Clinicopathological study of thyroid swelling and its management
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20201290Keywords:
Thyroid swelling, Thyroidectomy, Papillary carcinoma, FNAC, Thyroid HPEAbstract
Background: There is high prevalence of thyroid lesions in India. In this study, an attempt is made to find out the clinical spectrum of thyroid swellings in central India, diagnostic accuracy of fine needle aspiration cytology (FNAC), appropriate surgical management and to compare it with postoperative histopathological diagnosis so as to determine its role in surgical management.
Methods: In this prospective study, 100 subjects presenting to ENT OPD of GMC, Nagpur during the period from September 2017 to August 2019 with thyroid swelling who were fit to undergo surgery and willing to participate in the study were selected. After detailed evaluation and routine investigations, thyroid function test (TFT), FNAC, ultrasonography (USG) neck, all the subjects underwent required thyroidectomy. The postoperative histopathological examination (HPE) report was correlated with cytological report.
Results: In 100 subjects, majority of subjects were from 4th decade (32%) with female: male ratio=6.14:1. FNAC findings were colloid goiter (61%), nodular goiter (19%), follicular neoplasm (10%), and papillary carcinoma (9%). On HPE, colloid goitre (57%) was most common non-neoplastic lesion and papillary carcinoma (65.21 %) was most common malignant lesion. Hemithyroidectomy (70%) was most common procedure done. Transient hypocalcemia (5%), recurrent laryngeal nerve (RLN) paresis (2%) were the postoperative complications encountered. Sensitivity, specificity, accuracy, positive and negative predictive values of FNAC to diagnose malignancy were 55.6%, 100%, 91%, 100% and 90% respectively.
Conclusions: FNAC is an easy, rapid, reliable, cost-effective, minimally invasive and readily repeatable technique for diagnosis of thyroid swellings. The common false negative diagnosis is seen in follicular pattern cases, cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma.
References
David M, Coombes S, Young AE. The thyroid Gland, chapter 17, The new Arid’s companion in surgical studies, 3rd edition. Elsevier; 389-391.
Ridgway DEC. Clinical evaluation of solitary thyroid nodules, in The Thyroid: A Fundamental and Clinical Text. Philadelphia, Pa, USA: G. B. Lippincott; 1986;1377-85.
Burch HB, Burman KD, Reed HI, Buckner L, Raber T, Ownbey Jl. Fine needle aspiration of thyroid nodules. Determinants of insufficiency rate and malignancy yield at thyroidectomy. Acta Cytol. 1996;40:1176-83.
Miller JM, Kini SR, Hamburger JI. The diagnosis of malignant follicular neoplasms of the thyroid by needle biopsy. Cancer. 1985;55:2812-7.
Shafiqul I, Belayat HS, Akhtar N, Shameemus SK, Mohammad A. Comparative study of FNAC and histopathology in the diagnosis of thyroid swelling. Bangladesh J Otorhinolaryng. 2010;16 (1):13749.
Kessler A, Gavriel H, Zahav S, Vaiman M, Shlamkovitch N, Segal S, et al. Accuracy and consistency of fine- needle aspiration biopsy in the diagnosis and management of solitary thyroid nodules. Israel Medi Associa J. 2005;7(6);371-3.
Zambudio AR, Rodriguez J, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Annals of Surg. 2004;240(1):18-25.
Godara R, Garg P, Singla S. Thyromegaly: lack of consensus in management. The Internet J of Surg. 2007;10(1):8678.
Amjad KM, Abdul M, Moosabba MS. Clinicopathological study and management of thyroid swelling. J Advance Rese Biolog Sci. 2011;3:1-5.
Rao KM, Ananthakrishnan N, Narasimhans R, Veliath, Smilet SR, Jagdish S. The single thyroid nodule: 503 patients. Indian J Surg. 1993;55(10):487-92.
Gupta M, Gupta S, Gupta V. Correlation of fine needle aspiration cytology and histopathology in the diagnosis of solitary thyroid nodule. J Thyroid Res. 2010;18:379051.
Cusick EL, MacIntosh CA, Krukowski ZH, Williams VMM, Ewen SWB, Matheson NA. Management of isolated thyroid swelling: a prospective six years study of fine needle aspiration cytology in diagnosis. British Medi J. 1990;5:379051.
Ananthakrishnan N, Rao KM, Narasimhan R, Veliath, Smiley SR, Jagadish S. The Single Thyroid Nodule: a south Indian profile of 503 patients with special reference to incidence of malignancy. Indian J Surg. 1993;55(10):487-92.
Nagori LF, Algotar MJ. Solitary solid thyroid nodule. Indian J Surg. 1992;54(2):75-8.
Khadilkar UN, Maji P. Histopathological study of solitary nodules of thyroid. Kathmandu Univ Med JI. 2008;6(4):486-90.
Tsegaye B, Ergete W. Histopathologic pattern of thyroid disease. East African Medi J. 2003;80(10):525-8.
