Abstract
Objective: The incidence of thyroid cancer has rapidly increased in the United States (US) and other developed countries over the past 30 years but there is no study to find out the true incidence of thyroid cancer in Bangladesh. The aim of this study is to compare FNAC with histopathology reports and to find out the true incidence of thyroid malignancy in thyroidectomy patients presenting with thyroid swelling.
 Methods: This is a prospective study of 200 thyroid swelling patients underwent thyroid surgery done at Shaheed Suhrawardy Medical College Hospital, a tertiary Care Hospital in Dhaka from July 2017 to December 2020. FNAC and histopathology reports were studied to find out the incidence of benign and thyroid malignancy among the thyroid swelling.
 Results: The age of the patients ranged from 8 to 75 years. The mean age was 37.2 years. There were 156 female and 44 male patients with female male ratio 3.54:1. Diagnostic categorization of 200 thyroid swelling underwent surgery, FNAC based on Bathesda classification showed that 163 (81.5%) cases were cytologically benign, 37 (18.5%) cases were malignant category. Out of 200 cases histopathology showed134 cases(67.0%) are benign and 66(33.0%) are malignant thyroid swelling. Among the benign lesions96.31% are colloid goiter and among the malignant lesions 93.4% are papillary thyroid carcinoma.
 Conclusion: Although FNAC is an essential diagnostic test to rule out thyroid malignancy but histopathological examination is the only way to give true incidence of thyroid malignancy among the thyroid swelling and it is observed that there is high incidence of thyroid malignancy(33.0%) among the thyroid swelling patient underwent thyroid surgery.
 Bangladesh J Otorhinolaryngol; April 2021; 27(1): 12-16
Highlights
The incidence of thyroid cancer has increased dramatically during the past three decades and it is the fastest growing cancer in women[1]
FNAC, has limitation related to specimen adequacy, sampling techniques, skill of performing the procedure, interpretation of the aspirate, overlapping cytological features between benign and malignant follicular neoplasm and in the detection of some papillary carcinoma associated with other pathology like multinodular goiter, cystic changes[6]
The age of the patients ranged from 8 to 75 years with a mean age 37.2 years (Table I) The thyroid lesions were more common in females than male in a ratio of 3.54:1 Table III shows FNAC findings of 200 cases where 163 are benign and 37 cases are malignant lesion with benign malignant ratio is 4.4:1
Summary
The incidence of thyroid cancer has increased dramatically during the past three decades and it is the fastest growing cancer in women[1]. Bangladesh especially North Bengal area is an endemic zone for iodine deficiency goitre and one of the aetiology of thyroid cancer is iodine deficiency. They present as Incidence of Thyroid Cancer in Thyroid Swelling visible neck swelling which moves on deglutition. The diagnostic method of FNAC was first published in 1883 by Leyden.[4] But the diagnosis of thyroid swellings using aspiration cytology was first reported by Martin and Ellis in 19305. FNAC, has limitation related to specimen adequacy, sampling techniques, skill of performing the procedure, interpretation of the aspirate, overlapping cytological features between benign and malignant follicular neoplasm and in the detection of some papillary carcinoma associated with other pathology like multinodular goiter, cystic changes[6]. Mundasad et al had done a comparative study between FNAC and histopathology and founded that FNAC had a sensitivity(52.6%), specificity(86.6%) and accuracy(79.1%) for thyroid malignancy[7]
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