HISTOPATHOLOGICAL STUDY OF THYROID LESIONS

Background:Thyroid lesions are fairly common worldwide and are commonly encountered in clinical practice. Theincidence of various thyroid disorders shows a striking variation; both, on a national and regional basis. Thyroidgland can be affected by a wide spectrum of diseases ranging from functional and immunologically mediatedenlargement to neoplastic lesions.Objective:This study was carried out to estimate the frequency of thyroid lesions with respect to histopathological typesand to correlate thyroid lesions with demographic data and clinical features.Materials and Methods:This study included all types of thyroid specimens received in the department of Pathology; AMC METMedical College, Ahmedabad from June 2019 to December 2020.Results:Among the total 40 cases of thyroid lesions studied, the non-neoplastic lesions accounted for 26 cases (65%)and the neoplastic lesions constituted 14 cases (35%). The most common non-neoplastic lesion wasmultinodular /adenomatoid goiter (50%), followed by Hashimoto thyroiditis (7.5%), thyroglossal duct cyst(5%) and diffuse hyperplasia (2.5%). The most common benign neoplasm was Follicular adenoma (7.5%) andthe most common malignant neoplasm was papillary carcinoma (17.5%). Two cases (5%) of Non-invasivefollicular thyroid neoplasm with papillary-like nuclear features (NIFTP) of low / unknown malignant potentialwere reported.Conclusion:Histopathological examination of thyroid lesions provides definite diagnosis; which is mandatory for furthermanagement of patient.

Papel da arquitetura nuclear no manejo do carcinoma de tiroide / Role of nuclear architecture in the management of thyroid carcinoma

One of the biggest dilemmas facing a cytopathology slide is the differential diagnosis of follicular thyroid lesions, grouped as follicular pattern lesions, which include goiter, follicular adenoma and follicular carcinoma, follicular variant of papillary thyroid carcinoma and non-invasive follicular thyroid neoplasm with papillary like nuclear features. Such lesions share many characteristics, which makes the proper identification of malignant follicular lesions a challenge. The cytology obtained through fine needle aspiration puncture is the most effective standard method for diagnosis of thyroid nodules, but its diagnostic efficacy clearly decreases in lesions of thyroid follicular pattern. Thus, a series of auxiliary tools for diagnoses, such as morphometry and nuclear texture analysis, have been increasingly used in the pathologist's practice, as an objective and reproducible tool. These are techniques, which depend on the incorporation of software to digital image analysis and can add accuracy to classical morphological analysis and immunohistochemistry in the evaluation of follicular pattern lesions. In addition to immunocytochemistry and molecular techniques, morphometry allows the estimation of parameters identified in individual cells and represents a tool that, based on quantitative parameters, translates reliable parameters for objective classification of the malignancy. This study aims to review the nuclear characteristics and their role in the diagnosis of follicular thyroid lesions.

Um dos maiores dilemas diante de uma lâmina de citopatologia é o diagnóstico diferencial de lesões foliculares da tiroide agrupadas como lesões de padrão folicular e que incluem; bócio, adenoma e carcinoma foliculares, carcinoma papilífero variante folicular e a neoplasia folicular não invasiva com características nucleares papilares (Uno de los mayores dilemas que presenta una muestra de citopatología es el diagnóstico diferencial de las lesiones foliculares tiroideas reunidas como lesiones de patrón folicular, que incluyen: bocio, adenoma folicular, carcinoma folicular, variante folicular del carcinoma papilar y la neoplasia folicular no invasiva con características nucleares de tipo papilar). Tais lesões compartilham muitas características, o que faz com que a identificação adequada de lesões foliculares malignas represente um desafio. A citologia obtida através de punção aspirativa por agulha fina é o método padrão mais efetivo para diagnóstico em nódulos de tiroide, mas sua eficácia diagnóstica diminui nitidamente em lesões de padrão folicular da tiroide (La citología por punción y aspiración con aguja fina es el método estándar más eficaz para el diagnóstico de los nódulos tiroideos, pero su eficacia diagnóstica se ve notablemente reducida en las lesiones de patrón folicular de la tiroides). Assim, uma série de ferramentas auxiliares ao diagnóstico, como a morfometria e a análise de textura nuclear, têm sido utilizadas cada vez mais na prática do patologista, como ferramenta objetiva e reproduzível. São técnicas que dependem da incorporação de softwares para análise digital de imagens e podem agregar acurácia à análise morfológica clássica e à imunohistoquímica na avaliação de lesões de padrão folicular (para el análisis de imágenes digitales y puede agregar precisión al análisis morfológico clásico y la inmunohistoquímica en la evaluación de lesiones de patrón folicular). Somando-se à imunocitoquímica e às técnicas moleculares, a morfometria permite a estimativa de parâmetros identificados em células individuais e representam uma ferramenta que, a partir de parâmetros quantitativos, traduz parâmetros confiáveis para classificação objetiva de malignidade. O objetivo deste estudo é rever as características nucleares e seu papel no diagnóstico de lesões foliculares da tiroide (es revisar las características nucleares y su papel en el diagnóstico de las lesiones foliculares tiroideas).

