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ORIGINAL ARTICLE
Year : 2015  |  Volume : 12  |  Issue : 3  |  Page : 93-95

Pattern and frequency of thyroid pathologies among thyroid cytology specimen in rural part of central India: A retrospective secondary data analysis


1 Department of Pathology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
2 Department of Pathology, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India

Date of Web Publication16-Oct-2015

Correspondence Address:
Vivek Gupta
Department of Pathology, Jawaharlal Nehru Medical College, Sawangi, Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.157925

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  Abstract 

Background: Thyroid nodules are very frequent, with an annual incidence rate of 4-8%. Thyroid fine needle aspiration cytology (FNAC) is more than 50 years old and is the principal method of preoperative diagnosis in both children and adults. Aims: (1) To assess the pattern and frequency of thyroid lesions in cytology, (2) To study the correlation of thyroid lesions with different age groups (3) To identify the frequency benign and malignant thyroid lesions in cytology, (4) To report the thyroid lesions in Bethesda system of reporting pattern on cytology. Settings and Design: Rural Institute of Medical Science and research is a 750 bedded tertiary care institute. This is a retrospective study. Materials and Methods: 300 thyroid lesion (from December 2012 to May 2014) who attended the pathology department of Rural Institute of Medical Science and research was taken and association between variables and thyroid lesions were observed. Thyroid lesions were also classified according to Bethesda system of reporting. Statistical Analysis Used: SPSS. Results: Male to female ratio was 1:9. Frequency of benign thyroid lesions is 78% with the most common diagnosis being colloid nodule and colloid cyst. Thyroid malignancies were diagnosed in 5% cases. Bethesda category I included 11%, category II 78%, category III (AUS/FLUS) 2%, category IV (Follicular Neoplasm) 3%, category V (Suspicious of malignancy) 1%, category VI (malignant) 5%. Conclusions: Thyroid lesions can be efficiently classified on cytology.The Bethesda system has proved useful and helped improving communication between cytopathologists and clinicians leading to consistent management.

Keywords: Bethesda system, cytology, rural population, thyroid pahologies


How to cite this article:
Gupta V, Bhake A, Dayal S. Pattern and frequency of thyroid pathologies among thyroid cytology specimen in rural part of central India: A retrospective secondary data analysis. Thyroid Res Pract 2015;12:93-5

How to cite this URL:
Gupta V, Bhake A, Dayal S. Pattern and frequency of thyroid pathologies among thyroid cytology specimen in rural part of central India: A retrospective secondary data analysis. Thyroid Res Pract [serial online] 2015 [cited 2017 Mar 28];12:93-5. Available from: http://www.thetrp.net/text.asp?2015/12/3/93/157925


  Introduction Top


Thyroid nodules are very frequent; with a number of studies showing an annual incidence rate of 4-8%. [1] Autopsy and ultrasound data suggest that the prevalence rate for thyroid nodules in clinically normal individuals is around 50%. [2] Thyroid fine needle aspiration cytology (FNAC) is more than 50 years old and is the principal method of preoperative diagnosis in both children and adults. It has been shown to be superior to clinical, radionucleotide or thyroid ultrasound assessment alone. FNAC requires careful aspiration technique and interpretation of the cytological findings. Most practitioners rely on FNAC alone, especially for the first attempt at diagnosis. [3],[4] Cytopathologist use different terminologies and diagnostic criteria for reporting thyroid lesions, Bethesda reporting pattern developed by Papanicolaou Society is one among them. [5],[6] Bethesda reporting pattern enhances the communication and management of thyroid lesions to clinicians and helps reporting the pattern of various thyroid lesion in our population.

Aims and Objectives

  1. To assess the pattern and frequency of thyroid lesions in cytology
  2. To study the correlation of thyroid lesions with different age groups
  3. To identify the frequency benign and malignant thyroid lesions in cytology
  4. To report the thyroid lesions in Bethesda system of reporting pattern on cytology.



  Subjects and Methods Top


Rural Institute of Medical Science and research is a 750 bedded tertiary care institute serving the population of Etawah and nearby districts. This is a retrospective study (December 2012 to May 2014) in which data of all thyroid cytology patients who attended the pathology department was taken. In this duration out of 300 thyroid lesions, on the basis of FNAC specific pathology was seen in 300. Age and diagnosis of the thyroid cytology were recorded and association between variables and thyroid lesions were observed. Statistical analysis was done using SPSS.

For most patients both Papanicolaou stained and Romanowsky (Diff-Quick) stained smears were available for review. The cytological diagnosis was also classified according to Bethesda system of reporting pattern. [7]


  Results Top


Between December 2012 to May 2014, 300 thyroid cytology, were done in pathology department. On the basis of cytology smears specific diagnosis was recorded in 300 patients. In this study the patient's age ranged from 11-70 years, but highest prevalence was encountered in 21-30 years [Table 1]. Male is to female ratio was 1:9. Most of the lesions were benign 78%. The most common diagnosis was colloid nodule and colloid cyst together comprising 57%, followed by adenomatoid nodule 11%, Hashimoto thyroiditis 7%, granulomatous throiditis 3%. Thyroid malignancies were diagnosed in 5% of cases (Papillary carcinoma 4%). Follicular adenoma constituted 3% and other cases 4%. Unsatisfactory cases were 11% [Table 1].
Table 1: Distribution of cases according to age and diagnosis


