A CLINICOPATHOLOGICAL STUDY OF THYROID NODULES

DILDAR HAJI MUSA; MAHMOUD ALI ABDI; MOWAFAK MASOUD BAHADDIN

DILDAR HAJI MUSA Assistant Professor, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
MAHMOUD ALI ABDI Specialist Surgeon, Azadi Teaching Hospital, Directorate of Health, Duhok, Kurdistan Region, Iraq.
MOWAFAK MASOUD BAHADDIN Lecturer, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq

Keywords: Thyroid nodules, Clinicopathology, FNAC;, FNAC ;, Validity;, Malignancy;, Benign;

Abstract

https://doi.org/10.31386/dmj.2019.13.1.4

Background: Nodular thyroid disease is very common and surgeons needs to differentiate benign from malignant nodules. Fine needle aspiration cytology of malignancy (FNAC) can assist the surgeon to select the proper technique for thyroid nodule management. The clinical parameters of patients with thyroid nodules were explored and the rate of malignancy was assessed. As well, the role of fine needle aspiration cytology in the diagnosis of these nodules compared to histopathological findings was evaluated.

Patients and Methods: In the current prospective cross-sectional study, 79 patients diagnosed with thyroid swelling were undergone medical and clinical examinations, biochemical tests, and fine needle aspiration cytology at Azadi Teaching Hospital in Iraq in 2016. Tissue specimens of thyroid were sent for histopathological diagnosis.

Results: Thyroid nodules were more common in female (84.8%), the mean age was 40.28 years. The most common indication of surgical intervention was dysphagia. Multi-nodular was the commonest type of thyroid nodules (73.4%) followed by a follicular adenoma (8.9%) and Hashimoto’s thyroiditis (7.6%). Prevalence of malignancy was 7.6% and papillary thyroid cancer was the most common cancer (6.3%). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of fine needle aspiration cytology through histopathological diagnosis were 66.7%, 100%, 100%, 97.3%, and 97.5%, respectively.

Conclusions: The most common types of thyroid nodules were a multi-nodular goiter, follicular adenoma, and thyroiditis. Fine needle aspiration cytology is easily applicable and reliable method for thyroid nodules evaluation with an acceptable sensitivity.

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References

1. Gharib H, Papini E, Paschke R. Thyroid nodules: a review of current guidelines, practices, and prospects. European Journal of Endocrinology. 2008;159(5):493-505.
2. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.
3. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.
4. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. American journal of clinical pathology. 2009;132(5):658-65.
5. Pandey P, Dixit A, Mahajan NC. Fine-needle aspiration of the thyroid: A cytohistologic correlation with critical evaluation of discordant cases. Thyroid Research and practice. 2012;9(2):32.
6. Bagga P, Mahajan N. Fine needle aspiration cytology of thyroid swellings: How useful and accurate is it? Indian Journal of cancer. 2010;47(4):437.
7. Gnarini VL, Brigante G, Valle E Della, Diazzi C, Madeo B, Carani C, et al. Very high prevalence of ultrasound thyroid scan abnormalities in healthy volunteers in Modena , Italy. J. Endocrinol. Invest. 36: 2013;722-728.
8. Dean DS, Gharib H. Epidemiology of thyroid nodules. Vol. 22, Best Practice and Research: Clinical Endocrinology and Metabolism. 2008. p. 901–11.
9. Mulholland MW, Lillemoe KD, Doherty GM, Maier RV, Simeone DM, Upchurch GR. Greenfield's Surgery: Scientific Principles & Practice: Lippincott Williams & Wilkins; 2012.
10. Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. The oncologist. 2008 Feb 1;13(2):105-12.
11. Yunus M, Ahmed Z. Significance of ultrasound features in predicting malignant solid thyroid nodules: need for fine-needle aspiration. JPMA-Journal of the Pakistan Medical Association. 2010 Oct 1;60(10):848.
12. Vanderpump MPJ. The epidemiology of thyroid disease. British medical bulletin. 2011;39–51.
13. Faquin WC, Baloch ZW. Fine‐needle aspiration of follicular patterned lesions of the thyroid: diagnosis, management, and follow‐up according to National Cancer Institute (NCI) recommendations. Diagnostic cytopathology. 2010 Oct;38(10):731-9.
14. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. American journal of clinical pathology. 2010 Sep 1;134(3):450-6.
15. Khalid AN, Quraishi SA, Hollenbeak CS, Stack Jr BC. Fine‐needle aspiration biopsy versus ultrasound‐guided fine‐needle aspiration biopsy: Cost‐effectiveness as a frontline diagnostic modality for solitary thyroid nodules. Head & Neck. 2008 Aug;30(8):1035-9.
16. Haberal A, Toru S, Özen Ö, Arat Z, Bilezikçi B. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology. 2009;20(2):103-8.
17. Muratli A, Erdogan N, Sevim S, Unal I, Akyuz S. Diagnostic efficacy and importance of fine-needle aspiration cytology of thyroid nodules. Journal of Cytology/Indian Academy of Cytologists. 2014;31(2):73.
18. Nam‐Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography‐guided fine‐needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clinical endocrinology. 2004;60(1):21-8.
19. Baier ND, Hahn PF, Gervais DA, Samir A, Halpern EF, Mueller PR, Harisinghani MG. Fine-needle aspiration biopsy of thyroid nodules: experience in a cohort of 944 patients. American Journal of Roentgenology. 2009 Oct;193(4):1175-9.
20. Kim DL, Song KH, Kim SK. High prevalence of carcinoma in ultrasonography-guided fine needle aspiration cytology of thyroid nodules. Endocrine journal. 2007: 55(1):135–42.
21. Sipos JA. Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid. 2009 Dec 1; 19(12):1363-72.
22. Bessey LJ, Lai NBK, Coorough NE, Chen H, Sippel RS. Association for Academic Surgery The incidence of thyroid cancer by fine needle aspiration varies by age and gender. J Surg Res [Internet]. Elsevier Ltd; 2013;184(2):761–5.
23. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long‐term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer Cytopathology. 2007;111(6):508-16.
24. Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinology and Metabolism Clinics. 2007;36(3):707-