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Fine needle aspirate cytology of thyroid; a review of diagnostic patterns and comparison of findings with histology the gold standard, At moi teaching and referral hospital

Author: 
Kiptanui Chebii, Stephen Biwott Tanui, Dominic Alwala and Finson Bargoria
Subject Area: 
Health Sciences
Abstract: 

Thyroid masses are common surgical presentations with a worldwide prevalence of 4–7% in the general adult population. The vast majority of adult thyroid nodules are benign neoplasm’s, however, less than 10% are malignant, which makes it important to screen the nodules in order to offer appropriate surgery and avoid unnecessary surgery for benign nodules. It is preferred to operate only on those patients with suspicion of malignancy, while strict patient follow-up is necessary in dealing with benign cases. Fine needle aspiration cytology (FNAC) is known to play a pivotal role in the screening and management of thyroid swellings. This study was carried out at theMoi Teaching and Referral Hospital its objective was to assess FNAC patterns of thyroid masses and compare its findings with corresponding histological findings to find out if FNAC can be relied upon in evaluating thyroid in order to establish a basis of whether or not to incorporate its findings in the management of these masses pre-operatively. This was a retrospective study where FNAC and corresponding histological evaluation findings of 118 patients aged 17-88 years who had a pre-operative FNAC and subsequently a thyroid resection for definitive histological diagnosis between January 2007 and December 2014 were accessed from the archives of MTRH and compared for concordance and discordance. Of the 118 FNAC, 17 (14.40%) were inadequate to make a diagnosis, 14(11.86%) were suspicious for malignancy, and 78 (66.1%) were benign while 9 (7.62%) were malignant. The benign cases consisted predominantly of colloid goiter (54.54%) whereas the malignant ones consisted predominantly of papillary carcinomas (5.08%). The concordance, false positive and false negative rates were 90.80%, 3.44% and 5.74% respectively. The accuracy, sensitivity, specificity, positive predictive value and negative predictive values of FNAC were 90.80%, 54.54%, 96.05%, 66.66% and 94.58% respectively. There was a significant agreement between the two tests (p= 0.34). FNAC of thyroid is accurate and has a low rate of false-negatives and false-positives diagnoses hence can be adopted and relied upon in evaluating thyroid nodules pre-operatively. Use of FNAC reduces the rate of unnecessary surgeries, the cost of health care and the risks associated with surgeries, resulting in better outcome of patient’s care.

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