Retrospective Study for Evaluation of TIRAD Scoring System Irrespective of FNAC in Decision Making Outcomes in Thyroidectomy

Abstract

Abstract Background Thyroid nodules present a common clinical problem. Palpable nodules are present in about 5% of the population, and are noted incidentally on ultrasound in up to 70% of people, with increased prevalence in older patients. The incidence of thyroid nodules has increased due to exposure to medical radiation, iodine intake, obesity, insulin resistance, genetics and inorganic phosphates. With a 300% increase in the annual thyroid cancer rate. Aim of the Work The aim of this study is to evaluate the value of Ultrasound and TIRAD scoring system for decision making outcomes in thyroidectomy done for thyroid nodules. Patients and Methods This Retrospective cohort study was conducted at (General surgery department), Ain Shams University Hospitals and Ain shams University specialized Hospitals and was conducted over a period of six months starting from date of approval of the protocol. Results In our study, Conventional sonography has 66.66% sensitivity and 92.5% specificity as it suspected malignancy (positive suspecting findings) in 14 patients; eight of them were proved to be malignant and six of them were benign by histopathology accounting for low positive predictive value (57.14%) and it suspected benignity (negative suspecting findings) in 78 patients; 74 of them were perfectly correlated with the histopathology accounting for high negative predictive value (94.87%). In our study, the rate of detecting patients with thyroid cancer (sensitivity) was calculated as 80%, the rate of distinguishing healthy individuals (specificity) was 88.88%, the Positive Predictive Value (PPV) was 57.14% and the negative predictive value (NPV) was 96% for FNAC. In our study, the sensitivity and the specificity of FNAC in detecting cancer was near to the literature but the (PPV) was lower than the literature and was non diagnostic in fourty patients (40%), we think that this discrepancy depends on many factors including radiology, pathology, and the materials used in FNAC method, and patients with multiple nodules. Conclusion Neck US and FNAC have proven low sensitivity in differentiating malignant from benign thyroid nodules