Needle Aspiration Cytology Research Articles

Nasal dermoid cyst

Abstract: Congenital midline lesions of the nose include nasal dermoids, encephaloceles, and gliomas. The nasal dermoid is least rare of these and is an uncommon midline developmental anomaly. Unlike encephalocoeles and gliomas ,craniofacial dermoids may present as a cyst, a sinus or a fistula (Setiyawan, 2013). In this patient, it was a cystic nasal swelling obscuring vision without any problem in visual acuity. He had this lesion from childhood but presented to the outpatient department in adolescent age. Diagnostic nasal endoscopy, ultrasonography, fin- needle aspiration cytology, and contrast-enhanced computed tomography of the nose and paranasal sinuses were done reporting it as a nasal dermoid without any bony erosions. All routine investigations were done, and the patient was planned for excision under general anesthesia (GA). Excision of the mass was done under GA and sent for histopathology. Histopathological examination report confirmed it as a dermoid cyst.

Hydatid Cyst of the Floor of the Mouth: A Case Report

The occurrence of a hydatid cyst in the face is rare. We report the case of a 24-year-old male with a slow-growing swelling in the floor of the mouth. The patient's history revealed chest drainage from a ruptured pulmonary abscess four years ago, without a documented bacteriological diagnosis. Clinical examination found a non-inflammatory and encapsuled swelling lifting the tongue without adenopathy. MRI scan showed a well-encapsuled multivesicular cyst (05 x 04 cm). Needle aspiration for cytology and hydatid serology were inconclusive. A complete blood count (CBC) and chest radiography revealed no abnormality. The cyst was entirely removed, and the histopathological examination conclusion was compatible with hydatid disease, which confirmed our thoughts regarding the patient's history.

T-cell lymphoma involving the rectum of a dog

A mediastinal mass was diagnosed in a 7-year-4-month-old neutered female mixed breed dog following a 3-week history of lethargy, hyporexia and pyrexia. Bi-cavitary imaging, needle aspirate cytology and flow cytometry confirmed WHO clinical stage IVb, intermediate to large T-cell lymphoma involving the mediastinum, liver and spleen. The dog initially responded to a multidrug chemotherapy protocol but clinical deterioration occurred 3 months later. The dog presented with anorexia, vomiting and diarrhoea, associated with marked faecal tenesmus and haematochezia, initially believed by the primary care practitioner to be related to chemotherapy toxicity. However, rectal examination revealed multiple sessile and pedunculated masses. Further diagnostic imaging, cytology and flow cytometry confirmed progressive disease, including T-cell lymphoma of the rectum. Histology and immunohistochemistry confirmed an infiltrate of intermediate-sized CD3-positive neoplastic cells that expanded the rectal mucosa. Rectal lymphoma is uncommon in dogs and previous cases have been B cell in origin. In this report we describe the clinical presentation and macro- and microscopic findings of a case of canine T-cell lymphoma involving the rectum.

Thyroglossal Duct Carcinoma: A Case Report and Literature Review

Thyroglossal duct cancer is a relatively rare finding, presenting clinical features that resemble those of a benign cyst, a more common congenital abnormality that may manifest as a lump in the midline or neck area. Thyroglossal duct cysts are a commonly found aberration during the development of the thyroid gland. The prevalence of adenotonsillar hypertrophy is greater than that of branchial cleft abnormalities, and among the pediatric population, it is the second most common cause of neck masses, surpassed only by enlarged cervical lymph nodes. In specific instances, thyroglossal duct cysts have been seen to exhibit a low prevalence of cancer. The diagnosis of thyroglossal duct cancer is commonly made by histological examination of the tumor. In addition, needle aspiration cytology, ultrasonography, and computed tomography are employed as diagnostic tools to differentiate malignant patients from alternative potential diagnosis.