A study of correlation of pre-operative fine needle aspiration cytology and ultrasonography with post-operative histopathology in thyroid swellings

Background:Diseases of the thyroid gland can be due to inflammatory and neoplastic causes. Many diagnostic tests like ultrasound, thyroid nuclear scan and fine needle aspiration cytology (FNAC) are available for their evaluation. Histopathologically, they can be adenomas, colloid nodules, cysts, infectious nodules, lymphocytic or granulomatous nodules, congenital abnormalities or hyperplasia, or various types of malignancy. It is therefore crucial to have a clear diagnostic approach to ensure patients are managed appropriately and are not over or under-treated. Present study was done to evaluate FNAC and ultrasonography (USG) as a diagnostic method in thyroid swellings and to plan surgery accordingly.Methods: A prospective observational study was conducted among 60 adult patients undergoing thyroid surgery at Victoria and Bowring and Lady Curzon Hospital. They were investigated with FNAC and USG of thyroid, and were subjected to surgery and subsequent histopathological examination. The histopathological examination reports were correlated with the findings of FNAC and USG in order to evaluate their findings by statistical methods.Results:The sensitivity and specificity of FNAC was 87.5% and 98% respectively. All malignant lesions on FNAC were confirmed by histopathology indicating its excellence. Therefore FNAC helps in planning the correct management and avoids second surgery. And the sensitivity and specificity of USG was 75% and 86% respectively. Therefore combination of both FNAC and ultrasonography will improve the diagnostic accuracy to higher level and helps in better management. Conclusions:FNAC has high sensitivity and specificity, so it is closest to ideal test. However, a combination of both FNAC and ultrasound will give desirable results and so that we can avoid mismanagement.

Aspiration Cytology for Thyroid Lump in Remote Areas of Sindh

Background: Scandinavian countries were the first to use fine needle aspiration cytology (FNAC) as a diagnostic tool in the 1930. Fine needle aspiration cytology is a diagnostic approach, which helps the clinicians in diagnosis of the various lesions. Most common sites which can be targeted include breast lumps, lymph nodes, thyroid masses and other palpable swellings. The most common lesion encountered isthyroid nodule. In current cross sectional study we tried to find frequency of different thyroid lesions by fine needle aspiration cytology in different rural areas of Sindh.Methodology and Results: 158 samples were recruited from the Vital Laboratory Larkana with different pathological midline neck (thyroid) swelling during 2014 and 2015 by non-probability consecutive sampling. 125 (79.1%) were females and 33 (20.9%) were males with a ratio of 4:1. Majority of case were of 20-39 years of age (52.5%). Most of the cases were diagnosed with nodular goiter (88.6%) followed by colloid goiter (4.4%). In present study we failed to find any association of diagnosis with gender (p =0.211) and age (p =0.553).Conclusion: So in this study we concluded that large number of thyroid lesions present with nodular goiter at the age of 20-39 years. The frequency is increased for these lesions due to different risk factors.

