FINE NEEDLE ASPIRATION CYTOLOGY OF THYROID NODULE: DIAGNOSTIC ACCURACY AND PITFALLS

Saeed A. Mahar, Akhtar Husain, Najmul Islam

Abstract


Objective : To evaluate the utility of FNAC in patients with Thyroid Nodule. Methods : Records
of all patients treated surgically for thyroid nodule(s) at Aga Khan University Hospital from
January 2000 to December 2004 were reviewed. The patients who had pre operative FNAC as first
line of the evaluation and the final post operative histopathology report available were included in
the study. Results: 125 patients (90 female 35 male) had thyroid surgery. The cytological
diagnosis was made according to following categories: Benign, Follicular lesion, Malignant and
Inadequate sampling. Among 63 “Benign cases”, 57 were benign and 6 turned out to be
malignant. Among 44 cases from “Follicular group”, 31 were benign and 13 were malignant. Out
of 15 patients from “Malignant” group, 14 were malignant and 1 was benign. Among three
patients from the “Inadequate sampling group”, 2 turned out to be benign and one was malignant.
The overall results showed a sensitivity of 98%, specificity of 70%, and positive predictive value
of 91%, negative predictive value of 93% and diagnostic accuracy of 91%. Conclusion: We
conclude that FNAC is an invaluable and minimally invasive procedure for pre operative
assessment of patients with a thyroid nodule in our setting as well. FNAC has high sensitivity in
picking up malignancy in thyroid and also has high diagnostic accuracy in the evaluation of
thyroid nodules.
Keywords : Thyroid – FNAC - Histopathology

References


Vander JB, Gaston EA Dawber TR. The significance of

nontoxic thyroid nodule: final report of a 15 year study of the

incidence of thyroid malignancy. Ann Int Med 1968; 69:

-540.

Gharib H. fine needle aspiration biopsy of thyroid: An

appraisal. Ann Int Med 1993; 118: 282-289.

Rojeski MT, Gharib H. Nodular thyroid disease: evaluation

and management. N Eng J Med 1985;313: 428-436.

Guido M. Sclabas, Gregg A. Staerkel, Suzanne E.Shapiro, et

al Fine Needle aspiration of thyroid & correlation with

histopathology in a contemporary series of 240 patients. Am

J Surgery 2003; 186: 702-10.

Tyler DS, Shaha AR, Udelsman RA, et al. thyroid cancer;

update. Ann Surg oncol 2000; 376-98.

Wong CK, Wheeler MH. Thyroid nodules: rational

management. World J Surg 200; 24: 934-41.

Roman SA. Endocrine tumors: Evaluation of thyroid nodule.

Curr opin oncol 2003; 15: 66-70.

H. thyroid fine Needle aspiration (FNA) and cytology.

Thyroid 2003; 13: 80-6.

Baloch ZW, Sack MJ, yu GH, Livolsi VA, gupta PK. Fine

needle aspiration of thyroid an institutional experience.

Thyroid 1998; 8: 565-69.

Ghariab H. Fine needle aspiration of thyroid nodules

asvantages limitations and effects. Mayo clin proc 1994; 69:

-49.

Caraway NP Sniege N, Samaan. Diagnosyic pitfalls in

thyroid fine needle aspiration: a review of 394 cases. Diagn

cytopathol. 1993; 9: 345-50.

Hall TL, Layfield LJ, Philippe A, Rosenthal DL. Source of

diagnostic error in the fine needle aspiration of the thyroid.

Cancer 1989; 63:718-25.

Gharib H, Goellner JR. Fine needle aspiration biopsy of the

thyroid : an appraisal. Ann Intern med 1993; 118: 282-9

Goldstein RE, netterville JL, Burkey B, Johnson JE.

Implications of follicular neoplasms, atypia and lesions

suspicious for malignancy diagnosed by fine needle

aspiration of thyroid nodules. Ann Surg 2002; 235: 656-64.

Pahavasit A, Thompson GB, hay ID et al follicular and

hurthle cell thyroid neoplasma. Is frozen section evaluation

worthwhile Ann Surg 1997; 132: 647-80.

Richards MZ, Chisholm R, Bruder JM, Strodel WE. Is

thyroid frogen section too much for too little? Ann J Surgery

; 184: 510-14.