A Study of Correlation of Fine Needle Aspirationcytology and Histopathology in Diagnosis of Thyroidswelling

A Study of Correlation of Fine Needle Aspirationcytology and Histopathology in Diagnosis of Thyroidswelling

Patterns of salivary gland lesions on fine needle aspiration cytology (FNAC)

A diverse range of inflammatory, cystic and neoplastic processes affect salivary glands.Fine needle aspiration cytology (FNAC) is a reliable tool for evaluation of salivary gland lesions. To analyse the cytomorphological features of salivary gland lesions and to assess the frequency of distribution of these lesions. It was an observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. FNAC was performed on patients presenting with salivary gland swelling. May-Grunwald-Giemsa (MGG) and Papanicolaou (PAP) stained smears were examined under light microscope. The cytomorphological features were analysed and diagnosis was made. There were 65 cases which included 31 (47.7%) males and 34 (52.3%) females. The mean age of patients was 42.96 years. On microscopic examination, neoplastic lesions were 35 (53.8%) and non neoplastic lesions were 30 (46.2%). Pleomorphic adenoma was the most common benign neoplastic lesion and also was the most frequently diagnosed lesion in our study (21, 32.3%). Mucoepidermoid carcinoma cases were maximum among malignant lesions (4, 6.2%). Parotid gland was involved in majority of cases. FNAC is a simple, rapid, reliable tool for the evaluation of salivary gland lesions thereby helping clinicians in deciding the further management plan.

A Descriptive Study of Reporting of breast Fine Needle Aspirationcytology Using International Academy of Cytology Yokohama System

A Descriptive Study of Reporting of breast Fine Needle Aspirationcytology Using International Academy of Cytology Yokohama System

A Descriptive Study of Reporting of breast Fine Needle Aspirationcytology Using International Academy of Cytology Yokohama System

Background: The International Academy of Cytology (IAC) has established standardizedapproach for reporting breast FNAC by categorizing lesions in a five-tier system from C1 to C5. Materials and Methods: From May 2020 to April 2021, a descriptive cross-sectional study was conducted in the cytology section of the Department of Pathology, SMS Medical College, Jaipur. Results: The current study involved 335 cases of breast FNAC, with a maximum of 333 (99.40%) females and 2 (0.60%) males. Maximum cases were in the age range of 21-40 years. There were 79 (23.60%) cases in C1 (Insufficient) category, C2 (Benign) had 177 (52.80%) cases, C3 (Atypical) had 9 (2.70%) cases, C4 (Suspicious) had 16 (4.80%) cases, and C5 (Malignant) had 54 (16.10%) cases respectively. Fibroadenoma was the most prevalent benign lesion in our analysis, accounting for 45 of the 177 benign cases, whereas ductal carcinoma was the most common malignant lesion.In a total of 92 cases where histology was examined, 86 cases were found to be compatible with the cytological diagnosis. In a triple assessment, 103 (78.03%) of the 132 cases were concordant in the benign group, only 1 (12.50%) case showed concordance in the atypia category, and 21 (39.62%) of the 53 cases showed concordance in the suspicious or malignant category. The Risk Of Malignancy (ROM) was calculated as follows: inadequate 0%, benign 0%, atypia 0%, suspicious for malignancy 71.43%, and malignant 97.56% for each group. Conclusion: This system is a valuable tool for breast cancer patient diagnosis and care. It also simplifies clinical audits and aids in improved coordination between pathologists, hospitals, and institutes.

