Diagnostic accuracy of ultrasonography and fine needle aspiration cytology in thyroid swellings: correlation with final histopathology
DOI:
https://doi.org/10.18203/2349-2902.isj20262991Keywords:
Thyroid nodules, FNAC, USGAbstract
Background: Thyroid nodules are common in clinical practice and accurate preoperative differentiation between benign and malignant thyroid nodules is essential to avoid unnecessary surgery while ensuring timely management of malignancy. Ultrasonography (USG) and fine needle aspiration cytology (FNAC) are commonly used diagnostic tools, but their accuracy varies across clinical settings. To evaluate the diagnostic accuracy of USG and FNAC in thyroid swellings by comparing preoperative findings with final histopathological examination.
Methods: This retrospective observational study included 190 patients with thyroid swellings who underwent thyroidectomy at a tertiary care centre between January 2015 and May 2022. Preoperative USG and FNAC findings were correlated with postoperative histopathology. Sensitivity, specificity and diagnostic accuracy of each modality were calculated.
Results: Of the 190 patients screened, 187 with complete histopathological data were included in the final correlation analysis. Histopathology confirmed malignancy in 75 cases (40.1%) and benign disease in 112 cases (59.9%). When correlated with final histopathology, FNAC demonstrated sensitivity of 77.3%, specificity of 87.5% and diagnostic accuracy of 83.4% as compared to USG with sensitivity of 82.7%, specificity of 63.4% and diagnostic accuracy of 71.1%. Sonographic features such as taller-than-wide shape, solid composition and punctate echogenic foci showed significant association with malignancy (p<0.01).
Conclusions: USG and FNAC are valuable complementary tools in evaluating thyroid swellings. FNAC is a highly specific and accurate diagnostic modality for thyroid swellings, while USG serves as an effective screening and risk stratification tool. Their combined use significantly improves diagnostic accuracy and helps reduce unnecessary thyroid surgery, although histopathology remains the definitive diagnostic modality.
References
Gaikwad SL, Bhokare SB, Deshmukh VV, Dhillon M, Kale SM. Clinico pathological study of thyroid lesions in a rural tertiary care centre. Trop J Pathol Microbiol. 2018;4(1):40-5.
De D, Dutta S, Tarafdar S, Kar SS, Das U, Basu K, 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(4):349-54.
Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22(6):901-11.
Li Y, Jin C, Li J, Tong M, Wang M, Huang J, et al. Prevalence of thyroid nodules in China: a health examination cohort-based study. Front Endocrinol (Lausanne). 2021;12:676144.
Ossies M, Jammal G, Kazan D, Noun R. Comparison between fine needle aspiration cytology with histopathology in the diagnosis of thyroid nodules. J Pers Med. 2023;13(8):1197.
Mili MK, Goswami G, Jayan LK, Deb M, Pegu K. Correlation between Bethesda, TIRADS and HPE following thyroidectomy. J Cardiovasc Dis Res. 2025;16(5):339.
Cibas ES, Ali SZ, editors. The Bethesda System for Reporting Thyroid Cytopathology. 2nd ed. Cham: Springer. 2017.
Asmita A, Hemant HK, Prashant PK, Deepak DM, Deepali DG. Comparative diagnostic accuracy of ultrasonography and FNAC in thyroid nodules. J Contemp Clin Pract. 2025;11(6):527-33.
Salman MT, AlGhazzawi MS, Al-Kamil EA, Al-Salmi S, Yousuf MS, Abdulla TS. Accuracy of ultrasound scans as compared to fine needle aspiration cytology in the diagnosis of thyroid nodules. Cureus. 2023;15(2):35108.
Abbaraju SR, Sridhar P, Kota S, Farooqi Z, Panguluru NMAS. A clinical study comparing the accuracy of the clinical examination, ultrasonography, fine needle aspiration cytology with that of histopathology. Int Surg J. 2022;9(3):546-51.
Battina PK, Raju A, Jomy A, Reddy MR. A prospective study of correlation of ultrasonogram, fine needle aspiration cytology with postoperative histopathology in diagnosis of thyroid lesions in rural South India. Int J Acad Med Pharm. 2022;4(4):43-6.
Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. Radiology. 2005;234(3):859-65.
Gharib H, Papini E, Paschke R. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi and European Thyroid Association guidelines for management of thyroid nodules. Endocr Pract. 2010;16(1):1-43.
Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004;351(17):1764-71.
Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. Quantification of cancer risk of each clinical and ultrasonographic risk factor in thyroid nodules: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(12):448-56.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR Thyroid Imaging Reporting and Data System (TI-RADS): White paper of the ACR TI-RADS Committee. Radiology. 2017;284(1):342-53.
Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Imaging Reporting and Data System (EU-TIRADS): Guidelines for ultrasound malignancy risk stratification of thyroid nodules. Eur Radiol. 2017;27(5):2259-67.
Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Ultrasonographic characteristics predicting malignancy in thyroid nodules: a prospective study. Radiology. 2008;247(3):762-70.
Baloch ZW, LiVolsi VA. Pathology of thyroid and parathyroid disease. In: Mills SE, editor. Sternberg’s Diagnostic Surgical Pathology. 6th ed. Philadelphia: Wolters Kluwer. 2015.
Downloads
Published
How to Cite
Issue
Section
