Fine Needle Aspiration Cytology Of Thyroid Lesions Research Articles

Comparative study of fine needle aspiration cytology and histopathology correlation of various thyroid lesions

Patients with anterior neck swelling constitute common problems encountered in the clinical practice. In all age groups, including children, thyroid cancer is the most prevalent endocrine system cancer. Initial diagnostic testing using fine needle aspiration cytology (FNAC) has been found to be quick and cost effective. Therefore, it is widely accepted and more thyroid cases are diagnosed at an early stage, but it is associated with pitfalls due to difference in correlations between FNAC and Histopathological Examination (HPE). The purpose of the study is to compare the results of FNAC with histopathological findings in order to evaluate the diagnostic efficacy of FNAC.The present study was performed over a period of two years in a tertiary care center. Included in the study were 100 cases of thyroid nodule, which underwent FNAC and the post-operative specimens of whom were subjected to histopathological examination. The results obtained by FNAC were compared with histopathological findings.Out of the 100 cases taken for the purpose of the study, 92 were benign whereas 8 were malignant. The cytological and histopathological diagnosis correlated with each-other in 89 cases. A partial correlation between the cytological and histopathological diagnoses was found in 5 cases. In 6 cases the FNAC diagnosis was not correlating with histopathological diagnosis. FNAC revealed a sensitivity of 62.50%, a specificity of 97.83%, an accuracy of 95%, a positive predictive value of 71.43% and a negative predictive value of 96.77%.FNAC of thyroid lesions is thus proved to be a simple, cost effective and accurate method to diagnose and to guide the management of palpable thyroid lesions Thus, we can see that the diagnostic accuracy of FNAC procedure is very high making it a very useful investigation in the work-up of thyroid patients. However final diagnosis and treatment pattern should be based upon histopathology.

Fine needle aspiration cytology of thyroid lesions and thyroid profile – a correlative study

Introduction The Fine Needle Aspiration Cytology (FNAC) is a simple, safe, cost-effective minimally invasive procedure for diagnosing thyroid nodules/swelling. Clinicians usually evaluate thyroid function by estimating T3, T4 and TSH level for therapeutic planning. In this study the importance of FNAC in the diagnosis of thyroid diseases was evaluated and FNAC findings were correlated with clinical features and thyroid profile. Materials and Methods The study was designed as prospective cross-sectional hospital based (laboratory investigation) study for 2 months duration (from 17th July, 2017 to 16th September, 2017). Fifty cases of thyroid swelling attending Pathology Department for FNAC were included in the study. For Each case thyroid profile was done. Result Total 50 patients of thyroid swelling were included in the study, out of which 46 were female (92%) and 4 were male (8%). Male to female ratio was 1:12.5. Mean age was 45.44 ±16.02 years. Out of 50 patients 35 (70%) had diffuse thyroid swelling, 9 (18%) had left lobe and 6 (12%) had right lobe involvement. All the 50 patients with thyroid lesion had a common complaint of neck swelling. Some had associated dysphagia (12 cases, 24%) and/ or dyspnoea (6 cases, 12%), and only 2 had hoarseness of voice. Among 38 cases of non-neoplastic lesions colloid goitre was the commonest comprising 20 cases (52.63%), followed by 11 cases ( 28.95%) lymphocytic thyroiditis, 4 cases (10.53%) of granulomatous thyroiditis and 3 cases (7.89%) of follicular hyperplasia. Among 12 cases of neoplastic lesions papillary carcinoma was the commonest consisting of 7 cases (58.33%), followed by follicular neoplasm (4 cases, 33.33%) and 1 case of Hurthle cell neoplasm. Most of the colloid goitre cases were euthyroid (60%), lymphocytic thyroiditis was commonly associated with hypothyroidism (45.5% cases), and most cases of granulomatous thyroiditis were euthyroid (50%). All the patients with follicular hyperplasia had hyperthyroidism. Most of the cases with papillary carcinoma were in euthyroid (3 of 7, 42.86%) and followed by subclinical hypothyroid state (2cases, 28.57%) and one case of each hypothyroidism and subclinical hyperthyroidism. Follicular neoplasm was commonly associated with euthyroid state (75% cases). One case of Hurthle cell neoplasm had hyperthyroidism. Conclusion Thyroid gland being superficial, it is easy to perform fine needle aspiration. Similar thyroid disease shows variable hormone profile in different patient and different stages of the disease. Hence, FNAC of thyroid lesions in conjunction thyroid hormonal analysis helps in proper assessment and management of patients with thyroid lesion.