The Role of Ultrasound, Scintigraphy, and Cytology in Evaluating Thyroid Nodules

Abstract
 Background: Thyroid function testing and imaging studies guide the initial management of thyroid nodules. Our study aims to assess the role that ultrasound (US) and scintigraphy play in thyroid nodules.
 Methods: We conducted a prospective case series study of 212 consecutive patients presented with thyroid nodules at the tertiary University Hospital of Tirana (“Mother Teresa”) for further evaluation between January 2018 and March 2018. All patients were examined with US and scintigraphy with 99mTc and underwent fine- needle aspiration cytology. Generalized Linear Model (ordinal logistic) was used to predict the dependent variable with 'ordered' multiple categories and independent variables.
 Results: The majority of patients (85%) were female, and (15%) males, p<0.001. The ordered logit for US finding’s presence of microcalcifications, adenopathy, solid or solidcystic nodules, being in a higher TIR category was 1.27, 4.56, 2.70 and 1.70 more than absence of microcalcifications, adenopathy and cystic nodules, respectively. Conversely, a one unit (year) increase in age would result in a 0.035 unit decrease in the ordered log-odds of being in a higher TIR category. For the scintigraphy findings, the ordered logit for isohypofunctional and hypofunctional nodules (vs. isofunctional), in a higher TIR category, was 1.70 and 2.10 higher, respectively.
 Conclusions: In thyroid glandular nodules, only a small percentage are malignant, therefore examination with ultrasound, scintigraphy and FNA are important to lower the number of patients undergoing surgery. Given the study's results, scintigraphy has a significant value, but in order to diagnose malignant nodules ultrasound remained an initial and important diagnostic tool, which, when combined with FNA, rounds out a clear diagnosis of thyroid nodules.

Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series

Background Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2).MethodsWe retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria.ResultsThe mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%).ConclusionsWith a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.

Correlation Between Ultrasound and Cytological Findings of Patients With Suspicious Thyroid Nodules: The King Hamad University Hospital Experience.

BackgroundThyroid nodules are a common presentation in otolaryngology-head and neck clinics. The detection of thyroid nodules has increased significantly with the advancements in radiological technology such as computed tomography and ultrasound (US). The present study aims to improve the clinical practice and management of thyroid disorders by establishing correlations between US and cytological findings in the diagnosis of thyroid nodules.MethodologyA retrospective cohort study was conducted at the King Hamad University Hospital (KHUH), Bahrain. A total of 189 cases met the study criteria. Pathological records for thyroid nodule fine needle aspiration (FNA) cytology and US features of sampled nodules from the patients were obtained. The cytological results were categorized into the Bethesda grading system, while the US features were organized into internationally accepted features using the Thyroid Imaging Reporting and Data System (TIRADS).ResultsThe radiologic characteristics from US showed positive features largely for the composition (76.2%) and vascularity (59.3%). Very few showed echogenicity (6.9%). Most records indicated negatively for the shape (94.7%), margins (76.2%), echogenicity (63.5%), or echogenic foci (66.1%). Of the 47 cases in TIRADS 1 and 2, only two were found to be Bethesda 4 classification, showing that most of these nodules were benign. Among those with TIRADS 3 on US, 85% turned were benign (Bethesda 2), two of the remaining six were grade 3, and the other four were suspiciously malignant. Of the 100 cases in TIRADS 4 and 5, 63% were of Bethesda grade 2, and therefore, benign, 14% were mildly suspicious, and only 23% were in Bethesda grades 4-6. A significant positive correlation was noted between the TIRADS and Bethesda scores (r = 0.338, p ≤ 0.001).ConclusionsIf the thyroid nodules are classified properly by US using the TIRADS system, the probability of a nodule being malignant can be established with a certain level of confidence. The appropriate management of the nodule can be initiated avoiding unwarranted FNA procedures.

High grade tibiofibular canine osteosarcoma in a 5-year-old female rottweiler

Osteosarcoma is a common neoplastic condition of the bone mostly affecting the appendicular bones in dogs. A five-year-old female Rottweiler was presented with a swollen left hind limb. Haematology showed mild nonregenerative anaemia, severe leukocytosis, and moderate neutrophilia with-out left shift, monocytosis, and severe lymphopenia. Fine needle aspirate (FNA) cytology revealed oval to spindle cells with marked cellular pleomorphism, anisocytosis, binucleation, and proteinaceous granules in the background while radiographic examination revealed osteolysis of the tibia and fibular with new bone formation. These findings are consistent with osteosarcoma. A diagnosis of osteosarcoma was made, based on the cytology and radiography. Surgical amputation of the complete left limb was carried out. However, the dog died of leptospirosis one month later. Post mortem examination revealed pulmonary metastasis of the osteosarcoma. Histopathology of the limb growth revealed oval to spindle cells with intracytoplasmic eosinophilic materials and osteoid matrix. Diagnosis and treatment of dogs affected by osteosarcoma should be comprehensive and complete, with adequate follow-up. The marked lymphopenia could be associated with poor prognosis, therefore an index for prognosis in osteosarcoma. The mortality, in this case, could have been related to leptospirosis and associated with the immunosuppression from tumour metastasis.

