Diagnostic Accuracy of Fine needle Aspiration Cytology of Thyroid Nodules at two tertiary Hospitals in Zambia: a cross-sectional study
Keywords:
thyroid nodule, fine-needle aspiration cytology, diagnostic accuracy, histopathology.
Abstract
Introduction: Thyroid nodules are one of the common surgical presentations in Africa and are of great concern because of their potential to be malignant. Zambia is not excluded from these common surgical conditions. However, there are no pre-operative cellular or intra-operative tissue diagnoses of the thyroid nodules done before thyroidectomy making it difficult to plan for an optimal and definitive management. Fine needle aspiration cytology (FNAC) is known to play a pivotal role in the screening and management of thyroid swellings. This study serves to assess the diagnostic accuracy of FNAC on thyroid nodules in patients at two tertiary hospitals in Zambia in order to establish a basis of introducing its use in the management of thyroid nodules at the institutions. Objectives: To evaluate the accuracy of FNAC, as compared to histopathology, in the diagnosis of thyroid nodules at University Teaching Hospital (UTH) and Ndola Central Hospital (NCH) in Zambia. Methods: This was aprospective cross-sectional study conducted in UTHandNCHsurgery department from June 2014 to March 2015. Seventy-three patients, who presented with palpable thyroid nodules and underwent thyroidectomy, were enrolled in the study. The FNAC diagnosis of the patients was compared to the histopathology finding following thyroidectomy. Results: Females made up the majority of the patients (n=67, 91.8%). The ages of the patients ranged from 18 to 78 years. The mean age was 44.3 years and peak age of incidence was in fourth decade. All patients were clinically euthyroid at the time of enrolment. The FNAC findings included 23 cases reported as unsatisfactory (31.5%); 29 cases benign (39.7%); 2 cases atypical (2.7%); 6 cases suspicious (8.2%); and 13 cases malignant (17.8%).Histopathology findings were available from all 73 tissue samples of participants, of which 55 (75.3%) and 18 (24.7%) were reported as benign and malignant respectively. Of the 18 malignant cases identified by histology, the most common cancer was follicular carcinoma (n=9, 50%), followed by papillary carcinoma (n=6, 33.3%) and undifferentiated carcinoma (n=3, 16.7%). FNAC, in this study, had sensitivity, specificity, negative and positive predictive values, and accuracy of 83.33%, 89.09%, 94.23 and 71.42%, and 87.67% respectively. Conclusion: In this study FNAC of thyroid nodules had a high sensitivity, specificity, predictive values and accuracy, and can therefore be recommended to be adopted as a pre-operative tool for screening of thyroid nodules.References
1. Song H, Wei C, Li D, Hua K, Song J, Maskey N, et al. Comparison of Fine Needle Aspiration and Fine Needle Nonaspiration Cytology of Thyroid Nodules: A Meta-Analysis. Biomed Res Int [Internet]. 2015 [cited 2019 Dec 6];2015:796120. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26491689
2. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce. Thyroid [Internet]. 2006 Feb [cited 2019 Dec 6];16(2):109–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16420177
3. Mackenzie EJ, Mortimer RH. 6: Thyroid nodules and thyroid cancer. Med J Aust [Internet]. 2004 Mar 1 [cited 2019 Dec 6];180(5):242–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14984346
4. Nyonyintono1 J, Fualal J, Wamala D, Galukande M. East and Central African journal of surgery. East Cent African J surgery [Internet]. 2011 [cited 2019 Dec 6];16(2):46–54. Available from: http://www.bioline.org.br/request?js11029.
