A prospective work aimed to study the spectrum of cytological features of thyroidlesions in patients with thyroid swellings and to correlate the histological appearanceswhere ever tissues were available in patients, who attended the Govt General Hospital, Vijayawada Materials and methods: This study was conducted in the department of Pathology on patients with thyroid swellings who attended the Medical Surgical & ENT OPs of GovernmentGeneral Hospital Vijayawada during the period of June 2017 to May 2019.This study included patients of various age groups, both male and female Results: A total number of 375 aspirations were performed on patients with thyroidswellings, both male and female, who attended Medical, Surgical,ENT OPs duringthe above period. slides prepared were stained with H&E.Among the 375 cases aspirated material obtained was sufficient for diagnosis in330 cases. Remaining 45 cases showed only blood cellular elements and occasionalthyroid acinar cells. Conclusion: FNAC has been found to be a most valuable, economized, safe and simple diagnostic procedure in the evaluation of thyroid swellings.The present study was found to be very useful in differentiating Neoplastic from Non neoplastic thyroid lesions.The present study aided in the diagnosis of Malignant Thyroid lesions with great accuracy.
Fine needle aspiration cytology of thyroid lesions and classification as per the bethesda system
IP Innovative Publication Pvt. Ltd., 2018
Aims: The objective of this study was to analyse the thyroid cytology smears by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), to determine the distribution of diagnostic categories and subcategories, to analyse cytological feature, and to correlate cytopathology with histopathology wherever surgery was done. Materials and Methods: This is a prospective study was undertaken in the Department of Pathology, Sharda hospital, Greater Noida for a period of one year and 6 months starting from January 2016 to June 2017. Observation and Results: The distribution of various categories from 100 evaluated thyroid nodules were as follows: TBSRTC, 3% non-diagnostic, 92% benign, 0% AUS/FLUS, 1% Follicular neoplasm, 0% suspicious for malignancy and 4% malignant. Medullary carcinoma thyroid was misdiagnosed as adenomatoid nodule and thus not included in malignant category (category-6), but included in benign category (adenomatoid nodule). Conclusions: TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow up FNA or surgery and also the extent of surgery. Keywords: TBSRTC- The Bethesda system of reporting thyroid cytopathology, FNAC.
Cytopathology, 2014
Fine needle aspiration cytology of nodular thyroid lesions: a 2-year experience of the Bethesda system for reporting thyroid cytopathology in a large regional and a university hospital, with histological correlation Abstract Objective: Thyroid fine needle aspiration (FNA) contributes to the appropriate management of nodular thyroid lesions. The introduced categories in the Bethesda system for reporting thyroid cytopathology (TBSRTC) are associated with an implied cancer risk, providing a clinical management guideline. This study aims to evaluate the reproducibility of this implied risk and to compare the results from two different cytopathology departments. Methods: Five hundred histologically confirmed FNAs, studied since the introduction of TBSRTC, were obtained from 4208 and 3587 FNAs performed in a large regional hospital in Herakleion, Crete (group A) and a university hospital in Athens (group B), respectively. Reports were issued according to TBSRTC. Aspirates were prepared with ThinPrep รข and evaluated by two experienced cytopathologists. The reproducibility and accuracy were evaluated. Results: The proportion test for suspicious for malignancy (SFM) and malignant (M) cytology reports (P < 0.0001), and the number of malignancies on histology (P < 0.0001), were significantly higher in group A than in group B, consistent with a higher incidence of thyroid carcinomas in southern Greece. Although the malignancy rates were higher in group A than in group B for all categories, except M (A, 99.3%; B, 100%), the difference was only significant for benign aspirates (P = 0.0303). Malignancy rates for all categories in group A were above the TBSRTC recommended range, but were consistent with an increased prevalence of malignancy in that centre, differences in reporting practice and the variable ranges reported in the literature. There was lower sensitivity (P = 0.019) and overall accuracy (P = 0.003) in group A relative to group B, but no difference in specificity.