Serum MicroRNA-222 Expression for Malignancy Prediction in Euthyroid Patients with Indeterminate Thyroid Nodule

Abstract Background The Prevalence of thyroid nodules is rising nowadays, luckily most of them are benign. The risk of malignancy 5-15%, which necessitates the ultimate need to accurately distinguish benign from malignant nodule to avoid unnecessary thyroidectomy with risk of recurrent laryngeal nerve injury, postoperative hypothyroidism and lifetime thyroid replacement therapy, and other complications related to surgery and anaesthesia. Recent evidence suggests that circulating miRNA might have probable advantage as diagnostic or prognostic markers for numerous cancers. Given their reproducible and constant presence in sera, miRNA profiles have emerged as a non-invasive method to categorise a wide variety of human cancers. Aim of the study To evaluate a possible relationship between the expression level of circulating miRNA-222 and the histological outcome of euthyroid patients undergoing thyroidectomy for thyroid nodules with indeterminate FNAB cytology. Patients and Methods 45 patients of both genders, of age ranging from 19-70 years old visiting endocrine clinic or admitted to the endocrine surgical department with indeterminate thyroid nodules planned for thyroidectomy were included. All pateints were subjected to full medical history taking, general and local clinical examination, laboratory investigations (thyroid function tests), quantitative assay of serum micro RNA-222 expression by quantitative Real-Time polymerase chain reaction (qRT-PCR), ultrasonography imaging of thyroid gland, fine needle aspiration biopsy and cytology of the thyroid nodule, histopathological examination after thyroidectomy. Results The incidence of thyroid nodules was predominant in female gender in benign group and malignant group. Risk of malignancy increases as TI-RADS and Bethesda scores increases. Also, larger nodule in size has a more risk of malignancy (p = 0.034). Expression level of circulating miRNA222 in serum can’t differentiate between healthy, benign and malignant patients where there was no significant difference between them statistically (p = 0.867). Circulating miRNA-222 is a poor predicator for malignant nodules with sensitivity of 50%, specificity of 32.43%, with high negative predictive value (NPV=75%). Conclusion Expression level of circulating miRNA-222 is a poor predictor of malignant nodules in our studied group. The larger the nodule size the more risk of malignancy. Also, as TI-RADS and Bethesda scores increases the more risk of malignancy.

The Correlation between American College of Thyroid Imaging Reporting and Data System (ACR TI-RADS) and Fine Needle Aspiration (FNA) Cytology in Predicting Risk of Thyroid Malignancy: A Single Institution Quality Assurance Project

The Correlation between American College of Thyroid Imaging Reporting and Data System (ACR TI-RADS) and Fine Needle Aspiration (FNA) Cytology in Predicting Risk of Thyroid Malignancy: A Single Institution Quality Assurance Project

Late Presentation, Advanced Disease and Severe Acute Malnutrition are Common Among Children with Cancer in Tanzania

