Role of fine-needle aspiration cytology in evaluating thyroid nodules

Bahaj, Ahmed S.; Alkaff, Haddad; Melebari, Bashair N.; Melebari, Anwar N.; Sayed, Suhail I.; Mujtaba, Syeddah S.; Abdelmonim, Sherif K.; Alghamdi, Saeed; Alghamdi, Fares E.; Suliman, Omar A. Abu; Alessa, Mohammad A; Sheffah, Firas R. Abi; Al-Tammas, Anas H.; Alzahrani, Rajab; Marglani, Osama; Heaphy, John C.; Bawazir, Osama A.; Alherabi, Ameen Z.

doi:10.15537/smj.2020.10.25417

Cited by 14 publications

(8 citation statements)

References 25 publications

(39 reference statements)

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“…Bahaj et al conducted a population-based study evaluating the role of FNAC and reported a sensitivity, specificity, PPV, and NPV of 79.8%, 82.1%, 74.8% and 85.9% respectively. 17 Higher specificity and PPV were noted in our study. Sensitivity and NPV were less in our study.…”

Section: Discussionsupporting

confidence: 39%

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years

Chakraborty

Balakrishnan

Raphael

et al. 2022

South Asian J Cancer

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Introduction Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. Objective As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). Materials and Methods A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017–2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Statistical Analysis Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. Results The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively (p-value < 0.001, Fischer's exact test). Conclusion A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.

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Section: Discussionsupporting

confidence: 39%

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years

Chakraborty

Balakrishnan

Raphael

et al. 2022

South Asian J Cancer

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“…Maximum cases were found between 31 and 40 years of age (33.33%), with the lowest incidence in the seventh decade (5%). Females dominated the study population (86.66%) [ 9 , 10 ]. The female-to-male ratio was found to be 6.5:1.…”

Section: Discussionmentioning

confidence: 99%

A Cytohistologic Correlation Study of Thyroid Lesions: Evaluation of Diagnostic Accuracy and Pitfalls of Fine Needle Aspiration Cytology

Gowardhan,

Valand

2024

Cureus

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Background Only about 5% of palpable thyroid nodules are malignant; the rest are entirely benign. In order to reduce the number of unnecessary treatments and properly identify situations that need surgical intervention, it is essential to distinguish between benign and malignant lesions prior to surgery. There exists a “grey zone” in thyroid cytology characterized by a significant decrease in diagnostic accuracy, making it difficult to precisely classify the lesion and leading to discrepancies. Aims and objectives The study aims to accomplish the following objectives: (1) assess the prevalence of thyroid lesions according to age and sex; (2) evaluate the accuracy of the fine needle aspiration cytology (FNAC) in diagnosing thyroid conditions; and (3) investigate the causes of cytohistological discordance within the context of this study. Materials and methods In our five-year study of thyroid lesions, 125 cases were studied for cytohistological correlation. Discrepant and likened FNAs were classified according to the diagnostic findings. A review of the cytological smears and histological sections was conducted. Results The cytological diagnoses were correlated with histopathology in 109 cases (90.83%). A total of 11 cases (09.16%) were discrepant. There were no false positives (FPs). The causes of false negative (FN) diagnoses in our study can be attributed to geographic misses and failure to recognize dual pathologies. Conclusion FNA is a very precise and time-saving technique for the diagnosis and subsequent management of palpable thyroid nodules. Patients having thyroidectomies have a much higher malignant yield, and the frequency of procedures performed on the thyroid is decreased. When FNA interpretation based on strict specimen sufficiency standards is considered along with clinical and imaging findings, the occurrence of FN and FP diagnoses is expected to decrease.

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“…This problem must be considered, and the quality of the FNA reporting must be assessed in each hospital and the results shared with the pathologists. 23 An assessment of FNA technique, sampling quality, sufficiency, and cytologic diagnosis of thyroid FNA should be compared with the standards, which will definitely improve the delivery of service and patient satisfaction.…”

Section: To Be Included In the Referral Formmentioning

confidence: 99%

“…There are very few hospital-based molecular pathology laboratories in the region. 23 Most of the endocrinologists preferred to have the molecular test available, and they believed that it was going to change the practice of management of thyroid nodules in the area. A large number of respondents recommended surgery for indeterminant FNA results, which would result in more unnecessary surgeries and preventable complications.…”

Section: To Be Included In the Referral Formmentioning

confidence: 99%

Practice of thyroid nodule management in the Gulf Cooperation Council countries

Jammah

2021

SMJ

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Objectives: To assessed the current practices for the management of thyroid nodules in the Gulf Cooperation Council (GCC) Countries. Methods: We conducted a descriptive web-based survey to physicians and surgeons involved in the management of thyroid nodules. The survey included questions on referral, ultrasound (US) reporting, fine needle aspiration (FNA), management of thyroid nodules including the approach for indeterminate FNA results, and usage of molecular testing. Results: A total of 311 responders, 155 (49.8%) were endocrinologists. Results showed that referrals and US report lack a number of valuable information including family history (84.9%) and high-risk US features (92.9%). Approximately 263 (84.6%) preferred to include a scoring system or protocol to assess the nodule risk in US report. Approximately 193 (62.1%) sent the patient to interventional radiologists for FNA. Almost half (n=147, 47.3%) repeat the FNA in 2-3 months if the FNA result was a follicular lesion or atypia of undetermined significance and 142 (45.7%) opted for lobectomy for follicular neoplasm or suspicious of follicular neoplasm result. Only 44 (14.1%) performed molecular testing; however, 174 (55.9%) preferred it available. Significant variations in the approach were seen between endocrinologists versus non-endocrinologists. Conclusion: Practices variation in the management of thyroid nodules mandate a common practical guideline. Molecular testing is a preferable test for indeterminate FNA results by most of the responders though it is not widely available.

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Role of fine-needle aspiration cytology in evaluating thyroid nodules

Cited by 14 publications

References 25 publications

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years

A Cytohistologic Correlation Study of Thyroid Lesions: Evaluation of Diagnostic Accuracy and Pitfalls of Fine Needle Aspiration Cytology

Practice of thyroid nodule management in the Gulf Cooperation Council countries

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