A study on fine needle aspiration cytology of thyroid lesions with correlation to histopathological examination with special reference to Bethesda system of reporting at a tertiary care centre

Background: Annual incidence of thyroid nodules ranges from 40,000 to 70,000 per 1 lac population worldwide. Fine Needle Aspiration (FNA) of the thyroid is widely accepted simple, cost effective and quick to perform outpatient procedure with minimal complication. The National Cancer Institute (NCI) Bethesda, Maryland, United States standardized the reporting system for thyroid FNA by using Bethesda system for reporting thyroid cytopathology.Methods: FNA was performed in total 155 patients presenting with the thyroid swelling with or without Ultrasonography (USG) guidance. All patients were analyzed for age, gender, type of lesions. FNA was done and smears were examined and reported according to Bethesda system of reporting for thyroid cytopathology. Findings were correlated with post-operative histopathological diagnoses in 103 cases who underwent surgery.Results: Out of total 155 patients, 32 were male and 123 were female. Average age of presentation was 38.4 years. On cytology, according to Bethesda system, most cases were in benign category (76.1%) followed by malignant (8.4%). On histopathological study most common diagnosis was colloid goiter followed by papillary thyroid carcinoma. From the study it was found that sensitivity, specificity and accuracy of fine needle aspiration cytology of thyroid lesions were 81.8%, 97.3% and 95.4% respectively.Conclusions: Fine needle aspiration cytology is simple, easy to perform, cost effective procedure with high sensitivity, specificity and diagnostic accuracy in case of thyroid lesions.

Hallazgos ecográficos de la glándula tiroides en el personal técnico ocupacionalmente expuesto y no expuesto a radiaciones ionizantes del Hospital Central Universitario Dr. Antonio María Pineda / Ultrasound findings of the thyroid gland in technical staff occupationally exposed and not exposed to ionizing radiations of the Hospital Central Universitario Dr. Antonio María Pineda

Con el objetivo de identificar hallazgos ecográficos en el parénquima tiroideo en el personal ocupacionalmente expuesto y no expuesto a radiación ionizante (RI) del Hospital Central Universitario Dr. Antonio María Pineda, se realizó un estudio descriptivo transversal con una muestra de 45 individuos expuestos a RI del Servicio de Radiología y Diagnóstico por Imágenes Dr. Theoscar Sanoja Hernández y 38 individuos de los Servicios de Traumatología y Ortopedia y Medicina Física y Rehabilitación que no están expuestos a RI obteniendo que el 63% del personal expuesto presentaron algún tipo de alteración en el ultrasonido tiroideo en comparación con el 43% del personal no ocupacionalmente expuesto; los hallazgos más frecuentes en el personal expuesto fueron bocio difuso (44%), nódulos (32%) y quistes (24%) mientras que en el personal no expuesto fueron quistes (38%), bocio difuso (19%) y nódulos (19%). Estos hallazgos permiten concluir que el porcentaje del personal con afectación de la glándula tiroides fue mayor en personal expuesto y que los hallazgos ecográficos difieren entre los grupos estudiados(AU)

In order to identify ultrasound findings in thyroid parenchyma of hospital staff exposed and not exposed to ionizing radiation (IR) of the Hospital Central Universitario Dr. Antonio Maria Pineda, we performed a cross-sectional descriptive study with a sample of 45 individuals exposed to IR who worked in the Servicio de Radiología y Diagnóstico por Imágenes Dr. Theoscar Sanoja Hernández and 38 individuals who worked at the Servicios de Traumatología y Ortopedia y Medicina Física y Rehabilitación and were not exposed. The results showed that 63% of the exposed group had ultrasound thyroid findings in contrast to 43% of the non-exposed group. The most common findings in the exposed group were diffuse goiter (44%), nodules (32%) and cysts (24%) and in the non-exposed group were cysts (38%), diffuse goiter (19%) y nodules (19%). These findings show that ultrasound thyroid findings was higher in exposed hospital staff and that the type of thyroid disease differ among both groups(AU)