Background Majority of children with cancer live in low and middle-income countries (LMIC) where survival is disproportionately low compared to high-income countries (HIC). Among the challenges of managing childhood cancers in LMIC is late presentation, advanced disease, and the prevalence of severe malnutrition. Advanced disease and severe acute malnutrition are associated with poor treatment outcomes. Methodology This was a descriptive study conducted in Tanzania at Ocean Road Cancer Institute (ORCI) in 2010. Children and adolescents below 18 years were longitudinally enrolled in the study. Pathological diagnosis was made by examination of tissue biopsies, fine needle aspiration (FNAC) or bone marrow aspiration cytology (BMAC). Stage of disease at presentation was determined by physical examination and radiological investigations such as chest x-ray and ultrasonography. World Health Organization (WHO) anthropometric measurement chart was used to interpret measured Mid-upper arm circumference (MUAC) for age. Body mass index (BMI) is affected by tumour weight hence was not used to assess malnutrition in this study. Results One hundred and fifty-one (151) patients were enrolled in the study. The mean age at presentation was 5.8 years (range 3-17years), and 51.7% of participants were males. Three quarters (76.6%) of patients attended the first health facility within a month of onset of symptoms, but forty per cent (40%) of patients took six (6) months to reach ORCI for treatment. Eighty-six percent (86%) of patients presented with advanced disease (50.8% - locally advanced, 35.1% - metastatic disease). Metastatic disease was more frequent in patients with Neuroblastoma (NB) and Non Hodgikins Lymphoma (NHL) (66.6% each), Burkitt’s lymphoma (BL) (50%), Soft tissue sarcoma (STS) (40%) and Wilm’s tumour (WT) (35.3%). Severe wasting was seen in 12.6% of patients, and more prevalent among patients with BL (31.3%) and WT (25%). Conclusion Even though most patients sought health care early, they reached ORCI late with advanced disease (86%), and 12.6% had severe acute malnutrition. Keywords: Children, Cancer, Advanced Disease, Malnutrition.

A study on evaluation of the role of fine-needle aspiration cytology in the etiology of lymphadenopathy in the rural population attending tertiary care hospital

Introduction: Lymph nodes are a site for organized collections of lymphoreticular tissue and arepink-gray bean-shaped encapsulated organs. Lymph nodes are among the commonly aspiratedorgans for diagnostic purposes. Lymphadenopathy is of great clinical significance as underlyingdiseases may range from a treatable infectious etiology to malignant neoplasms Fine needleaspiration cytology (FNAC) is a reliable as well as an inexpensive method used to diagnoselymphadenopathy of various sites. Aims: To evaluate the usefulness of FNAC as a diagnostic tool inthe etiological causes of lymphadenopathy and to study the cytomorphological features associatedwith various lymphadenopathies. Materials and Methods: The present prospective study wascarried out in the Department of Pathology at Maharajah's Institute of Medical Sciences,Vizianagaram, a Tertiary Care Centre. A total of 210 patients of all age groups underwent FNAC ofenlarged lymph nodes during this study period. Results: FNAC diagnosis was found to be as follows:tubercular lymphadenitis in 98 cases (46.67%) followed by reactive hyperplasia in 35 cases(16.67%), metastatic carcinoma 29 (13.8%), granulomatous lymphadenitis 27 (12.85%), non-specific lymphadenitis 8 (3.8%), acute suppurative lymphadenitis 7 (3.33%) and lymphoma 4 (1.8).Conclusion: FNAC of lymph nodes is an excellent first-line investigation to determine the nature ofthe lesion. It is quick, safe, minimally invasive, and reliable and is readily accepted by the patient.

Fine Needle Aspiration versus Fine Needle Capillary Sampling Technique in Cyto-diagnosis of Thyroid Lesions

Introduction: In diagnosis of thyroid lesions, the negative pressure applied during fine needle aspirationcytology (FNAC) frequently produces bloody smears. This results in a compromise in cellular concentrationand architecture which may lead to improper interpretation. Fine needle capillary sampling cytology(FNCC), on the other hand, avoids active aspiration as it depends on capillary tension to collect tissuesamples in the needle bore. This study evaluated the diagnostic performance of FNAC and FNCC in thyroidlesions. Methods: A total of 120 patients were included in this study conducted over a duration of 19months. All thyroid swellings advised for cyto-diagnosis were sampled by both fine-needle aspiration(FNAC) and non-aspiration (FNCC) techniques. The slides were assessed according to the Mair et al.scoring system. Results: In the FNCC group, 72 (60%) smears were diagnostically superior while 54 (45%)smears were diagnostically superior in the FNAC group. Blood contamination (p=0.003), cellular trauma(p=0.019), and degree of cellular degeneration (p=0.026) were less and cellular architecture (p=0.047) waspreserved more in FNCC in comparison to FNAC groups. Conclusion: This study showed the superiority ofFNCC for the interpretation and diagnosis of thyroid lesions. However, the combination of both FNAC andFNCC could maximize the diagnostic yield.

