Sucheta Yadav, Vaishali Singh, Medha Misra, Abhilash Abhilash, Neha Singh, Vishakha Gupta
FNAC plays an important role in categorizing patients who can be managed by medical intervention alone and those who require surgery. Every category has an associated risk of being diagnosed as a malignancy on histopathological examination. This helps in patient stratification and in determining the extent of surgical management and follow-up required.
BACKGROUND: Cytomorphological study of fine-needle aspirates has gained wide acceptance as one of the first-line assessments done for thyroid swellings. The Bethesda System for Reporting Thyroid Cytology (TBSRTC) has provided a standard, formal, and effective method of communication between pathologists and clinicians. Aim: This study aimed to evaluate the cytomorphological spectrum of thyroid lesions using the revised (2023) TBSRTC and to assess cytohistological correlation in cases with available surgical follow-up.
METHODS: Patients with thyroid swellings underwent fine-needle aspiration (FNA). Smears were prepared, fixed, and stained with hematoxylin and eosin and May-Grunwald-Giemsa. They were studied under the microscope and categorized according to the revised edition of TBSRTC. Correlation with histopathological diagnosis was analyzed in 54 cases. McNemar's test was applied to assess diagnostic agreement between cytology and histopathology. The chi-square test and Fisher's exact test were used to analyze cyto-histological concordance. A p-value <0.05 was considered statistically significant.
RESULTS: The frequency of occurrence of thyroid swellings was approximately sixfold higher in female cases than in male cases. The highest incidence of these swellings was between 21 and 30 years of age. Bethesda category II had the highest prevalence, 292 (82.26%) cases. The cytological and histopathological correlation in 54 cases reported that p-values for category-wise comparisons were highly significant (p < 0.001), except for Bethesda III and IV categories.
CONCLUSIONS: FNAC plays an important role in categorizing patients who can be managed by medical intervention alone and those who require surgery. Every category has an associated risk of being diagnosed as a malignancy on histopathological examination. This helps in patient stratification and in determining the extent of surgical management and follow-up required.