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The smears reviewed were also classified in Bethesda system of reporting pattern for thyroid. Bethesda category 1 included 11%, category II 78%, category III (AUS/FLUS) 2%, category IV (Follicular Neoplasm) 3%, category V (Suspicious of malignancy) 1%, category VI (malignant) 5% [Figure 1].
Figure 1: Case distribution according to Bethesda Reporting Pattern


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  Discussion Top


Thyroid FNAC is commonly performed outpatient procedure relied by most clinicians and has radically changed the management of patients with thyroid disease. In our study highest no of cases were in 21-30 years, whereas other study reported the median age to be 44 years. [4] Male and female ratio was 1:9 in our study, other studies [4],[8] the ratio was 1:5.2 and 1:7.7. Benign lesions in present study were 78% whereas in other studies [4],[8] they ranged from 33-90%. Out of the benign lesions colloid nodule and colloid cyst together comprised of 57%. Colloid nodule was given the diagnosis when the smears had adequate no of benign follicular cell clusters and had colloid in background with colloidophages. Colloid cyst was said when the smears has few or no benign follicular cells but contains abundant colloid in background and macorphages. The distribution of cases reported [8] was as follows: Colloid goiter 74.1%, hashimotos thyroiditis 20.3%, granulomatous thyroiditis 1.3%, hyperplastic/adenematoid nodule 3.9%. Inadequate smears were labelled when less than six follicular cells clusters and each cluster containing less than 10 follicular cells were present. Inadequacy rate was 11% in present study, 7.1% as reported by Sinna [4] 2012, 1.6% as reported [7] and 34% as reported [9] by Naugler. Thyroid malignancies accounted for 5% of all cases which is less in comparison to Sinna 2012 and somewhat more than by Bagga 2010. Thyroid FNAC offered a first diagnosis in our cases and differentiated between benign and malignant thyroid lesion thus helping in early diagnosis and treatment of malignant lesions. The study also shows the prevalence of various thyroid lesion in different age groups.

The smears were also classified in Bethesda reporting pattern. In the year 2007, the National Cancer Institute (NCI), Bethesda, Maryland, United States, organized the NCI Thyroid Fine Needle Aspiration State-of-the-ScienceConference, and an initiative was undertaken to publish an  Atlas More Details and guidelines using a standardized nomenclature for the interpretation of thyroid fine needle aspirates (FNA), known as the Bethesda system for reporting thyroid cytopathology. [10] The atlas describes six diagnostic categories of lesions: Non-diagnostic/unsatisfactory, benign, atypical follicular lesion of undetermined significance (AFLUS),"suspicious" for follicular neoplasm (SFN), suspicious for malignancy (SM), and malignant. [7]

Our results were comparable with the results of Mondal et al., [11] they reported that 6.8% cases non-diagnostic (category 1), 83% category II, 0.9% AFLUS, 4.1% category IV, 1.4% category V, and 3.8% category VI.

The Bethesda system is very useful for a standardized system of reporting thyroid cytopathology, improving communication between cytopathologists and clinicians, leading to more consistent management approaches. [12]

 
  References Top

1.
Cramer H. Fine needle aspiration cytology of the thyroid: An appraisal. Cancer 2000;90:325-9.  Back to cited text no. 1
[PUBMED]    
2.
American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12:63-103.  Back to cited text no. 2
    
3.
Cibas ES. Fine needle aspiration in the work up of thyroid nodule. Otolaryngol Clin North Am 2010;43:257-71.  Back to cited text no. 3
    
4.
Sinna EA, Ezzat N. Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions. J Egypt Natl Canc Inst 2012;24:63-70.  Back to cited text no. 4
    
5.
Redman R, Yoder BJ, Massoll NA. Perceptions of diagnostic terminology and cytopathologic reporting of fineneedle aspiration biopsies of thyroid nodules: A survey of clinicians and pathologists. Thyroid 2006;16:1003-8.  Back to cited text no. 5
    
6.
Lewis CM, Chang KP, Pitman M, Faquin WC, Randolph GW. Thyroid fineneedle aspiration biopsy: Variability in reporting. Thyroid 2009;19:717-23.  Back to cited text no. 6
    
7.
Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658-65.  Back to cited text no. 7
    
8.
Bagga PK, Mahajan NC. Fine needle aspiration cytology of thyroid swellings: How useful and accurate is it? Indian J Cancer 2010;47:437-42.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Geldenhuys L, Naugler CT. Impact of a reporting template on thyroid fine needle aspiration cytology reporting and cytohistologic concordance. J Cytol 2009;26:105-8.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph G, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: A synopsis of the national cancer institute thyroid fineneedle aspiration state of the science conference. Diagn Cytopathol 2008;36:425-37.  Back to cited text no. 10
    
11.
Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. J Cytol 2013;30:94-9.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.
Ozluk Y, Pehlivan E, Gulluoglu MG, Poyanli A, Salmaslioglu A, Colak N, et al. The use of the Bethesda terminology in thyroid fineneedle aspiration results in a lower rate of surgery for nonmalignant nodules: A report from a reference center in Turkey. Int J Surg Pathol 2011;19:761-71.  Back to cited text no. 12
    


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