Objective: To evaluate and demonstrate the accuracy of fine-needle aspiration (FNA) in thyroid lesions in our department and to highlight probable causes of errors leading to unsatisfactory sampling, which may depend on the characteristics of the nodule.
Methods: This is a retrospective study conducted on 319 diagnosed cases of thyroid nodules referred to the Surgery Unit of Puls hospital, Tîrgu Mureș in the January 2014 – December 2015 period, who underwent fine-needle aspiration. Histological examination was considered to be the gold standard; therefore we compared the cytological diagnosis with the histological one.
Results: Of the 319 cases, 289 (90.6%) were female and 30 (9.4%) male patients; 210 cases (69.3%) were interpreted as benign, 46 cases (15.2%) as follicular lesion of undetermined significance, 4 cases (1.3%) as suspect for malignancy, 1 case (0.3%) as malignant sampling, and 42 cases (13.9%) as unsatisfactory. We compared the results of fine-needle aspiration cytology (FNAC) with the corresponding histopathological results (49 in total). FNAC achieved a sensitivity of 76.47%, a specificity of 83.1%, a positive predictive value of 35.1%, a negative predictive value of 96.7%, a false positive rate of 16.9%, a false negative rate of 23%, and an overall accuracy of 82.3%.
Conclusions: The results of our study demonstrate the accuracy of the FNA technique in the first-line diagnosis of thyroid nodules.
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1. Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63-102.
2. Orell SR. In: Orell SR, Sterrett GF, Walters MN, Whitakar D, editors. Manual and atlas of fine needle aspiration cytology. New Delhi: Churchill-Livingstone; 2005. p. 125-164.
4. Galera-Davidson H. Diagnostic problems in thyroid fine needle aspirations. Diagn Cytopathol. 1997;17:422-428.
5. Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK. Fine needle aspiration of thyroid an institutional experience. Thyroid. 1998;8:565-569.
6. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009;132:658-665.
7. Lingam RK, Qarib MH, Tolley NS. Evaluating thyroid nodules: predicting and selecting malignant nodules for fine-needle aspiration (FNA) cytology. Insights Imaging. 2013;4:617-624.
8. Belfiore A, La Rosa GL. Fine-needle aspiration biopsy of the thyroid. Endocrinology & Metabolism Clinics of North America. 2001;30:361-400.
9. Saggiorato E, De PR, Volante M. Characterization of thyroid ‘follicular neoplasms’ in fine-needle aspiration cytological specimens using a panel of immunohistochemical markers: a proposal for clinical application. Endocr Relat Cancer. 2005;12:305-317.
10. Guhamallick M, Sengupta S, Bhattacharya NK, Chowdhury M. Cytodiagnosis of thyroid lesions-usefulness and pitfalls: A study of 288 cases. Journal of Cytology. 2008;25:6-9.
11. Raab SS, Vrbin CM, Grzybicki DM, et al. Errors in Thyroid Gland Fine-Needle Aspiration. Am J Clin Pathol. 2006;125:873-882.
12. Hamburger JI. Diagnosis of thyroid nodules by fine needle biopsy: use and abuse. J Clin Endocrinol Metab. 1994;79:335-339.
13. Rossi ED, Raffaelli M, Minimo C. Immunocytochemical evaluation of thyroid neoplasms on thin-layer smears from fine-needle aspiration biopsies. Cancer. 2005;105:87-95.
14. Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of thyroid nodules: comparison of three sets of guidelines. AJR Am J Roentgenol. 2010;194:31-37.