A Study of Histopathological Spectrum of Thyroid Lesions

Introduction: Thyroid lesions are fairly common worldwide and are commonly encountered in clinical practice. Thyroid lesionsmay be developmental, inflammatory, hyperplastic, and neoplastic.Aim: This study aims to study the spectrum of various lesions of the thyroid and various histopathological patterns of thyroidlesions.Materials and Methods: In this retrospective observational study, a total of 100 thyroid tissue specimens were examined.Relevant clinical information such as patient age, gender, and clinical presentation and other information such as fine-needleaspiration cytology, ultrasound, and surgical findings were obtained.Results: Non-neoplastic lesions accounted for 84 cases (84%) and neoplastic lesions constituted 16%. The most commonnon-neoplastic lesion was multinodular goiter (MNG) (43%), followed by colloid goiter (29%), Hashimoto thyroiditis (9%), andthyroglossal duct cyst (3%).Conclusion: In our study, thyroid diseases showed definite female predominance, with most of them occurring in an age groupof 31–40 years. MNG is the most common disease occurring clinically, radiologically, and cytologically. Follicular adenoma wasthe most common benign neoplastic disease.

Endoscopic Thyroidectomy for Benign Thyroid Lesions: A Prospective Study

Thyroidectomy is one of the most common operations performed throughout the world, with solitary thyroid nodules being one of the more common indications for surgery. Though conventional open thyroidectomy is considered extremely safe and remains the treatment of choice, it is associated with an undesirable scar. Endoscopic thyroidectomy has the distinct advantage of limiting external scarring and having better cosmetic results. It moreover is associated with reduced post-operative pain, and enhanced postoperative recovery. Methods: It was a hospital based non randomized prospective descriptive study carried out in department of general surgery at tertiary hospital in which 39 patients with benign thyroid lesions were included on the basis of a predefined inclusion and exclusion criteria. Detailed history, clinical and local examination was done in all the cases. Thyroid function tests, FNAC under ultrasound guidance, indirect laryngoscopy and imaging of thyroid gland was done in all the cases. All patients underwent endoscopic thyroid surgery (Total, near total, subtotal or hemithyroidectomy). Patients were followed up for 6 months after surgery. P value less than 0.05 was taken as statistically significant. Results: Out of 39 studied cases there were 35 males and 4 females with a M:F ratio of 1:8.75. Most common age group was found to be 30-40 years with a mean age of 32 yrs. Average size of thyroid nodule was 3.20 cms and right lobe was predominantly involved (69.23%). Predominant Pathology on FNAC was found to be colloid goiter (71.79%). All patients underwent endoscopic thyroidectomy. Mean duration of surgery was 55 minutes. Most common surgery undertaken was hemithyroidectomy (84.62%) followed by total thyroidectomy (10.16%) and completion total thyroidectomy (5.13%). Average total blood loss was significantly less (36 ml). Mean visual analogue score at 24 and 48 hours post-operatively were 4.14 and 2.85. Mean duration of hospital stay was 3.3 days. Majority of the patients (89.75%) were extremely satisfied with the cosmetic results. Conclusion: Endoscopic thyroidectomy for Benign thyroid lesion is associated with less blood loss during surgery, comparatively less severe pain, decreased mean duration of hospital stay and satisfactory cosmetic results.

Re: Diagnostic Value of Volume-Based Fluorine-18-Fluorodeoxyglucose PET/CT Parameters for Characterizing Thyroid Incidentaloma

No abstract available.

Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation

Background: Thyroid gland is afflicted by various pathologies ranging from diffuse enlargement (goitre) to nodular lesions, thyroiditis, and malignancy. Presently high resolution ultrasound with color Doppler is the primary imaging modality of choice in morphological evaluation of thyroid gland. It is used to define the nature of the lesion, whether solid or cystic, to differentiate thyroid from extra thyroidal masses, to assess the size of nodule in patients who are under observation or therapy, to monitor patient who are at increased risk of thyroid malignancy especially those with radiation exposure or having a family history, to detect recurrence of thyroid malignancy after surgery and in interventional procedure like guiding in FNAC. Materials and methods: Study was carried out using standard 5-12 MHz frequency probe with grey scale and color Doppler spectrum to evaluate and analysis of different thyroid nodules and taking Ultrasound guided fine needle aspiration cytology and correlate histopathologically. Results: Majority of patients belonged to middle age group between 21-60 years with mean age of 38.2 years. Colloid goitre was most common presentation on ultrasound and it showed wide spectrum of appearance, majority being nodular with anechoic echotexture. Malignant lesions of thyroid were usually hypoechoic, though all hypoechoic lesions were not malignant. (Sensitivity of 75%, specificity of 81.48%, PPV of 37.5% and NPV 95.65%). The most sensitive sign for picking up malignancy on USG were Intralesional vascularity; absent halo sign and regional lymph node Siddharth Zala, C. Raychaudhuri. Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation. IAIM, 2019; 6(4): 86-91. Page 87 involvement (sensitivity of 100%) the most specific signs were invasion of adjacent tissue (specificity of 92.59%), Lymphadenopathy (85.18%) and hypoechotexture (81.48%). A combination of signs aid in prediction of malignancy and in guidance for site of FNAC. The most useful combination of sign proved to be Invasion to adjacent tissue, Lymphadenopathy, absent halo, hypoechogenicity, microcalcification and Intralesional vascularity on color flow imaging. Conclusion: The ultrasonographic findings in thyroiditis were usually hetroechogenicity and coarse calcification with diffuse vascularity on color flow imaging. The addition of color flow imaging to gray scale ultrasound had increased the overall sensitivity for diagnosis of thyroiditis (96.87%) and was also highly specific (89.70%)

Histopathological analysis of thyroid lesions: an institutional experience

Background: Diseases of thyroid are one of the most common endocrine disorders affecting general population which range from non-neoplastic to neoplastic lesions. The incidence and pattern of thyroid lesions depend on various factors which include sex, age, ethnic and geographical patterns. Majority of thyroid lesions are non-neoplastic only <5% are malignant. The aim of the present study was to determine the frequency and histomorphological pattern of thyroidectomy specimens and their relationship with age and sex of the patient.Methods: This retrospective study was conducted in the department of pathology, Govt. Medical College, Alappuzha for a period of 2 years. The study included 620 thyroidectomy specimens received in the Department of Pathology. All the biopsy reports were reviewed, and different lesions were categorised according to age and gender distribution. The data was analysed by standard statistical methods.Results: The commonest of the non-neoplastic lesions was nodular colloid goiter followed by lymphocytic thyroiditis, Hashimoto thyroiditis Nodular hyperplasia and thyroglossal cyst. Most common malignant lesion in this study is papillary carcinoma and benign lesion is follicular adenoma. Age group of patients ranged from 6 ½ to 84 years. The study showed a female predominance of 88.38%.Conclusions: Thyroid disorders are commonly encountered endocrine diseases. The study showed a female predominance. Peak age of incidence of thyroid lesions was between 40 and 50 years. Most common lesion was follicular adenoma and most common malignant lesion was papillary carcinoma.Histopathological examination is the mainstay for definite diagnosis and management of thyroid neoplasms.

A Comparison Of Aspiration With Non Aspiration Technique In Fine Needle Cytology Of Thyroid Lesions

Back ground: Fine needle cytology is a valuable adjunct to preoperative diagnosis of thyroid lesions and it can helps in assessment of benign and malignant condition.Aims and objectives: To compare the efficacy of fine needle non aspiration cytology (FNNAC) with that of fine needle aspiration cytology (FNAC) in thyroid lesions.Materials and methods:FNAC and FNNAC techniques were studied in 50 cases of thyroid lesions. All the needle-sampling procedures were done by a single operator.The samples were assessed cytologically and evaluated using Mair et al scoring systemResult: The degree of cellular trauma, degree of cellular degeneration, blood contamination were less and the retention of architecture and cellular yield was more in FNNAC compared to FNAC with significant statistical difference. More number of FNNAC smears are diagnostically superior. Conclusion: The FNNAC technique is the first and best choice for vascular organ like thyroid compared to FNAC.