The Role of Aspiration and Thyroxine Suppression Therapy in Management of Benign Thyroid Nodules

A prospective study on 142 patients presenting with (benign euthyroid nodule) , after diagnostic work-up included a clinical evaluation, thyroid function tests, ultrasonography, thyroid scintigraphy and fine needle aspiration cytology. Based on the investigations, patients were managed with aspiration andthyroxine suppression therapy for sex month . Patients were divided into four groups according to their response of treatment ,group( 1) complete shrinkage response ,group( 2) reduction in size ,group (3) no response but same size and group (4) enlarge in size non responders’.Of the 142 patients17 (12 %) were male, and 125 (88 %) were female. The age rangein 99 (69.7%) patients were between 21 and 50 years and forty three patients were above 50 years of age. We divided our result into four groups,group( 1) complete shrinkage response29 patients’ (20.5%),group( 2) reduction in size 45 patients’ (31.8%),group (3) no response but same size38 patients’ (26.7%) and group (4) enlarge in size non responders30 patients’(21% )Thyroxine suppressive treatment were effective in shrinking about one fifth of thyroid nodules. Similarly, there was reduction in size in about one third of nodule.From 17 male 6 patients (35 %) achieve complete response ,while only23 female patients (18 %) achieve complete response, and from17 male patients 5 (29 %) achievereduction in size,while only 40 female patients (32 %) achieve reduction in size. Young age less than fifty achieve good response than older patients(63.6%).Single aspiration needed in26 patients(18.3%) while multiple aspiration needed in 116 patients(81.7%).

Fine needle aspiration cytology study of spectrum of neck masses in a tertiary care hospital

Neck lesions are frequently encountered in clinical practice and found responsible for significant morbidity and mortality. Palpable lesions in the region of the head and neck include a wide differential diagnosis including inflammatory lesions and neoplasms. The sensitivity and specificity of fine-needle aspiration biopsy in detecting a malignancy range from 77% to 97% and 93% to 100%, respectively. Fine needle-aspiration cytology (FNAC) represents a relatively accurate, inexpensive and rapid technique for elucidation of the etiology of neck masses. It can be performed as an OPD procedure and is well accepted by the patients. Lymphadenitis accounted for the majority of the cases (36.1%) of which Reactive Lymphadenitis was the commonest followed by granulomatous lymphadenitis. Metastatic tumors accounted for 26.6% of the cases followed by thyroid swellings (21.5%). Squamous cell carcinoma (10.2%) was the most common metastatic lesion while colloid goiter (17.4%) predominate in the thyroid swellings. Histopathological correlation was carried out wherever feasible. In our study, Lymphadenitis accounted for the majority of the cases followed by metastatic lesions of the neck.

A Study to Evaluate the Size of Thyroid Nodules as an Indicator for Malignancy

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It’s the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery. Subjects and Methods: This study included 20 patients who underwent thyroidectomy. We compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery. Results: 20 patients with thyroid nodule underwent thyroid surgery. 13 patients had nodule <4cm and 7 patients were 4 cm. For patients with nodules <4 cm, 3 patients had a malignancy, and for those with nodules 4 cm, 1 patients had a malignancy. For benign cases FNAC and histopathology reports are showing same results, (p<0.05). Conclusion: Thyroid nodules 4 cm are not risk factor of malignancy. Thyroid nodules 4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.