Foad Ali Moosa, Fazal Wahab Khan, Naheed Sultan, Masood Hussain Rao.
Up to what extent FNAC is accurate in detecting malignancy in solitary thyroid nodule? (a comparison with post-operative histopathology findings).
Med Channel Jan ;16(2):280-3.

INTRODUCTION: Fine needle aspiration cytology has proved to be an excellent tool in the initial management of thyroid nodules. Numerous studies have shown its high sensitivity and specificity in diagnosing malignant tumors of the thyroid, especially papillary thyroid carcinoma. As with other diagnostic tests, its effectiveness is also dependent on the expertise of the operator performing the procedure and the adequacy of the specimen for interpretation of the cytomorphologic features AIMS & OBJECTIVES: Aim of the study is to determine the accuracy of FNAC in detecting malignancy in management of solitary thyroid nodule METHODS: A retrospective comparative study was conducted on 98 cases of solitary thyroid nodules who underwent for surgery between the years Aug 2003 and July 2008 in surgical unit I CHK. Five factors were analyzed when comparing the preoperative FNAC results with final histological findings: sensitivity, specificity, accuracy, positive and negative predictive values using 2×2 table. RESULTS: The youngest patient in this study was 25 years old and the oldest patient was 65 years. The highest prevalence of a solitary nodule in our series was observed in the 4th decade of life i.e. in 41 patients (42.0%). Mean age of patients was 40.5 + 2.2 years. A total of 68 patients (69.4%) were females and 30 (30.6%) were males. There is a significant female preponderance of solitary nodule. Sensitivity was calculated 77.7%, specificity 98.9%, and accuracy 96.9% with a positive and negative predictive value of 87.5% and 97.8% respectively. CONCLUSION: The above mentioned results suggest high specificity and sensitivity of FNAC done pre-operatively to investigate and differentiate benign from malignant lesions in cases of solitary thyroid nodules. . We recommend that preoperative FNAC should be performed routinely in all patients presenting with solitary thyroid lesion to rule out any malignant lesion so that unnecessary thyroid surgeries can be prevented. For only suspected carcinoma in 10%, surgery may be performed.

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