Diagnostic Utility of Cell Block Technique As an Adjunct to Cytological Smears in Evaluation of Thyroid Aspirates on Fine Needle Aspiration Cytology

Background: Direct smears and cell blocks prepared from residual tissue fluids complement each other for establishing a conclusive cytopathologic diagnosis in thyroid lesions. Aim of the Study: Evaluation of the diagnostic utility of fine-needle aspiration cytology (FNAC) alone and in combination with cell blocks in the diagnosis of thyroid lesions. Materials and Methods: A hospital-based prospective longitudinal study was conducted in which 100 thyroid smears were categorized as neoplastic, nonneoplastic and inadequate using FNAC and cell block technique. All specimens were classified using point scoring system modified by Mair et al. Direct smears were compared with cell-block specimens on variables of cellularity, background blood and clot, cellular degeneration and retention of appropriate architecture using Fisher's exact and unpaired t-test. Results: Sixty-two percent of cell block specimens showed a moderate amount of background material (P = 0.01), display of excellent architecture was also significantly more in cell block (20%) technique than direct smears (9%), and degree of cellular degeneration was minimal in significantly more cell blocks (26%) than direct smears (12%), thereby making diagnosis easy as opposed to FNAC which yielded more cellular material than cell blocks (P = 0.02). Four cases showing hemorrhagic material on direct smears were diagnosed on cell block as one case each of colloid goiter and chronic lymphocytic thyroiditis and two cases of adenomatous goiter and two cases showing hemorrhagic material on cell block were diagnosed with chronic lymphocytic thyroiditis on direct smears. Conclusion: FNAC and cell block complement each other and combining both techniques improves the diagnostic yield and facilitates accurate diagnosis. It is advisable to perform cell-block for each case of FNAC of thyroid lesions.

Diagnostic Efficacy of Fine Needle Aspiration Cytology and Cell Block Technique in Thyroid Lesions: A Hospital-based Study

Introduction: Fine Needle Aspiration Cytology (FNAC) and Cell Block are very commonly used initial tests for triaging thyroid lesions and play a pivotal role in deciding subsequent clinical management of thyroid nodules. In most cases, after excision, the diagnosis remains unchanged, but at times discordance does occur when benign lesions are reported on FNAC and cell blocks are found to be malignant on final histopathology and vice-versa. Aim: To assess the diagnostic efficacy of both FNAC and Cell Block technique in the evaluation of thyroid lesions by comparing their respective results with final histopathological diagnosis (after excision) in case of malignancies and clinico- radiological follow-up in benign cases. Materials and Methods: An observational hospital-based study was conducted in the Department of Pathology in a Tertiary Care Teaching Institute from 1st November, 2016 to 31st October, 2017. A total of 100 cases of thyroid masses were subjected to both FNAC and Cell Block and the diagnostic efficacy of both the techniques was assessed using MedCalc Statistical Software. Results: Mean age of the patients was 42.75±15.75 years with a range of 12-75 years. Females constituted 88% of the sample with male to female ratio of 1:7.3. 88% lesions were benign, 8% were malignant and 4% suspicious of malignancy on conventional smears in comparison to cell block which showed 90% benign, 8% malignant and 2% suspicious lesions. The validity of FNAC in terms of sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy was found to be 100%, 95.65%, 66.67%, 100.00% and 96.00% respectively, whereas for cell blocks these statistics were 100%, 97.83%, 80%, 100% and 98% respectively. Conclusion: Cell block improved the overall diagnostic accuracy of FNAC when used as an adjunct leading to 100% diagnostic yield. The results of this study also establish that FNAC and Cell blocks are sensitive, specific, and accurate as preliminary diagnostic tests for evaluation of patients with thyroid swellings. Moreover, their combined use can reduce the diagnostic errors and to improve the overall reporting efficacy. It is thus advised to perform cell block for each case of FNAC in thyroid lesions.