5. McDougall IR. Epidemiology and Etiology of Thyroid Nodules and Thyroid Cancers. In: Thyroid Cancer in Clinical Practice [Internet]. London: Springer London; 2007 [cited 2019 Dec 6]. p. 1–16. Available from: http://link.springer.com/10.1007/978-1-84628-748-0_1
6. Ogbera AO, Kuku SF. Epidemiology of thyroid diseases in Africa. Indian J Endocrinol Metab [Internet]. 2011 Jul [cited 2019 Dec 6];15(Suppl 2):S82-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21966659
7. Muhammad T, Iqbal M. FNAC OF THYROID NODULE; DIAGNOSTIC ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY (FNAC). Prof Med J [Internet]. 2010 [cited 2019 Dec 6];17(4):589–97. Available from: https://www.researchgate.net/publication/49615966_FNAC_OF_THYROID_NODULE_DIAGNOSTIC_ACCURACY_OF_FINE_NEEDLE_ASPIRATION_CYTOLOGY_FNAC/citation/download
8. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations. Cancer [Internet]. 2007 Aug 6 [cited 2019 Dec 6];111(5):306–15. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17680588
9. Rout K, Ray CS, Behera SK, Biswal R. A Comparative Study of FNAC and Histopathology of Thyroid Swellings. Indian J Otolaryngol Head Neck Surg [Internet]. 2011 Oct [cited 2019 Dec 6];63(4):370–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23024944
10. Wu HH-J, Jones JN, Osman J. Fine-needle aspiration cytology of the thyroid: Ten years experience in a community teaching hospital. Diagn Cytopathol [Internet]. 2006 Feb [cited 2019 Dec 6];34(2):93–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16514671
11. Wang D, Fu H-J, Xu H-X, Guo L-H, Li X-L, He Y-P, et al. Comparison of fine needle aspiration and non-aspiration cytology for diagnosis of thyroid nodules: A prospective, randomized, and controlled trial. Clin Hemorheol Microcirc [Internet]. 2017 May 5 [cited 2019 Dec 6];66(1):67–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28128748
12. Mehanna HM, Jain A, Morton RP, Watkinson J, Shaha A. Investigating the thyroid nodule. BMJ [Internet]. 2009 Mar 13 [cited 2019 Dec 6];338:b733. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19286747
13. Desai G, Islam R. The changing pattern of surgical pathology of the thyroid gland in Zambia. Cent Afr J Med [Internet]. 1992 Jun 1 [cited 2019 Dec 6];38(6):240–2. Available from: https://journals.co.za/content/CAJM/38/6/AJA00089176_700
14. Mirzakarimov F, Odimba B, Tembo P. Patterns of Surgically Treated Thyroid Disease in Lusaka, Zambia . Med J Zambia [Internet]. [cited 2019 Dec 6];39(4):7–11. Available from: https://www.ajol.info/index.php/mjz/article/view/110599
15. Alshaikh S, Harb Z, Aljufairi E, Almahari SA. Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. Cytojournal [Internet]. 2018 [cited 2019 Dec 7];15:4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29531571
16. Chandanwale S, Singh N, Kumar H. Clinicopathological correlation of thyroid nodules. Int J Pharm Biomed Sci. 2012;3:97-102.
17. Khairy GEA, Murshid KR. Role of fine needle aspiration biopsy in the management of thyroid nodules. East Afr Med J [Internet]. 2001 Aug 1 [cited 2019 Dec 6];78(8):408–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11921562
2. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce. Thyroid [Internet]. 2006 Feb [cited 2019 Dec 6];16(2):109–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16420177
3. Mackenzie EJ, Mortimer RH. 6: Thyroid nodules and thyroid cancer. Med J Aust [Internet]. 2004 Mar 1 [cited 2019 Dec 6];180(5):242–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14984346
4. Nyonyintono1 J, Fualal J, Wamala D, Galukande M. East and Central African journal of surgery. East Cent African J surgery [Internet]. 2011 [cited 2019 Dec 6];16(2):46–54. Available from: http://www.bioline.org.br/request?js11029.
