Diagnostic Efficacy of Ultrasonography and Fine-needle Aspiration Cytology in Correlation with Histopathology in Euthyroid Patients Having Solitary Thyroid Nodule

Vijay Kumar Sharma

doi:10.11648/j.cmr.20190801.11

Abstract

Objective: In patients with solitary thyroid nodules, first approach is to confirm whether the nodule is benign or malignant. Commonly available investigations used in the evaluation include thyroid hormone assays, fine needle aspiration cytology (FNAC) and ultrasonography (USG) among others. These procedures are not without drawbacks. The present study was undertaken to compare the diagnostic efficacy of USG and FNAC in correlation with histopathology in euthyroid patients having solitary thyroid nodule. Study Design: A prospective study was carried out on 48 euthyroid cases of solitary thyroid nodule attending the Department of ENT, SMS Medical College & Hospital, Jaipur, during the period of March 2016 to November 2017. All patients underwent ultrasonography and fine-needle aspiration cytology. The results of FNAC and USG were correlated with post surgical histopathogical examination (HPE) of the specimens to evaluate their sensitivity and specificity by statistical methods. Results: Ultrasound was 87.5% sensitive & 92.50% specific in the detection of malignancy in solitary thyroid nodules while the fine needle aspiration cytology had a sensitivity of 87.50% & specificity of 100% in the same regard. Conclusion: It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignancy nodules.

Highlights

Solitary thyroid nodule in the general population is very common with an estimated prevalence that ranges from 4% by palpation to 67% by ultrasonography. [1, 2] Autopsy studies reveal that 50% of adults had nodules, the majority of which were impalpable
[5] USG findings are largely subjective and are prone for errors in high-volume institutes. [15, 16] fine needle aspiration/ biopsy (FNAB) is the most commonly used diagnostic technique for the preoperative evaluation of thyroid nodules, there remains the issue of gray-zone nodules that need further diagnostic investigation. [14, 17] The present study was undertaken to compare the diagnostic efficacy of USG and fine needle aspiration cytology (FNAC) in correlation with histopathology in euthyroid patients having solitary thyroid nodule
It was observed that out of 48 cases, 10 cases were suspicious for malignancy on USG. Among these 10 suspicious cases, 7 cases were found to be malignant on gold standard histopathogical examination (HPE) and 3 cases were benign on HPE (Table 3)

Summary

Introduction

Solitary thyroid nodule in the general population is very common with an estimated prevalence that ranges from 4% by palpation to 67% by ultrasonography. Few subjects in surgery have generated as much controversy as the management of solitary thyroid nodule (STN), the two major issues being the diagnostic workup and the extent of thyroidectomy. The second most common type is follicular thyroid cancer (FTC), which accounts for 10% to 20% of all cases. [12] Anaplastic thyroid cancer (ATC) is one of the most aggressive and rapidly fatal cancers It can develop from DTC on dedifferentiation over time or it arises de novo. It can develop from DTC on dedifferentiation over time or it arises de novo. [13]

Methods

Results

Conclusion