Fine-needle aspiration of thyroid and diagnostic accuracy

BACKGROUND: Fine-needle aspiration cytology (FNAC) is widely considered as the gold standard in the assessment of thyroid lesions. The aim of this study is to determine the diagnostic accuracy of FNAC of thyroid lesions performed at our institution and correlate it with histopathological findings and also to compare our findings with that of studies from other regions of the world. MATERIALS AND METHODS: The present study is a 1-year prospective study of FNAC of thyroid lesions performed in the pathology department of our institution during January 2014–December 2014. The FNAC findings were correlated with the histopathological diagnosis, wherever available. The records of 236 patients who had undergone FNAC during the study period were followed by histopathological evaluation wherever possible. The cytological results were classified as inadequate, benign, suspicious, and malignant. The histopathology diagnosis was classified as nonneoplastic (benign) and neoplastic (malignant). RESULTS: The results of the FNA histological diagnosis showed that 6 (2.5%) of the patients had FNA, which were inadequate for cytological assessment, 222 (93.6%) patients had benign lesions, 4 (2.2%) had lesions that were suspicious for malignancy, and 4 (2.2%) had malignant neoplasm. CONCLUSIONS: The correlation of FNAC findings with the histopathological diagnosis showed that our FNAC diagnostic accuracy rate was 97.55% with a sensitivity of 85.75% and specificity of 100%. The results of our study are comparable with the previous studies done and showed that FNAC is a sensitive, specific, and accurate initial diagnostic test for preoperative evaluation of patients with thyroid swelling. It is recommended as the first-line investigation.

A Cytohistopathological Correlation of Thyroid Lesions with Critical Evaluation Of Discordant Cases: An Experience At A Tertiary Care Hospital

Background: Fine Needle Aspiration Cytology (FNAC) is important for pre-operative diagnosis of benign and malignant thyroid lesions. It is usually the first line of investigation and a minimally invasive diagnostic procedure whose essential role is to diagnose and distinguish benign from malignant lesions. Thus the present study was undertaken to determine sensitivity, specificity and accuracy of FNAC in the diagnosis of thyroid lesions and to correlate cytological findings with histopathology. Methods: A prospective study was conducted in a tertiary care centre to study FNAC of thyroid lesions along with its histopathological correlation over a period of 2 years starting from June 2013 to June 2015 Result: 56(93%) patients were females and 4(7%) patients were males. Patients age ranged from 15 to 65 years .Commonest lesion encountered in thyroid gland was colloid goitre, while papillary carcinoma was the most frequent malignant lesion. Cyto-histopathological correlation of 60 cases was done. Sensitivity ,specificity and diagnostic accuracy of the study for malignant lesions was 96.36%,100%,and 96.66% respectively. Conclusion: FNAC is a safe, simple, highly accurate, economical method for evaluation of palpable thyroid lesions. There is almost perfect cyto-histopathological concordance and the results are consistent with those available in the literature. FNAC helps in avoiding unnecessary surgeries in patients diagnosed to have a benign pathology based on cytology. Thus FNAC serves as a useful screening test to triage thyroid lesions before surgery. DOI: 10.21276/APALM.1154

