Thyroid cancer in Yemen.

To evaluate the characteristics of thyroid cancer [TC] patients in regard to demographic distribution, histological variants, mode of presentation and modalities of diagnosis and treatment. We retrospectively audited the records of 97 consecutive cases with histologically proved thyroid cancer between 1997 and 2001 presenting to the Kuwait University Hospital, Sana'a, Yemen. Patients with TC in this study comprise 17.7% of goiter patients who were admitted at the same period. Females constituted 89.7% [n=87], and males 10.3% [n=10]. The average age of diagnosis was 38.4 years. More than two thirds were at the age of 40 and less. Among patients with goiter, the percentage of carcinoma was higher in the following groups, males [37.9% versus 16.6%, p=0.028], patients aged of 47 or more [25.8% versus 12.6%, p=0.001], patients with enlarged lymph nodes [9.3% versus 3.8%, p=0.020], and patients with recurrent disease after being operated for a presumably benign disease [8.2% versus 2.9%, p=0.012]. The average period since patients noticed the swelling until seeking medical help was 4 years. Most patients [90%] came from highland areas. Multinodular swelling was the most common clinical finding [43.3%], and hoarseness was the most common symptom [17.5%]. In histopathological examination, papillary carcinoma accounted for 93.8% of the cases and papillary microcarcinoma was found in 10 cases [10.3%]. The papillary/follicular carcinoma ratio was 22:1. Hormone assay and ultrasonic imaging were the most commonly used investigations. Sub total thyroidectomy was the most common procedure used in treatment [39%]. Not all histological variants of TC are represented in this study. Papillary carcinoma formed the bulk of TC cases. Salt iodization program might have an effect on the incidence of thyroid malignancy, and on the papillary/follicular carcinoma ratio. Better level of expertise is needed in the field of fine needle aspiration and ultrasonography. A consensus has to be reached, which is based on our environment and capabilities, where TC has to be managed aggressively by experienced surgeons. Yemen is in real need of a national cancer registry to assess the problem on a national level

diagnostic value of fine needle aspiration cytology in thyroid swellings in a University Hospital, Yemen

To evaluate the correlation between the fine needle aspiration [FNA] cytology and the histopathological findings in cases of the thyroid swellings and to assess the accuracy of cytological examination of thyroid nodules. This study was carried out at Kuwait University Hospital, Sana'a, Yemen. There were 243 thyroid FNAs of which 199 had subsequent excisional histopathological examination in the period 1997 to 2001. All the records of cytology and histology were reviewed. Cases were classified into 6 subsets: benign follicular lesion, thyroiditis, follicular neoplasm, suspicious for papillary carcinoma, malignant, and non-diagnostic aspirate. For statistical analysis, we excluded cases, which had not had subsequent histopathological examination [n=44], and cases with non-diagnostic aspirate [n=3], so only the histology and medical records of 196 cases were reviewed and correlated with the cytology results. There were 156 [78.4%] cases of benign aspirate, 31 [15.6%] cases of follicular neoplasm, 4 [2%] cases that were suspicious for papillary carcinoma, 4 [2%] cases of papillary carcinoma, and 3 [1.5%] cases of non-diagnostic aspirates. The 196 cases, which underwent cytological and histopathological examinations, were classified as non-neoplastic and neoplastic [including follicular neoplasm and malignancy] according to postoperative histopathology and correlation which, was carried out with preoperative cytology. There were 115 true negatives, 26 true positives, 42 false negatives, and 13 false positives. This gives a sensitivity of 38%, specificity of 89.9%, positive predictive value of 66.7%, negative predictive value of 73.2%, and accuracy of 72%. The sensitivity of FNA cytology in this study is very low compared to published studies, which had adversely affected the surgical decision making as well as the outcome. We should realise that negative FNA cytology does not exclude malignancy and we have to seriously evaluate the situation and to rethink on how to raise the scale of sensitivity in FNA cytology in the diagnosis of thyroid nodules, and to improve the level of expertise in cytology