role of fine needle aspiration cytology in the management of thyroid goitre

ABSTRACT

The role of fine needle aspiration [FNA] cytology was examined in series of 86 euthyroid patients from July 1989 till July 1991. Needle aspiration was performed at first clinic attendance and repeated when necessary [either unsatisfactory or for follow up]. A diagnosis of benign colloid goitre was made in 40 patients, lymphocytic thyroiditis in 14 patients, thyroid cyst in 2 patients and malignant thyroid in 20 patients, whereas 10 patients were reported as inconclusive. Malignancy was confirmed histologically post-operatively in all the 20 patients. There was only one false negative case of follicular adenoma which was diagnosed as benign colloid goitre by FNA. Histological confirmation [either surgical or true cut biopsy] was obtained in 45 patients. The sensitivity of the procedure was 95.2 percent while the specificity was 58.33 percent and the accuracy rate was 97.14 percent. Surgery was avoided in 43 patients, and the surgical yield was 64.5 percent. In cases of lymphocytic thyroiditis which are relatively common in the Middle East it can be more sensitive than immunological tests. We conclude that FNA offers the best chance for the clinician to decide for or against surgery with more accuracy than other methods of evaluation as benign cytologic findings can support long-term medical management for clinically non-suspicious multiodular goitre, simple thyroid cyst and thyroiditis and it can define surgical strategy in case of malignancy. We recommend FNA as the initial diagnostic test in the evaluation of goitre. It is an inexpensive, easy procedure, with few, if any complications