FNAC is a Primary Diagnostic Tool in Thyroid Swelling

Fine needle aspiration cytology (FNAC) is regarded as the gold standard investigation in diagnosis & managment of thyroid swellings , also distinguish benign and malignant lesions, especially to rule out need of surgery. To study role of FNAC in Thyroid lesions.2) To correlate the cytological findings with histopathological diagnosis. A Total of 79 patients with Thyroid swellings submitted for fine needle aspiration cytology at GMERS Medical College and hospital Valsad, between January 2012 to December 2013 were studied. Out of 79 cases,female patient outnumbered male patients , majority of cases were non neoplastic 74 cases (93.68%), whereas 5 cases (6.32%) were neoplastic. Tissue examination was available for subsequent histopathological correlation in 19 cases. Fine needle aspiration cytology of thyroid swelling provides a reliable diagnosis and is an excellent first line method for investigating the nature of lesion.FNAC show good histopathological correlation.

Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions: A hospital-based study

Background: Fine needle aspiration cytology (FNAC) is the commonly used test for diagnosis of thyroid nodules. FNAC is a cost-effective procedure that provides specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be subjected to surgery only in cases of malignancy, thereby decreasing the rate of surgery and its consequent complications. The purpose of our study was to find the diagnostic accuracy of FNAC in thyroid lesions and to compare it with histopathology. Materials and Methods: A retrospective hospital-based study was conducted at Department of Pathology in a tertiary care institute and associated hospital of Bhopal. Data were collected from the records of FNAC and histopathology of thyroid lesions, done in last 4 years duration. Analysis was done by entering data in SPSS software, and Chi-square test was applied to find statistical significance. Results: FNAC was done on 234 patients in 4 years duration. The most common thyroid lesions were benign [221 (94.4%)], followed by malignant only [6 (2.6%)], indeterminate [3 (1.3%)], and inadequate [4 (1.7%)]. Out of 221 (94.4%) benign thyroid lesions, 33% were simple colloid goiter, 27.6% goiter with cystic changes, 16.28% nodular colloid goiter, 10.41% lymphocytic thyroiditis, 4.53% thyroglossal cyst, 4.07% colloid goiter with hemorrhage, 0.9% were follicular adenoma, and others formed 3.17%. Out of six (2.6%) malignant thyroid lesions, three were papillary carcinoma and the other three were follicular neoplasm. Conclusions: The cytological criterion for the diagnosis of thyroid lesions as benign and malignant by FNAC is a highly reliable method for the diagnosis. FNAC showed sensitivity, specificity, and diagnostic accuracy of 100% in the diagnosis of malignant lesions like papillary carcinoma as well as thyroglossal cyst and abscess.

Thyroid tuberculosis – role of PCR in diagnosis of a rare entity

Tuberculosis is a rare cause of granulomatous thyroiditis, whose diagnosis may be difficult with routine cytopathology and staining for acid-fast bacilli (AFB). Amongst 7962 cases of various thyroid lesions subjected to fine needle aspiration cytology (FNAC) over a period of 12 years, 34 cases (0.43%) were found to have cytological features of granulomatous inflammation with or without necrosis, which could be due to tuberculosis, granulomatous thyroiditis or other causes of granulomatous inflammation such as sarcoidosis or fungal infections. DNA was extracted from the material available on May-Grünwald-Giemsa-stained smears from the archival material. PCR for Mycobacterium tuberculosis was performed for insertion sequence IS6110. The age of the patients ranged from 32 to 58 years (median 48 years); 24 were female and 10 male. FNAC from thyroid swellings showed epithelioid granulomas with giant cells and/or necrosis. Although acid-fast bacilli were only seen in smears in two cases, 19/34 (55.9%) showed the presence of 123 bp DNA band under ultraviolet transillumination. Five control cases were negative. Our study of archival cytological material illustrates the importance of PCR as a potentially useful tool for the detection of M. tuberculosis DNA from FNAC of thyroid lesions, which could provide an alternative for rapid diagnosis of thyroid tuberculosis in AFB-negative cases.