Usefulness of Preoperative FNAC of Thyroid Swelling Along with Application of Bethesda System of Reporting

Abstract

Introduction: Fine needle aspiration cytology (FNAC) is the commonly used test for diagnosis of thyroid swellings. 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, thereby decreasing the rate of surgery and its consequent complications. Aims and Objective: Study is aimed to accuracy of FNAC in thyroid as compare with histopathology and classify various cytomorphological lesions of thyroid according to The Bethesda System for Reporting of Thyroid Cytopathology (TBSRTC). Material and Methods: This prospective study was done at our department from January 2013 to June 2015. Total 411 cases presented with thyroid swelling were subjected to thyroid fine needle aspiration cytology (FNAC) and the smears were made followed by routine staining and reporting. The categorization according to the Bethesda system of reporting thyroid cytology was done. The cytological diagnosis was correlated with the histological diagnosis wherever it was available. The accuracy of FNAC for the diagnosis of nonneoplastic and neoplastic lesions was determined using histopathology as the gold standard. Results: Out of total 411 cases, 387 (94.16%) were benign, 15 (3.52%) were Follicular neoplasm, 7(1.70%) cases were malignant and 2 (0.48%) were inadequate. Most frequently encountered lesion was colloid goitre in 217 (52.79%) cases followed by thyroiditis in 75 (18.24%) cases, 67 (16.30%) cases of nodular goitre, 26 (6.32%) cases of hyperplastic goitre and 2 (0.48%) cases of thyroglossal cysts. The cytological and histological concordance was determined in 97 cases. FNA revealed a sensitivity of 85.71%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 98.76%. Conclusion: TBSRTC can help with a better patient's outcome due to proper clinical management of thyroid swellings and saves patients from unnecessary thyroid surgery.

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