Thyroid gland fine needle aspiration cytology, a retrospective review in a tertiary hospital
Background: Fine needle aspiration cytology (FNAC) is accepted as the gold standard diagnostic tool for the assessment of thyroid nodules. Our objectives were to determine the cytological pattern of thyroid lesions and diagnostic accuracy of FNAC of thyroid lesions performed in our hospital to compare it with data published in literature, and to stress on the importance of using standardized cytological reporting system for thyroid FNAC. Methods: This is a retrospective review, done in King Abdul-Aziz University Hospital, King Saud University, Riyadh. We reviewed records of 80 patients; all underwent FNAC and thyroid surgery, from January 2010 to December 2012. Information was extracted from files including age, sex, FNAC results and final histopathological diagnosis. FNAC results were grouped according to the Bethesda System for reporting thyroid cytopathology. Final histopathology was grouped as either benign or malignant. Results: A total of 81 FNACs of thyroid lesions were done during the study period. The results of the FNA cytological diagnosis showed that one (1.2%) of the patients had FNAC which was unsatisfactory, 48 (59%) patients had benign lesions, 12 (14.8 %) had follicular lesion of undetermined significance, six (7.4%) had results of a follicular neoplasm, two (2.4%) had results of suspicious for malignancy, and 12 (14.8%) had FNAC results showing malignancy. These FNAC findings, in relation to histopathological diagnosis, showed that our FNAC diagnostic accuracy rate was 95%, with a sensitivity of 80%, and specificity of 100%. Conclusion: The results of our study are comparable with data in literature and show that FNAC is a sensitive, specific and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings. Also, the implementation of a standardized cytological reporting system will results in improved understanding of FNAC results, and subsequently, the management of nodular thyroid disease
IP innovative publication pvt. ltd, 2019
Introduction: Fine Needle Aspiration Cytology (FNAC) is the first line diagnostic procedure for evaluating thyroid lesions. The present study was carried out to assess the diagnostic utility of thyroid FNAC using The Bethesda System for Reporting Thyroid Cytopathology. Materials and Methods: It was a one year prospective study conducted in the Department of Pathology, Government Medical College, Jammu and included all patients presenting with thyroid swelling referred to this department. The thyroid fine needle aspirates from these patients were classified into six categories according to The Bethesda System for Reporting Thyroid Cytopathology. The Risk of Malignancy was calculated for each Bethesda category by follow-up histopathology. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were also calculated using histopathology diagnosis as gold standard. Results: Thyroid fine needle aspirates from a total of 300 patients were classified according to Bethesda system as Nondiagnostic (ND)- 17cases(5.67%), Benign- 264cases(88%), Atypia of Undetermined Significance (AUS)- 1case(0.33%), Follicular Neoplasm(FN)-6cases(2%), Suspicious for malignancy(SFM)- 0case( 0%) and Malignant- 12cases(4%). The Risk of Malignancy was Nondiagnostic- 50%, Benign-0%, AUS-0%, FN-50%, Suspicious for malignancy-not possible, Malignant-100%. Sensitivity, Specificity, PPV and NPV were 100%, 100%, 100%, 100% (FN excluded); 80%, 100%, 100%, 96% (FN included as benign); and 100%, 95.83%, 83.33%, 100% (FN included as malignant). Conclusion: The present study concludes Bethesda system to be an effective reporting system for thyroid cytology, FNAC to be a sensitive and specific test for evaluation of thyroid lesions and FNAC using Bethesda guidelines is useful in risk assessment of thyroid nodules thereby guiding appropriate management.
