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A clinico-cytohistopathological evaluation of thyroid swellings: a prospective study

Author: 
Sumeet Angral, Manish Sharma, Mohit Goel and Deepakshi Angral
Subject Area: 
Health Sciences
Abstract: 

Introduction: Enlargement of thyroid gland (goiter) is a commonly encountered endocrine problem in clinical practice and accurate preoperative evaluation of thyroid disorder becomes important for proper management of the patient. Epidemiological studies suggest an annual incidence of 0.1% to 1.5% of nodular disease. Aims and objectives: This study designs to determine the clinical parameters, probable clinical diagnosis and comparative results of fine needle aspiration cytology (FNAC) and definitive histopathology (performed postoperatively) of thyroid swellings. Material and methods: This study was carried out at Government medical college, Jammu for a period of 1 year i.e. from May 2015 to May 2016. This prospective study comprises total 30 cases with thyroid lesions referred to cytology after proper clinical examination and routine investigations. Definitive histopathological examination of specimen after surgery was done. Results: 16 (53%) cases were between 31-40years of age. While 77% of the patients were female, only 23% were males. Right thyroid lobe was the site of affection in 15 (50%) cases. Based on clinical signs, symptoms and FNAC report four cases (13%) were found suspicious of malignancy and staged according to TNM classification. Out of 30 cases, 24(80%) cases had colloid goiter on FNAC, while 4 (14%) cases had follicular neoplasia, 1(3%) case each was diagnosed as having Hurthle cell neoplasia and thyroid cyst. Out of 30 cases, 25 (84%) cases had post-operative HPR of colloid goitre. This included one case with thyroid cyst, whose histological nature was not suggested previously by FNAC report. Four (13%) cases had HPR of follicular adenoma and only one (3%) cases had benign Hurthle cell neoplasm. Out of 30 cases, 22(73%) cases underwent lobectomy, while 5 (17%) cases were subjected to subtotal thyroidectomy. Two cases (7%) underwent near total thyroidectomy and only 1 (3%) case was subjected to isthmusectomy. Overall specificity of FNAC was 80% and sensitivity 97%. FNAC had false-negative rate of 3% and accuracy of 80%. FNAC was 96% specific in cases of colloid goiter and in only 4% of cases of colloid goiter was non-diagnostic as it could not predict the nature of swelling in thyroid cyst. FNAC could not predict the malignant or benign nature of follicular neoplasia as well as Hurthle cell neoplasia in none of the concerned cases. All the five cases of follicular and Hurthle cell neoplasia were confirmed to be of benign nature only by definitive histopathology. Conclusion: The serum TSH should be initial screening test to assess thyroid function, as it is a sensitive and reliable index of thyroid function. FNAC should be obtained as the initial diagnostic test to exclude malignancy in prominent palpable or suspicious nodules. FNAC does not help in differentiating benign and malignant counterparts of follicular neoplasia and hurthle cell neoplasia and definitive pathology is established only on histopathology performed post-operatively.

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