Abstract
Thyroid disease affects about 5% of the World's population. Fine Needle Aspiration Cytology (FNAC) helps in planning extent of surgery. In some studies, FNAC has been found to have a low accuracy for malignancy. To estimate the sensitivity and specificity of FNAC in detecting malignancy for thyroid disease using histopathology as the gold standard. Patients who underwent clinical and laboratory evaluation and thyroidectomy at Mulago National Referral hospital and the Pathology department of Makerere University College of Health Sciences were consecutively recruited over a four months period. Analysis using STATA version 10 focused on sensitivity, specificity and accuracy of FNAC in detecting malignancy. In total, 99 patients were recruited, the F:M ratio was 15.5:1 and median age was 42 years (IQR 34-50). The median duration of symptoms was 364 weeks (IQR 104-986). The proportion of patients with malignancy was 13.3% with papillary thyroid carcinoma being the most predominant type and colloid goiter was the most predominant benign thyroid disease. The sensitivity was 61.5% and specificity 89.5%. This study revealed high specificity and low sensitivity of Fine Needle Aspiration Cytology (FNAC) at detecting malignancy in thyroid nodules.
Highlights
Thyroid disease affects about 5% of the general population Worldwide ranging from hypothyroidism, hyperthyroidism, thyroiditis, cancer of the thyroid and nodules
Despite several studies showing a high accuracy with Fine Needle Aspiration Cytology (FNAC), emerging studies especially in tropical Africa and other developing countries with a high prevalence of nodular thyroid disease, have shown the accuracy of FNAC to be lower than previously reported[4,5] and its diagnostic performance has been shown to vary across different studies[6] Knowledge on the burden of thyroid disease in Uganda is still limited
Sample size was estimated using the formula for single proportions[8]
Summary
Thyroid disease affects about 5% of the general population Worldwide ranging from hypothyroidism, hyperthyroidism, thyroiditis, cancer of the thyroid and nodules. Nodular thyroid disease is a common clinical problem with a prevalence of 4%-7% and annual incidence of 0.1% in some adult populations[1,2]. Aspiration Cytology (FNAC) has been in use since the 1950s and is a safe, cost effective method of diagnosing thyroid nodules[3]. Objective: To estimate the sensitivity and specificity of FNAC in detecting malignancy for thyroid disease using histopathology as the gold standard. Analysis using STATA version 10 focused on sensitivity, specificity and accuracy of FNAC in detecting malignancy. Conclusion: This study revealed high specificity and low sensitivity of Fine Needle Aspiration Cytology (FNAC) at detecting malignancy in thyroid nodules Keywords: Diagnostic accuracy, fine needle aspiration, cytology, thyroidectomy, tertiary hospital. Diagnostic accuracy of fine needle aspiration cytology in patients undergoing thyroidectomy in Uganda: a tertiary hospital experience.
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