CD56 expression in benign and malignant thyroid lesions

@#Introduction: Thyroid cancer is the most common endocrine malignancy with more than 95% originating from follicular epithelial cells. Diagnostic dilemma may arise in occasional cases such as when an encapsulated nodule with a follicular growth pattern exhibits clear nuclei with grooves making it difficult to distinguish a follicular adenoma from encapsulated follicular variant papillary thyroid carcinoma. This study aimed to evaluate the diagnostic utility of an immunohistochemical marker, CD56, to distinguish between benign and malignant thyroid lesions. Materials and Methods: We retrospectively studied CD56 expression in 54 benign and 54 malignant thyroid lesions using archival formalin fixed paraffin-embedded tissue blocks for the study period from January 2010 to December 2015, diagnosed in a tertiary hospital. Results: CD56 was expressed in 52/54 (96.3%) of benign specimens and only 24/54 (44.4%) of malignant ones. The malignant specimens comprised 31 (57.4%) papillary thyroid carcinomas (PTC), 11 (20.3%) follicular carcinomas (FC), seven (13%) medullary thyroid carcinomas (MC), one (1.9%) poorly differentiated carcinoma (PC) and four (7.4%) anaplastic carcinomas (AC). CD56 was not expressed in 28/31 (90.3%) of the PTCs, 1/11 (9.1%) FCs, 1/4 (25%) of ACs while all MCs and the PD were positive. The benign group comprised nodular hyperplasias (29/54), lymphocytic thyroiditis (10/54), follicular adenomas (FA) (14/54) and one hyalinising trabecular tumour. CD56 was expressed in all the benign cases except one FA and one nodular hyperplasia. Thirteen of the 14 FAs were CD56 positive. The difference in expression between benign and malignant tumours was statistically significant as the p value was <0.01. Conclusion: CD56 is a potentially good immunohistochemical marker for differentiating papillary thyroid carcinoma from other benign follicular lesions of the thyroid especially in differentiating follicular variant PTC from FA in equivocal cases.

A Prospective Study on Assessing the Reliability of Fine Needle Aspiration Cytology in Outcomes of Thyroid Lesions

Background: FNAC has been considered as gold standard technique to diagnose various thyroid gland lesions. As Thyroid gland is superficial in location it is easily approachable for direct physical examination, cytological evaluation & histopathological study. The main objective of FNAC of thyroid is to categorize patients who need surgery for neoplastic disorder from those having functional or inflammatory abnormality requiring a clinical follow up & medical treatment. Aims & Objectives: To study cytomorphological features of thyroid enlargement & palpable lesions of thyroid. To correlate cytomorphological features of thyroid lesions with histopathological features wherever possible. Methods: The present study was conducted in Department of Clinical Pathology, Lok Nayak Jai Prakash Narayan Hospital. Around 150 cases of thyroid lesions were enrolled during the period 3 years (March 2014-February 2017). All relevant clinical profile of these cases was taken from case records. Results: In the present study, a total of 150 cases of thyroid swellings were categorized under TBSRTC. Of which maximum cases were seen of benign  etiology i.e.  colloid goitre  more   commonly affecting middle age group i.e. 31-45yrs with female preponderance. As sensitivity & specificity of FNAC was considered, in benign Sensitivity & specificity was reported to be 96% & 100% respectively. Whereas, in malignant lesions both were found to be 100%. Conclusions: The conclusion drawn from this study implicates FNAC as a useful primary investigative modality for evaluation of palpable thyroid lesions. It also helps in distinguishing lesions based on the clinical management required.

Accuracy of fine needle aspiration cytology with histopathology of thyroid lesions – 15 years study at Government ENT hospital, Hyderabad, Telangana

