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This study aims to perform an integrative literature review on FNAB of the thyroid and its current contributions facing thyroid nodules, as an important diagnostic tool to eliminate early thyroid cancer, a recurrent pathology in offices. Regarding the methods, because this is an integrative review of literature, through a descriptive study, we used databases such as Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The query was performed using the controlled descriptors from DeCS/MeSH: "thyroid nodule", "fine needle biopsy", "thyroid", "liquid-based cytology", "molecular test". Moreover, as a result we obtained a general review about the appropriateness of FNAB of the thyroid, an efficient and reliable diagnostic method in the decision and selection of patients who will need surgery. However, this method presents some limitations, such as the need for improvement in the quality of the sample collection or in its interpretation, limitations that can be reduced, decreasing the cases of false positives and negatives, when collected by experienced professionals, guided by ultrasound, and can be combined with color Doppler, as well as, seek opinions from other specialists. The present study also addressed the new diagnostic methods for thyroid nodules, such as liquid-based cytology, used as a technique in conjunction with conventional smears when ancillary techniques are applied, and molecular tests, which have given professionals the opportunity to provide a more accurate evaluation in cases of indeterminate nodules. With this, we reiterate the importance of identifying the best individualized strategy for the patient, preventing unnecessary procedures and offering improved quality of life.
This study aims to perform an integrative literature review on FNAB of the thyroid and its current contributions facing thyroid nodules, as an important diagnostic tool to eliminate early thyroid cancer, a recurrent pathology in offices. Regarding the methods, because this is an integrative review of literature, through a descriptive study, we used databases such as Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The query was performed using the controlled descriptors from DeCS/MeSH: "thyroid nodule", "fine needle biopsy", "thyroid", "liquid-based cytology", "molecular test". Moreover, as a result we obtained a general review about the appropriateness of FNAB of the thyroid, an efficient and reliable diagnostic method in the decision and selection of patients who will need surgery. However, this method presents some limitations, such as the need for improvement in the quality of the sample collection or in its interpretation, limitations that can be reduced, decreasing the cases of false positives and negatives, when collected by experienced professionals, guided by ultrasound, and can be combined with color Doppler, as well as, seek opinions from other specialists. The present study also addressed the new diagnostic methods for thyroid nodules, such as liquid-based cytology, used as a technique in conjunction with conventional smears when ancillary techniques are applied, and molecular tests, which have given professionals the opportunity to provide a more accurate evaluation in cases of indeterminate nodules. With this, we reiterate the importance of identifying the best individualized strategy for the patient, preventing unnecessary procedures and offering improved quality of life.
Background. Thyroid cancer is prevalent both internationally and locally, and is the most common cause of endocrine malignancies in Africa. The prognosis of thyroid cancer in general is quite good, but to achieve good outcomes, appropriate methods for diagnosis are important. A cytology result obtained from a fine needle aspiration and biopsy (FNAB) is one such method, and is less invasive and has less risk compared with obtaining a histological result via open surgery. However, there are accuracy differences that have been reported in different literature findings. Objectives. To determine the diagnostic accuracy rate of thyroid FNAB compared with histopathological samples at an urban hospital in South Africa (SA), and compare this with international standards. Methods. A retrospective observational study was conducted of patients who had undergone both FNAB and thyroidectomies at Helen Joseph Hospital, Gauteng Province, SA, a public tertiary hospital, between 1 January 2016 and 31 December 2021. Various analytical methods were used, including Poisson generalised linear model, binomial generalised linear model, a two-proportion z-test, McNemar’s test and the F1 score. Results. There were 164 participants in this study who were between the ages of 21 and 82 years old. Thirty-six records were excluded for use as a comparison between cytology and histology, as they were in Bethesda categories 1, 3 and 4. Out of the 128 records that were compared, there was statistically significant agreement v. non-agreement between cytology and histology findings for thyroid nodules (109 v. 19, p<0.001, respectively). A comparison between our sample population and internationally published standards in terms of rate of malignancy noted that our rate of malignancy was slightly higher in Bethesda 2 patients (5.88%) v. internationally published standards (0 - 3%), and slightly lower in Bethesda 4 (23.52%) and 6 (77.77%) v. internationally published standards (25 - 40% and 97 - 99%, respectively. Conclusion. There was good correlation between cytology and histology for thyroid nodules. Differences were noted between the percentage of malignant cases in the different Bethesda categories compared with international standards as noted above. We recommend that further studies are conducted locally to improve knowledge on this topic.
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