Udelsman R, Westra WH, Donovan PI et al. randomized

prospective evaluation of frozen section analysis for

follicular neoplasms of the thyroid. Ann Surg 2001; 233:

-20.

Layfield LJ Reichman A, Bottlesk, Guiliano A. clinical

determinants for the management of thyroid nodules by fine

needle aspiration cytology. Arch otolaryngoi head neck

surgery 1992: 182: 717-21.

Liel Y, Ariad S, Barchana M. Long term follow up of

patients with initially benign thyroid fine needle aspiration.

Thyroid 2001; 11: 775-8.

Franklyn JA, Sheppared MC Aspiration cytology of thyroid.

BML 1987; 295: 510-11.

Lowhagen T, Eillems J, Lundell G, Sundblad R, Granberg P.

Aspiration biopsy cytology in diagnosis of thyroid cancer.

World J Surg 1981; 5: 61-73

Al-Sayer HM, krukowaski ZH, Williams VMM, manthesons

NA. Fine needle aspirations cytology in isolated thyroid

swellings a prospective two year evaluation. BMJ 1985; 290:

-2.

Gharib H, Goellner JR. Fine Needle aspiration biopsy of the

thyroid an appraisal Ann Intern Med 1993; 118: 282-9.

Anderson JB, Webb AJ. Fine Needle aspiration biopsy and

the diagnosis of thyroid cancer BR J Surg 1987; 74: 292-96.

Leonard N, Mekher DH. To operate or not to operate the

value of fine needle aspiration cytology in the assessment of

thyroid swellings. J Clin pathol 1997; 50: 941-3.

Gardner HA, Ducatman BS, Wang HH predictive value of

fine needle aspiration of thyroid in the classification of

follicular lesians. Cancer 1993; 71: 2598- 603.

Miller JM Kini SR, Hamburger JI. The diagnosis of

malignant follicular neoplasm of thyroid by needle biopsy.

Cancer 1985; 55: 2812-7.

Baloch Z.W. Fleisher, S. Livolsi, VA, Gupta PK. Diagnosis

of follicular neoplasm, a grey zone in thyroid fine needle

aspiration cytology. Diagnostic cytophathology 2002; 26, 41-

Caraway NP, Sneige N, Samaan N. Diagnostic pitfalls in

thyroid fine needle aspiration: a review of 394 cases. Diagn

Cytopatho 1993; 9: 345-50

Cruso D, Muzzaferri EL. Fine needle aspiration biopsy in the

management of thyroid nodules. Endocrinologist 1991; 1:

-202

Muzzaferri EL. Management of a Solitary thyroid nodule. N

Eng J Med 1993: 328: 553 – 9

Ridgway CE. Clinical review 30: Clinicians evaluation of a

solitary thyroid nodule. J clin Endocrinol metab 1992; 74:

-5

Chang H.Y, Lin J-D, Chen JF, Hunag B-Y, Hsueh C, jeng

LB et al Corelation of fine needle aspiration cytology and

frozen section biopsies in the diagnosis of thyroid nodules. J

Cein Pathol 1997; 50: 1005-9

Ikram M, Hyder J, Muzaffar S, Hasan SH. Fine Needle

Aspiration cytology (FNAC) in the management of thyroid

pathology – the Aga Khan University Hospital experience. J

Pak Med Assoc 1999;49(6):133-5.

Afroze N, Kayani N, Hasan SH. Role of Fine needle

aspiration cytology in the diagnosis of palpable thyroid

lesions. Indian J Pathol Microbiol 2002;45(3):241-6.

Safirullah, Naeem Mumtaz, Akbar Khan. Role of Fine

Needle Aspiration Cytology (FNAC) in the diagnosis of

Thyroid swellings. J Postgrad Med Inst 2004; 18(2): 196-

Leenhardt L, Hejblum G, France B, et al Indications and

limits of ultrasound guided cytology in the management of

non palpable thyroid nodules. J Clin Endocrine Metab, 1999;

: 24-8

Mittendorf EZ, tamarkin SW, Mc Henry CR. The results of

ultrasound guided fine needle aspiration biopsy for

evaluation of nodular.Thyroid disease Surgery 2002; 132:

– 54.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]