Background: Swellings of thyroid gland are common in most parts of the world, including countries like India where iodine deficiency is endemic. Its prevalence ranges from 4% to 10% in the general adult population and from 0.2% to 1.2% in children, affecting females more commonly than males. Aim and objective: To evaluate diagnostic accuracy of Fine needle aspiration cytology of thyroid lesions, to categorize thyroid lesions as per the Bethesda system, to correlate cytomorphology with histopathology, to determine the accuracy of FNAC in terms of sensitivity, specificity, positive predictive value and negative predictive value in comparison with histopathology in the diagnosis of a thyroid lesions. Materials and methods: It was a retrospective study undertaken over a period of one and half years from October 2016 to March 2017 in the Department of Pathology, Government ENT Hospital, Hyderabad. FNAC was performed with 26 gauge needle; smears were fixed in ether-95% alcohol solution and stained with Haematoxylin and Eosin stain. Different types of excised thyroid specimens received were subjected to routine processing, cutting, staining and histopathological features were analysed. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of aspiration cytology in detecting all the benign and malignant lesions of thyroid were 67.4%, 99.2%, N. Sreemani Kumari, Madhavi Parigi, Seema Afroze. Accuracy of fine needle aspiration cytology with histopathology of thyroid lesions - 1.5 years study at Government ENT hospital, Hyderabad, Telangana. IAIM, 2017; 4(8): 49-63. Page 50 93.9%, and 94.2% respectively. The diagnostic accuracy of detecting thyroid lesions by FNAC was 94.1%. Conclusion: Fine needle aspiration cytology is a minimally invasive, simple, reliable, safe and cost effective gold standard cytology technique with minimal discomfort and complications to the patient. FNAC avoids unnecessary thyroidectomies for benign thyroid pathologies.

Thyroid Lesions: FNAC and Histopathology Correlation in Our Experience.

Background: Fine needle aspiration cytology is considered the gold standard diagnostic test for the diagnosis of thyroid nodules. Fine needle aspiration cytology is a cost effective procedure that provides a specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be followed up in cases of benign diagnosis and subjected to surgery in cases of malignant diagnosis thereby decreasing the rate of unnecessary surgery. The purpose of the present study was to correlate the fine needle aspiration cytology findings with histopathology of excised specimens. Methods: This was a prospective study conducted on 310 consecutive patients between June 2012 and May 2015. All patients with clinically diagnosed thyroid nodule were included in the study. Results: In our study sensitivity of the thyroid FNAC ranges from 93.02% to 100% and its specificity from 60.42% to 96.62% respectively. Positive predictive value is 94.44% and negative predictive value is 100%. Commonest benign condition is multinodular goiter and malignancy is papillary carcinoma. Most difficult thyroid lesions to be reported are those in the intermediate category as cytomorphological features are overlapping.Conclusion: Fine needle aspiration cytology is a simple, easy to perform, cost effective, and easily repeated procedure for the diagnosis of thyroid cancer. It is recommended as the first line investigation for the diagnosis of thyroid nodules.

Value of susceptibility weighted imaging in differential diagnosis of benign and maliagnant thyroid lesions / 实用放射学杂志

Objective To evaluate the value of differential diagnosis between benign and malignant thyroid lesions by susceptibility weighted imaging(SWI).Methods 53 patients with 20 malignant thyroid lesions and 71 benign thyroid lesions confirmed by surgery and pathology were analyzed retrospectively.All cases received conventional MRI and SWI preoperatively.Location,volume,SWI parameters including signal to noise ratio(SNR),contrast noise ratio(CNR)and intratumor susceptibility hypointensity (ITSHIA)datas in benign and malignant lesions were compared and analyzed.Results There was no statistical significance between benign and malignant thyroid lesions in the location,volume,SNR and CNR(χ2 or t =0.014,0.286,0.927,1.169;P =0.907,0.778,0.368,0.259 respectively).The maximum diameter (1.90 mm±0.32 mm),degree of maximum diameter(1.33±0.47),frequence(1.40±0.20)and area ratio(1.09±0.28)for benign thyroid lesions were less than those for malignant lesions(3.39 mm±0.79 mm,2.25±0.44,1.40±0.68,1.70±0.47)respectively (t or Z =12.629,5.788,3.41 5,5.795;P =0.000,0.000,0.001,0.000).Conclusion SWI semiquantitative assessment of pathlogical vascularity is useful in differential diagnosis of benign and malignant thyroid lesions.

Radiographic analysis of thyroid lesions using USG and CT scan.