The Role of Fine Needle Aspiration Cytology (Fnac) In the Evalution of Thyroid Lesions
Abstract: Objective: To determine the sensitivity, specificity and diagnostic accuracy of fine needle aspiration cytology in the management of thyroid lesions. Material and Methods: A prospective study of Fine needle aspiration cytology of the thyroid gland was undertaken to evaluate its diagnostic utility, during the period from June 2011 to December 2013 in the Department of Pathology, S.P. Medical College Bikaner. A total of 52 patients presenting with palpable thyroid nodule was included in the study. All the patients underwent fine needle aspiration of the nodule. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. A comparison of FNA cytology and biopsy results was made. Results: Age of the patients ranged from 15-70 yrs with a mean age of 42.44 yrs. The majority of the patients were females in the present study with 45 (86.5%) females and 7 males, with a ratio of 6.41:1. Urban and rural distribution of sample population included 38 (73.1%) cases from rural and 14 (26.9%) cases from the urban population. Of the 52 cases of thyroid lesions, 39 were Non neoplastic lesions and 9 were Neoplastic lesions. Of the Non neoplastic lesions, 34 were Nodular colloid/ Adenomatous goiter, 4 Hashimoto thyroiditis, 1 neoplasm and 1 anaplastic neoplasm. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. 28 cases were Non-neoplastic, 9 cases were Neoplastic. Out of 9 cases of Neoplastic lesions, 4 were Papillary carcinoma, 5 were Follicular adenoma. The diagnostic accuracy of non neoplastic and neoplastic lesions is 96.42% and 88.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value for FNAC of thyroid lesion neoplasm in the present study are 92.86%, 95.65%, 92.86% and 95.65% respectively. Conclusion: It helps to categorize Non-neoplastic from Neoplastic thyroid lesions. Its use has decreased the number of surgeries performed. FNAC of thyroid lesions has been shown to be safe, simple, cost effective and accurate method for the management of palpable thyroid lesions. However, in view of a small number of false negative results, the FNA results should be interpreted in the light of clinical findings. In case of doubt the true nature of the disease should be confirmed by biopsy. Keywords: Palpable thyroid lesions, Fine Needle Aspiration Cytology, Histopathology, Sensitivity, Specificity
Tropical Journal of Pathology and Microbiology, 2019
Background: Thyroid lesions are one of the significant clinical problems encountered in most of patients coming to the tertiary care units. Fine Needle Aspiration Cytology (FNAC) is the present day's worldwide accepted diagnostic tool as it is a cost effective, minimally invasive, low complication, non-operative method and has a high sensitivity and specificity in most of thyroid lesions. Fine Needle Aspiration Cytology can be used in the diagnosis of these lesions and hence categorising them into benign / inflammatory / neoplastic and aiding the clinician in the next step of surgical / medical management and reduces the unwanted surgeries. Aim: To study the clinical and cytological spectrum of thyroid lesions encountered in everyday practice. Materials and Methods: This was a retrospective study conducted over the period of 1 year and 1 month, from January 2018 to January 2019 in department of pathology Gadag Institute Medical Science, Gadag. A total of 101 Patients with thyroid lesions who underwent Fine Needle Aspiration procedure were identified and their clinical details, available biochemical and radiological parameters were collected, and cyto-morphological features were studied. The lesions were categorised into benign, inflammatory, Follicular neoplasm, malignant and inadequate. Results: Out of 101 cases studied, 47 (46.5%) were Benign, 33 (32.6%) were Inflammatory,09 (8.9%) cases were Follicular Neoplasm and 04 (3.9%) cases were Malignant while 09 (8.9%) cases were inadequate. Conclusions: FNAC is one of the simple useful primary diagnostic tool for the identification and categorization of thyroid lesions. It is safe, cost-effective, minimally invasive and sensitive technique for its diagnosis.
Fine needle aspiration of thyroid lesions has proven to be an important, simple, safe, cost effective and accurate method for diagnosing the various thyroid lesions. Multiple organizations have proposed diagnostic guidelines for reporting thyroid cytology. National Cancer Institute (NCI) organized the NCI Thyroid Fine Needle Aspiration State of the Science conference in 2007 and proposed the Bethesda System for reporting Thyroid Cytopathology (TBSRTC). The aim of the study is to highlight the application of new nomenclature which can improve inter-laboratory agreement thus leading to more consistent management approach. MATERIALS AND METHODS: The present study was done on 91 random FNAC cases of thyroid lesions in Pathology Department, SGRDIMSAR. The cases were classified according to 6 levels of TBSRTC which are DC-I: Non diagnostic, DC-II: Benign, DC-III: atypia/follicular lesion of undetermined significance (AUS/FLUS), DC-IV: Follicular neoplasm/suspicion for a follicular neoplasm (FN/SFN), DC-V: suspicious for malignancy and DC-VI: Malignant RESULTS: In the present study females outnumbered males with the ratio of 5:1. The age group varied from 13-80 years with maximum number of cases in 3 rd and 4 th decade. Maximum numbers of the cases (48.5%) were benign followed by FN/SFN and malignant category constituting 20.8% and 12.2% respectively. 8.7% were classified under AUS/FLUS category, 6.5% as non-diagnostic and 3.3% as suspicious of malignancy. CONCLUSION: The management of thyroid lesions has been complicated by the lack of universal terminology. TBSTRC is an effective thyroid FNA classification to guide clinical management of patients with thyroid nodules. Its implementation should be encouraged in our country because of its easy understandability and reproducibility.
Tropical Journal of Pathology and Microbiology, 2019
Introduction: FNAC is the first line diagnostic test for evaluation of thyroid lesions. Identification of cytological features is key element in diagnosing thyroid lesions, which will reduce the number of unnecessary surgeries of thyroid nodules. Bethesda system of reporting helps the clinicians to take appropriate therapeutic intervention. Aim: To study the cytomorphological features of various thyroid lesions and to categorize as per Bethesda system proposed by NCI Bethesda USA in 2007. Materials and Methods: This is a prospective study of cases of thyroid lesions received in cytology section of Department of Pathology, KIMS Hubballi, during Jan 2017 to Dec 2017. FNAC was performed and reported according to Bethesda system. Results: FNAC was performed on 370 cases of thyroid lesions. Maximum number of cases were in the age group of 21-30 years.Male to female ratio was 1: 9.27. Maximum number of cases presented in less than 6 month duration. Most of the cases presented with swelling in the neck. Out of the total 370 cases, 351were benign lesion, 6 cases were malignant, 8 were unsatisfactory, 3 were follicular neoplasm/suspicious of follicular neoplasm, 1 was suspicious for malignancy and 1 was follicular lesions of undetermined significance. Out of 351 benign lesions, commonest was colloid/ nodular goiter, followed by lymphocytic/Hashimotos thyroiditis. Conclusion: FNAC is the most simple, rapid and safe diagnostic test for evaluation of thyroid lesions with high degree of accuracy. Bethesda system of reporting thyroid cytopathology is very useful as it is systematic and standardized and hence provides better communication between clinicians and cytopathologist for appropriate therapeutic intervention.
Background: Thyroid disorders and associated nodular enlargement of thyroid gland is very common.Fine needle aspiration cytology of thyroid has been introduced as most reliable and cost effective methods for diagnosing clinically important thyroid disorders. To eliminate confusion Bethesda system for reporting thyroid cytopathology (TBSRTC) has been implemented with main objective being to standardise the diagnostic terminology. Objectives: This study aims to study and classify various cytomorphological lesions of the thyroid according to The Bethesda System for Reporting of Thyroid Cytopathology (TBSRTC) Material and Methods:. We did a one year retrospective study of results of FNAC in thyroid lesions in Dr Shankarrao chavan government medical college,Vishnupuri, Nanded. Fine needle aspiration done on 100 patients with palpable thyroid lesions were analyzed and classified according to TBSRTC. Results:Out of total 100 cases studied,70 (70%) were non neoplastic, 15 (15%) were neoplastic, 10 (10%) was indeterminate and 5 (5%) was inadequate. Conclusion; FNAC is a simple, safe, cost effective and widely accepted modality for evaluation of thyroid lesions. FNA helps to avoid unnecessary surgery in patients with benign lesions. TBSRTC brings standardisation in reporting thyroid FNAC. Reduced the inter-observer variation and provides definitive management guidelines.