5. McDougall IR. Epidemiology and Etiology of Thyroid Nodules and Thyroid Cancers. In: Thyroid Cancer in Clinical Practice [Internet]. London: Springer London; 2007 [cited 2019 Dec 6]. p. 1–16. Available from: http://link.springer.com/10.1007/978-1-84628-748-0_1
6. Ogbera AO, Kuku SF. Epidemiology of thyroid diseases in Africa. Indian J Endocrinol Metab [Internet]. 2011 Jul [cited 2019 Dec 6];15(Suppl 2):S82-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21966659
7. Muhammad T, Iqbal M. FNAC OF THYROID NODULE; DIAGNOSTIC ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY (FNAC). Prof Med J [Internet]. 2010 [cited 2019 Dec 6];17(4):589–97. Available from: https://www.researchgate.net/publication/49615966_FNAC_OF_THYROID_NODULE_DIAGNOSTIC_ACCURACY_OF_FINE_NEEDLE_ASPIRATION_CYTOLOGY_FNAC/citation/download
8. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations. Cancer [Internet]. 2007 Aug 6 [cited 2019 Dec 6];111(5):306–15. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17680588
9. Rout K, Ray CS, Behera SK, Biswal R. A Comparative Study of FNAC and Histopathology of Thyroid Swellings. Indian J Otolaryngol Head Neck Surg [Internet]. 2011 Oct [cited 2019 Dec 6];63(4):370–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23024944
10. Wu HH-J, Jones JN, Osman J. Fine-needle aspiration cytology of the thyroid: Ten years experience in a community teaching hospital. Diagn Cytopathol [Internet]. 2006 Feb [cited 2019 Dec 6];34(2):93–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16514671
11. Wang D, Fu H-J, Xu H-X, Guo L-H, Li X-L, He Y-P, et al. Comparison of fine needle aspiration and non-aspiration cytology for diagnosis of thyroid nodules: A prospective, randomized, and controlled trial. Clin Hemorheol Microcirc [Internet]. 2017 May 5 [cited 2019 Dec 6];66(1):67–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28128748
12. Mehanna HM, Jain A, Morton RP, Watkinson J, Shaha A. Investigating the thyroid nodule. BMJ [Internet]. 2009 Mar 13 [cited 2019 Dec 6];338:b733. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19286747
13. Desai G, Islam R. The changing pattern of surgical pathology of the thyroid gland in Zambia. Cent Afr J Med [Internet]. 1992 Jun 1 [cited 2019 Dec 6];38(6):240–2. Available from: https://journals.co.za/content/CAJM/38/6/AJA00089176_700
14. Mirzakarimov F, Odimba B, Tembo P. Patterns of Surgically Treated Thyroid Disease in Lusaka, Zambia . Med J Zambia [Internet]. [cited 2019 Dec 6];39(4):7–11. Available from: https://www.ajol.info/index.php/mjz/article/view/110599
15. Alshaikh S, Harb Z, Aljufairi E, Almahari SA. Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. Cytojournal [Internet]. 2018 [cited 2019 Dec 7];15:4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29531571
16. Chandanwale S, Singh N, Kumar H. Clinicopathological correlation of thyroid nodules. Int J Pharm Biomed Sci. 2012;3:97-102.
17. Khairy GEA, Murshid KR. Role of fine needle aspiration biopsy in the management of thyroid nodules. East Afr Med J [Internet]. 2001 Aug 1 [cited 2019 Dec 6];78(8):408–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11921562
Published
2020-06-30
How to Cite
1.
Chipaila J, Makupe A, Malyangu E, Maswahu D, Kabwe J, Odimba E. Diagnostic Accuracy of Fine needle Aspiration Cytology of Thyroid Nodules at two tertiary Hospitals in Zambia: a cross-sectional study. University of Zambia Journal of Agricultural and Biomedical Sciences [Internet]. 30Jun.2020 [cited 4May2024];4(2). Available from: https://journals.unza.zm/index.php/JABS/article/view/388
Section
Biomedical Sciences