Background: To establish diagnosis of thyroid lesions using USG as the modality of choice, sonographically characterize those lesions as regards to their nature (benign v/s malignant), to define the spatial extent of these lesions and their relationship to the surrounding structures using USG and CT scan and to guide FNAC of these lesions whenever indicated and establish their pathological correlation. Aim: To estimate the role of USG and CT in evaluation of thyroid lesions Material and methods: The present study was a prospective and observational (non interventional) type of study. This study aimed at evaluating patients came to the Radiology Department of Dhiraj General Hospital, by using USG and CT scan. This study comprised of 97 patients, sonographic evaluation was carried out in all 97 patients while CT scan was used in evaluation of 22 patients. Sonography with color doppler examination was carried out by PhILIPS HD9 AND GE LOGIC P5 and using 7.5 MHZ transducers. CT Scanning was done by using Siemens 16 slice CT Scanner. Results: Largest group of patients were in 31-40 years with sex ratio of M: F = 1:4.7. The most common clinical feature that patient complained of was asymptomatic lump in the neck (55%), which correlates with the most common pathology which was Goiter. The largest group comprised of non toxic goitre followed by thyroid neoplasms. ALL patients of grave 's diseas had diffusely hypoechoeic thyroid gland with prominent thyroid septae and capsule, the gland was enlarged in 4 cases and of normal size in one patient. Colour Doppler study showed all patients exhibited increased vascularity reffered to as thyroid inferno pattern at colour flow imaging. Conclusion: High resolution USG is recommended as the primary imaging modality in the evaluation of thyroid diseases. It has a high sensitivity and specificity in the diagnosis of thyroid diseases. CT scan plays a role in evaluation of retrotracheal and retrosternal goiters, large thyroid masses and staging of thyroid malignancies.

Evaluation of thyroid lesions by FNAC among youth and children: A hospital based observational study.

Introduction: Thyroid lesions are rare in children and youth. compared to adult, they show high mlignancy rate. peak incedence is between 20 to 24 years of age. Objectives: To evaluate the utility of Fine Needle Aspiration Cytology (FNAC) of thyroid lesions in children and youth by “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)" . Materials and Methods: A prospective study was conducted over a period of 18 months. FNAC was performed on 106 children and youth of 1 year to 24 years age and classified according to TBSRTC.Results: Median age was 18.9 years. Majority (57.5%) were females in 20 years to 24 years age group. Out of 106 patients, 4.7%, 85.8%, 4.7%, 1.9%, 0.9% and 2% were distributed among diagnostic categories I, II, III, IV, V and VI of TBSRTC respectively. Six (5.6%) patients underwent. surgery and histopathological study was done. The sensitivity, specificity and accuracy rates were 100%, 97.8% and 98% respectively. Conclusion: TBSRTC for FNAC of thyroid is a definitive diagnostic test to triage patients on the requirement of surgery and to differentiate maligant from non-malignant lesions in children and youth.

Spectrum of thyroid lesions on fine needle aspiration cytology.

The incidence of thyroid lesions is increasing significantly nowadays. Many a times, differentiation between physiological, inflammatory, autoimmune, hyperfunctioning and hypofunctioning of thyroid gland, benign and malignant tumor poses diagnostic difficulty. Fine needle aspiration cytology (FNAC) with clinical correlation, along with ultrasonography and thyroid function tests are done in relevant cases. Final diagnosis requires morphological examination of the lesions. FNAC is widely accepted and has become the cornerstone in evaluation of the thyroid lesions, as unnecessary surgery can be avoided. We studied a total of 251 cases in the age range of 3 years to 72 years, who presented with thyroid swelling over a period of one year and got a spectrum of thyroid lesions on cytology. Incidence was more in females 230 cases (91.63%) compared to males 21 cases (8.36%). Nodular goiter was the commonest disease constituting 127 cases (50.59%) followed by Hashimoto’s thyroiditis 93 cases (33.05%) and malignancy was reported in 7 cases (2.78%). USG guided FNAC for optimization of results is necessary for the location of target lesion. Careful searching for malignant cells and repeat FNAC are the key to a successful diagnosis and to plan a proper surgical procedure. Follow-up is necessary in case of a benign mass.