Fine Needle Aspiration Cytology of Thyroid Lesions: A Cytohistological Correlation Study on Diagnostic Accuracy and Pitfalls

Authors

Satyajit Behera  1 , Bagmi Mishra  2 , Diptish Kumar Sahoo  3 , Jyotiranjan Mohapatra  4
Assistant Professor, Department of General Surgery, Dharanidhar Medical College and Hospital, Kendujhar, Odisha, India. 1 , Assistant Professor, Department of Pathology, SUM Ultimate Medicare Hospital, Bhubaneswar, Odisha, India. 2 , Department of Orthopedics, Shri Jagannath Medical College and Hospital, Puri, Odisha, India. 3 , Assistant Professor, Department of General Surgery, Shri Jagannath Medical College and Hospital, Puri, Odisha, India. 4
“crossref”/
Views: 14  
Downloads: 6  

##plugins.themes.bootstrap3.article.sidebar##

PDF
Published: 2025-04-26
Keywords:
Thyroid Nodule Fine-Needle Aspiration Cytology Cytodiagnosis Diagnostic Accuracy

##plugins.themes.bootstrap3.article.main##

Abstract

Background: Given the low malignancy rate in palpable thyroid nodules (~5%), accurate pre-operative differentiation of benign from malignant lesions is critical to avoid unnecessary surgery. However, thyroid cytology has a diagnostic "grey zone" with reduced classification precision, leading to ambiguity. Aims: This study aimed to: (1) determine the age and sex distribution of thyroid lesions; (2) evaluate the diagnostic performance (sensitivity, specificity) of fine needle aspiration cytology (FNACC); and (3) identify reasons for cytological-histological discrepancies. Methods: A retrospective analysis of 64 thyroid lesion cases from a five-year cohort involved cytohistological correlation. FNAC diagnoses were categorized based on agreement or disagreement with histology. Cytological smears and histological sections underwent independent re-evaluation. Results: Cytopathological diagnoses agreed with histopathology in 58/63 cases (92.06% concordance; 7.93% discordance, 5 cases). No false positive cytological diagnoses occurred. False negative diagnoses were attributed to sampling error and challenges in recognizing concurrent distinct pathologies. Conclusion: FNAC is an efficient and accurate tool for evaluating palpable thyroid nodules and guiding clinical management. The high malignancy detection rate in resected nodules suggests a reduction in overall thyroid surgeries. Integrating stringent FNAC adequacy criteria with clinical and radiological correlation is crucial to minimize false negative and false positive diagnoses.

##plugins.themes.bootstrap3.article.details##

Fine Needle Aspiration Cytology of Thyroid Lesions: A Cytohistological Correlation Study on Diagnostic Accuracy and Pitfalls. (2025). Annals of Medicine and Medical Sciences, 256-261. https://ammspub.com/index.php/amms/article/view/156
Original Article

Copyright (c) 2025 Satyajit Behera, Bagmi Mishra, Diptish Kumar Sahoo, Jyotiranjan Mohapatra

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.

[1] Jiang H, Tian Y, Yan W, et al.: The prevalence of thyroid nodules and an analysis of related lifestyle factors in Beijing communities. Int J Environ Res Public Health. 2016, 13:442. 10.3390/ijerph13040442.

[2] Saran S: Multinodular goiter. Goiter - Causes and Treatment. Agrawal NK (ed): 2020.

[3] De D, Dutta S, Tarafdar S, et al.: Comparison between sonographic features and fine needle aspiration cytology with histopathology in the diagnosis of solitary thyroid nodule. Indian J Endocrinol Metab. 2020, 24:349-54. 10.4103/ijem.IJEM_349_20.

[4] Mohebbi M, Dehaki MG, Mozaffari M: Comparison between ultrasonographic findings and fine needle aspiration cytology in differentiating malignant and benign thyroid nodules. Eur J TranslMyol. 2019, 29:8354. 10.4081/ejtm.2019.8354.

[5] Cibas ES, Ali SZ: The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017, 27:1341-6. 10.1089/thy.2017.0500.

[6] Afroze N, Kayani N, Hasan SH: Role of fine needle aspiration cytology in the diagnosis of palpable thyroid lesions. Indian J PatholMicrobiol. 2002, 45:241-6.

[7] Gallagher J, Oertel YC, Oertel JE: Follicular variant of papillary carcinoma of the thyroid: fine-needle aspirates with histologic correlation. DiagnCytopathol. 1997, 16:207-13. 10.1002/(sici)1097- 0339(199703)16:3<207::aid-dc3>3.0.co;2-c.

[8] Yan Z, Yang GC, Waisman J: A low-power, "architectural," clue to the follicular variant of papillary thyroid adenocarcinoma in aspiration biopsy. Acta Cytol. 2000, 44:211-7. 10.1159/000326362.

[9] Bahaj AS, Alkaff HH, Melebari BN, et al.: Role of fine-needle aspiration cytology in evaluating thyroid nodules. A retrospective study from a tertiary care center of Western region, Saudi Arabia. Saudi Med J. 2020, 41:1098-103. 10.15537/smj.2020.10.25417.

[10] Alhassan R, Al Busaidi N, Al Rawahi AH, Al Musalhi H, Al Muqbali A, Shanmugam P, Ramadhan FA: Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from.

