The spectrum of thyroid lesions on fine needle aspiration cytology
Keywords:Fine-needle aspiration cytology, Follicular neoplasm, Thyroid, The Bethesda system
Background: Fine Needle Aspiration Cytology (FNAC) of thyroid gland is the most common preoperative investigation for diagnosis of thyroid lesions. Though various tests like thyroid profile, ultrasonography and radionuclide scan are available, they are used as adjuvant diagnostic modalities. FNAC is simple, easy to perform, non-invasive and cost-effective procedure. Primary aim is to study the spectrum of various thyroid lesions on FNAC. Also, the study is aimed to categorise the thyroid lesions according to the Bethesda system for Reporting Thyroid Cytopathology (2017).
Methods: This is a retrospective observational study carried out in the pathology department at tertiary care academic institute for a period of three years. FNAC was done in a patient with thyroid swelling by non-aspiration technique. Slides were prepared, fixed in 95% ethyl alcohol and processed with routine stains.
Results: Out of 210 cases, 150 cases (71.42%) were benign lesions, 15 cases (7.14%) were Follicular neoplasm/Suspicious for follicular neoplasm, 14(6.66%) cases were reported as Atypia of undetermined significance, 13 cases (6.19%) were Unsatisfactory/Nondiagnostic, 11 cases (5.2%) were malignant and 7 cases (3.3%) were suspicious for malignancy.
Conclusions: FNAC is the most effective tool for the diagnosis of thyroid lesions. The Bethesda system is used to categorise the thyroid lesions and helps in better communication between clinicians and pathologists for the best surgical and medical management. The number of benign cases were higher and the number of cases in the category of suspicious for malignancy were lower with female preponderance.
Wong LQ, Baloch ZW. Analysis of the Bethesda System for reporting Thyroid Cytopathology and Similar Precursor Thyroid Cytopathology Reporting Schemes. Adv Anat Pathol. 2012;19(5):313-9.
Guhamallick M, Sengupta S, Bhattacharya NK, Basu N, Roy S, Ghosh AK, M Chowdhury. Cytodiagnosis of thyroid lesions-usefulness and pitfalls: A study of 288 cases. J Cytol. 2008;25(1):6-9.
Heller MT, Gilbert C, Ohori NP, Tublin ME. Correlation of Ultrasound Findings With the Bethesda Cytopathology Classification for Thyroid Nodule Fine-Needle Aspiration: A Primer for Radiologists. AJR Am J Roentgenol. 2013;201(3):W487-94.
Kumar M, Potekar R, Yelikar BR, Patil V, Karigoudar M, Pande P. Diagnostic accuracy of frozen section in comparison with fine needle aspiration cytology in thyroid lesions: A prospective study. Iran J Pathol. 2013;8(4):219-26.
Sukumaran R, Kattoor J, Pillai KR, Ramadas PT, Nayak N, Somanathan T, et al. Fine Needle Aspiration Cytology of Thyroid Lesions and its Correlation with Histopathology in a Series of 248 Patients. Indian J Surg Oncol. 2014;5(3):237-41.
Ucler R, Usluogulları CA, Tam AA, Ozdemir D, Balkan F, Yalcın S, et al. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol. 2015;43(8):622-8.
Pandey P, Dixit A, Mahajan NC. Fine-needle aspiration of the thyroid: a cytohistologic correlation with critical evaluation of discordant cases. Thyroid Res Pract. 2012;9(2):32-9.
Williams MD, Suliburk JW, Staerkel GA, Busaidy NL, Clayman GL, Evans DB, et al. Clinical significance of distinguishing between follicular lesion and follicular neoplasm in thyroid fine-needle aspiration biopsy. Ann Surg Oncol. 2009;16(11):3146-53.
Zarif HA, Ghandurah SE, Al-Garni MA, Binmahfooz SK, Alsaywid BS, Satti MB. Thyroid nodules cytopathology applying the bethesda system with histopathological correlation. Saudi J Med Med Sci. 2018;6(3):143-8.
Kannan S, Raju N, Kekatpure V, Chandrasekhar NH, Pillai V, Keshavamurthy AR, et al. Improving Bethesda reporting in thyroid cytology: A team effort goes a long way and still miles to go…. Indian J Endocr Metab. 2017;21(2):277-81.
Melo-Uribe MA, Sanabria Á, Romero-Rojas A, Pérez G, Vargas EJ, Abaúnza MC, et al. The Bethesda system for reporting thyroid cytopathology in Colombia: Correlation with histopathological diagnoses in oncology and non-oncology institutions. J Cytol. 2015; 32(1):12-6.
Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle Aspiration of Thyroid Nodules: A Study of 4703 Patients With Histologic and Clinical Correlations. Cancer. 2007; 111(5): 306-15.
Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. The Bethesda Thyroid Fine-Needle Aspiration Classification System: Year 1 at an Academic Institution. Thyroid. 2009;19(11):1215-23.
Sarkis LM, Norlen O, Aniss A, Watson N, Delbridge LW, Sidhu SB, et al. The Australian experience with the Bethesda classification system for thyroid fine needle aspiration biopsies. Pathol. 2014;46(7):592-5.
Mehra P, Verma AK. Thyroid cytopathology reporting by the bethesda system: a two-year prospective study in an academic institution. Patholog Res Int. 2015;2015:240505.
Ke J, Jianyong L, Ying L, Genpeng L, Linlin S, Zhihui L, et al. The use of The Bethesda System for Reporting Thyroid Cytopathology in a Chinese population: An analysis of 13 351 specimens. Diagnostic Cytopathol. 2019 May 9.
Upadhyaya P, Dhakal S, Adhikari P, Adhikari B, Khadka D, Niraula SR. Histopathological review of diagnostic categories of the Bethesda system for reporting thyroid cytopathology – An institutional experience of 5 years. J Cytol. 2019;36(1):48-52.
Hajmanoochehri F, Rabiee E. FNAC accuracy in diagnosis of thyroid neoplasms considering all diagnostic categories of the Bethesda reporting system: A single-institute experience. J Cytol. 2015;32(4):238-43.
Ozluk Y, Pehlivan E, Gulluoglu MG, Poyanli A, Salmaslioglu A, Colak N, et al. The Use of the Bethesda Terminology in Thyroid Fine-Needle Aspiration Results in a Lower Rate of Surgery for Nonmalignant Nodules: A Report From a Reference Center in Turkey. Int J Surg Pathol. 2011;19(6):761-71
Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow‑up. J Cytol. 2013;30(2):94-9.