Correlation between thyroid fine needle aspiration cytology and postoperative final histopathology: a 5-year single-centre retrospective study


  • Amr S. Alaus Department of General Surgery, Salmaniya Medical Complex, Bahrain
  • Fares Alsobyani Department of General Surgery, Salmaniya Medical Complex, Bahrain
  • Abdulrahman Al-Awadhi Department of Pathology, Salmaniya Medical Complex, Bahrain
  • Ahmed Alqashar Department of General Surgery, Salmaniya Medical Complex, Bahrain



Fine-needle aspiration, Thyroid cancer, Histopathology, Bethesda


Background: Thyroid nodules are common problems encountered in our routine practice. Fine needle aspiration cytology (FNAC) is the most accurate and cost-effective method for evaluating thyroid nodules. It is the procedure of choice for identifying patients who require surgical excision.

Methods: This is a retrospective single-center observational study in Salmaniya Medical Complex, a tertiary care center, in Kingdom of Bahrain that aims to to correlate preoperative FNAC results with the post-surgical histopathology report, and to compare our diagnostic performance results to previously published literature.

Results: The post-operative histology was reported as benign in 62% of patients and malignant in 38% of patients. Bethesda II was the most common category in our sample, with 14.3% having a final histopathological diagnosis of malignancy (false negative results). Malignancy was found in 84% and 96.8% of Bethesda V and VI, respectively. Our FNAC data achieved an 80.95% sensitivity, specificity of 93.51% specificity, and a total accuracy of 87.86%. The positive predictive value was 91.07%, and an 85.71% negative predictive value, which were comparable to data from published series.

Conclusions: FNAC remains the most accurate and cost-effective method for evaluating thyroid nodules. However, its diagnostic value varies among different institutions. Our results demonstrated higher rates of malignancy compared to other published series in both category I and II. Due to the chance of false negative rates in these categories and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow up.


Poller DN, Baloch ZW, Fadda G, Johnson SJ, Bongiovanni M, Pontecorvi A, et al. Thyroid FNA: New classifications and new interpretations. Cancer Cytopathol. 2016;124(7):457-66.

Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules: A Review. JAMA. 2018;319(9):914-24.

Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Practice Res Clin Endocrinol Metabolism. 2008;22(6):901-11.

Abdullahi IM, Yasin NA, Dirken ES, Mohamoud AM, Guler I, Adani AA. Comparative study of fine needle aspiration cytology and histopathology in thyroid nodules at a tertiary care hospital: First report from Somalia. Asian J Surg. 2022;S1015-9584(22):01657-8.

Alhassan R, Al Busaidi N, Al Rawahi AH, Al Musalhi H, Al Muqbali A, Shanmugam P, et al. Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: Retrospective Study from Oman. Ann Saud Med. 2022;42(4):246-51.

Alsalami J, Bai UR, Lakhtakia R. Accuracy of fine needle aspiration cytology of thyroid lesion with corresponding histopathology: A single institutional experience. Thyroid Res Pract. 2016;13:140-3.

Al-Awadhi MA, Abulfateh NM, Abu-Hassan F, Fikree MA, Janahi E, Carlo R. Cancer Incidence and Mortality in the Kingdom of Bahrain Statistics and Trends. Manama: Bahrain Medical Bulletin. 2016;38(1):30-4.

Abou-Foul AK, Muzaffar J, Diakos E, Best JE, Momtahan N, Jayaram S. Correlation Between Thyroid Fine Needle Aspiration Cytology and Postoperative Histology: A 10-Year Single-Centre Experience. Cureus. 2021;13(4):e14504.

Alshaikh S, Majed KS, Chandran N, AlMahari SA. Spectrum of thyroid nodules in a tertiary care center in the Kingdom of Bahrain. J Bahrain Med Soc. 2022;34(3):32-6.

Alshahrani AS, Algazlan AG, Junaid M, Aldosari A, Amer KA, Mubarki MH, et al. Association of fine-needle aspiration of thyroid nodules with final histopathology in diagnosing thyroid malignancy: A Single Institute Retrospective Study. Cureus. 2022;14(11):e31733.

Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017;27(11):1341-6.

Poller DN, Bongiovanni M, Trimboli P. Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: A systematic review and meta‐analysis. Cancer Cytopathol. 2019;128(1):36-42.

Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol. 2012;56(4):333-9.

Dorairajan N, Jayashree N. Solitary nodule of the thyroid and the role of fine needle aspiration cytology in diagnosis. J Indian Med Assoc. 1996;94(2):50-2.

Sharma C. Diagnostic accuracy of fine needle aspiration cytology of thyroid and evaluation of discordant cases. J Egypt Natl Canc Inst. 2015;27(3):147-53.

Sidawy MK, Del Vecchio DM, Knoll SM. Fine-needle aspiration of thyroid nodules: correlation between cytology and histology and evaluation of discrepant cases. Cancer. 1997;81(4):253-9.

Soh SB, Aw TC. Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility. Ann Lab Med. 2019;39(1):3-14.

Sharma R, Verma N, Kaushal V, