Objective: Goiter is a common form of thyroid swelling among population living in areas of iodine deficiency. Of the goiters, non-toxic multinodular goiter (MNG) is the most common and benign form of thyroid disease. However, studies have shown that long-standing MNGs may harbour malignancy. The present study was, therefore, undertaken to ascertain the prevalence of malignancy in clinically diagnosed non-toxic MNGs. Methods: This cross-sectional study was conducted in the Department of Surgery (all four-units) and ENT Department, Rajshahi Medical College Hospital, Rajshahi from July 2007 to June 2008 on 100 patients of clinically non-toxic MNG who underwent thyroid surgery. Biopsy materials were taken from the excised nodules and were sent for histopathological examination to see what proportion of them harboured malignancy. Result: The findings of the study showed that 40% of patients were 30-40 years old with mean age of the patients being 35.5 ± 10.1 (range: 14-75) years. Majority (87%) of the patients was female. Half of the patients with non-toxic MNGs had a history of thyroid swelling for 1-5 years and the rest half for > 5 years with median duration of illness being 5.5 years (range: 1-30 years). Of the 100 patients 4% had stridor and 6% dyspnoea; dysphagia and cervical lymphadenopathy each was 6%. Nearly 60% of the patients had goiter of size 15 sq-cm or below. Sub-total thyroidectomy was the most common operation performed (33%) followed by right hemi-thyroidectomy (24%), near total thyroidectomy (20%), left hemi-thyroidectomy (18%) and total thyroidectomy (5%). Histopathological examination of resected specimens revealed that 15% of the MNGs had malignancy with papillary to follicular carcinoma ratio being 4:1. Histopathological typing showed that 79% was simple MNGs, 4% follicular adenoma, 12% papillary carcinoma, 3% follicular carcinoma and 2% chronic thyroiditis. Neither age nor sex was found to be associated with presence of malignancies in MNGs (p = 0.865 and p = 0.647 respectively). The goiter-size was also not associated with presence of malignancies (p = 0.691). However, the mean duration of thyroid swelling in patients who had malignancy was much higher (8.5 years) than that in patients who did not haveany malignancy (5.7 years) (p = 0.024). Conclusion: The study concluded that a small proportion of long-standing non-toxic MNGs may turn into malignancy. Therefore, routine operative treatment without confirming that the cases are malignant does not seem to be justified. Ibrahim Card Med J 2020; 10 (1&2): 84-88
Background & Objective: Fine-needle aspiration cytology (FNAC) is frequently used to evaluate a breast lump, for it is safe, reliable, and time saving outdoor procedure for evaluation of breast lumps. However, in recent times, the diagnosis of breast lesions has mostly become dependent on Tru-cut biopsies with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). The present study was undertaken to compare the diagnostic accuracy of Tru-cut Biopsy and Fine Needle Aspiration Cytology (FNAC) in the evaluation of a clinically palpable breast lump. Methods: This cross-sectional study was conducted in the in Department of Surgery, Rajshahi Medical College & Hospital, Rajshahi, Bangladesh over a period of one year from July 2019 to June 2020. A total of 60 women with clinically palpable breast lumps were consecutively included in the study. All patients underwent FNAC and Tru-cut Biopsy to make a provisional (clinical) diagnosis of breast lump followed by histopathology of the excision biopsy taken during surgery to confirm the diagnosis. The diagnostic accuracies (sensitivity, specificity, positive and negative predictive values) of the two diagnostic modalities (FNAC and Tr-cut Biopsy) were then judged by comparing them with the histopathological diagnosis of the excision biopsy. Result: In the present study majority (86.7%) of the lesions was malignant in terms of histopathology with almost all being infiltrating carcinoma (98%). Only 8(13.3%) cases were benign breast lesions and all of them were fibroadenoma. While Tru-cut or Core-needle biopsy (CNB) diagnosed 85% of the lesions as malignant, FNAC diagnosed 65% of lesions as malignant. The sensitivity of CNB was observed to be 98.1% and its specificity was 100%. In contrast, the sensitivity of FNAC was much lower (65%), although its specificity was comparable to that of CNB (100%). While the overall diagnostic accuracy of CNB was 98.3%, that of FNAC was 78.3%. The test of agreement between Tru-cut biopsy and FNAC using kappa-statistics showed that the two diagnostic modalities had moderate agreement in differentiating malignant breast tumours from the benign ones (k-value = 0.494, p < 0.001). Conclusion: The study concluded that Tru-cut biopsy and FNAC both are hundred percent specific in excluding a benign breast lesion. However, the sensitivity of FNAC is much lower compared to that of CNB with overall diagnostic accuracy of Tru-cut biopsy being much higher than FNAC. Ibrahim Card Med J 2021; 11 (1): 21-27
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