[11] Oman. Ann Saudi Med. 2022, 42:246-51. 10.5144/0256-4947.2022.246.

[12] Busseniers AE, Oertel YC: "Cellular adenomatoid nodules" of the thyroid: review of 219 fine-needle aspirates. DiagnCytopathol. 1993, 9:581-9. 10.1002/dc.2840090523.

[13] Das DK, Khanna CM, Tripathi RP, et al.: Solitary nodular goiter: review of cytomorphologic features in 441 cases. Acta Cytol. 1999, 43:563-74. 10.1159/000331147.

[14] Nguyen GK, Ginsberg J, Crockford PM, Villanueva R R: Hashimoto's thyroiditis: cytodiagnostic accuracy and pitfalls. DiagnCytopathol. 1997, 16:531-6. 10.1002/(sici)1097-0339(199706)16:6<531: aid-dc12>3.0.co;2-j

[15] Löwhagen T, Sprenger E: Cytologic presentation of thyroid tumors in aspiration biopsy smear. A review of60 cases. Acta Cytol. 1974, 18:192-7.

[16] Deshpande V, Kapila K, Sai KS, Verma K: Follicular neoplasms of the thyroid: decision tree approach using morphologic and morphometric parameters. Acta Cytol. 1997, 41:369-76. 10.1159/000332527.

[17] Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK: Diagnosis of "follicular neoplasm": a gray zone in thyroid fine- needle aspiration cytology. DiagnCytopathol. 2002, 26:41-4. 10.1002/dc.10043.

[18] Schlinkert RT, van Heerden JA, Goellner JR, et al.: Factors that predict malignant thyroid lesions when fine- needle aspiration is "suspicious for follicular neoplasm". Mayo Clin Proc. 1997, 72:913-6. 10.1016/S0025- 6196(11)63360-0.

[19] Gharib H: Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc. 1994, 69:44-9. 10.1016/s0025-6196(12)61611-5.

[20] Prabhu s, Umashankar T: Scoring system for papillary thyroid carcinoma - a histopathological study. Trop J PatholMicrobiol. 2018, 4:610-6. 10.17511/jopm.2018.i08.11.

[21] Lindsay S: Carcinoma of the Thyroid Gland. A Clinical and Pathological Study of 239 Patients at the University of California Hospital. Charles C Thomas, Springfield (IL); 1960.

[22] Leung CS, Hartwick RW, Bédard YC: Correlation of cytologic and histologic features in variants of papillary carcinoma of the thyroid. Acta Cytol. 1993, 37:645-50.

[23] Francis IM, Das DK, Sheikh ZA, Sharma PN, Gupta SK: Role of nuclear grooves in the diagnosis of papillary thyroid carcinoma. A quantitative assessment on fine needle aspiration smears. Acta Cytol. 1995, 39:409-15.

[24] Paniza AC, Mendes TB, Viana MD, et al.: Revised criteria for diagnosis of NIFTP reveals a better correlation with tumor biological behavior. Endocr Connect. 2019, 8:1529-38. 10.1530/EC-19-0459.

[25] Ko HM, Jhu IK, Yang SH, Lee JH, Nam JH, Juhng SW, Choi C: Clinicopathologic analysis of fine needle aspiration cytology of the thyroid: a review of 1,613 cases and correlation with histopathologic diagnoses. Acta Cytol. 2003, 47:727-32. 10.1159/000326596.

[26] Mai KT, Yazdi HM, Commons AS, Perkins DG, MacDonald L: Neoplastic non-papillary thyroid carcinoma lesions with a fine chromatin pattern. Pathol Int. 1999, 49:601-7. 10.1046/j.1440-1827.1999.00908.x

[27] Mitra RB, Pathak S, Guha D, Patra SP, Chowdhury BR, Chowdhury S: Fine needle aspiration cytology of thyroid gland and histopathological correlation--revisited. J Indian Med Assoc. 2002, 100:382-4.

[28] Bakhos R, Selvaggi SM, DeJong S, et al.: Fine-needle aspiration of the thyroid: Rate and causes of cytohistopathologic discordance. DiagnCytopathol. 2000, 24:233-7.

[29] Abu-Salem OT: FNACB thyroid gland: comparison study between pre- and post-operative histological diagnosis. Arch Inst Pasteur Tunis. 2003, 80:57-60.

[30] Amrikachi M, Ramzy I, Rubenfeld S, Wheeler TM: Accuracy of fine-needle aspiration of thyroid: a review of 6226 cases and correlation with surgical or clinical outcome. Arch Pathol Lab Med. 2001, 125:484-8. 10.5858/2001-125-0484-AOFNACO.

[31] Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK: Fine-needle aspiration of thyroid: an institutional experience. Thyroid. 1998, 8:565-9. 10.1089/thy.1998.8.565.

[32] Čáp J, Ryska A, Rehorková P, Hovorková E, Kerekes Z, Pohnetalová D: Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clin Endocrinol (Oxf). 1999, 51:509-15. 10.1046/j.1365-2265.1999.00847.x.

[33] Giard RW, Hermans J: Use and accuracy of fine-needle aspiration cytology in histologically proven thyroid carcinoma: an audit using a national nathology database. Cancer. 2000, 90:330-4.