The diagnostic utility of ultrasound scanning, fine needle aspiration cytology and cell block technique in the pre-operative diagnosis of suspicious thyroid nodules

[摘要] Introduction: Ultrasound scanning (USS) and fine needle aspiration cytology (FNAC) are first-lineinvestigations to assess thyroid diseases, which assist in recognizing the suspicious thyroid nodules(SusTNs) pre-operatively.Objectives: To determine the diagnostic utility of USS, FNAC and cell block technique in preoperativediagnosis of SusTNs.Method: A descriptive cross-sectional study, conducted at Colombo South Teaching Hospital andDepartment of Pathology, University of Sri Jayewardenepura. Patients with ultrasonically detectedSusTNs were included. Direct smears and cell blocks were prepared from the USS guided FNACsamples of each patient. The TIRADS classification was used for radiological assessment and theBethesda system for cytological interpretation. Specimens with insufficient cellularity were excluded.Results: Seventy-one patients (15-76 years) with a mean age of 49.8 were included, the majority werefemales (84.5%). When USS findings of the SusTNs were compared with that of FNAC, the sensitivitywas 50%. 18.9% of TR4a, 66.6% of TR4b and 100% of TR4c specimens were diagnosed as malignant(Bethesda V and VI) in FNAC samples. Cell block findings in 82% of the cases matched with the FNACresults, which was statistically significant (p<0.001).Discussion: TIRADS 4 in USS denotes moderate suspicion for malignancy. The subcategories TR4a,TR4b and TR4c denote undetermined nodules, suspicious nodules and highly suspicious nodules,respectively. There is a statistically significant association between TR4c nodules and thyroidcarcinoma (100%).Conclusion: FNAC and cell block techniques complement each other in the pre-operative assessmentof SusTNs. Cytology results were useful to separate TIRADS 4 into the subcategories in which TR4cdemonstrated significant predictability of malignancy. The pre-operative assessment of SusTNs isimperative to minimize unnecessary thyroid surgeries.

[学科分类] 生理学与病理学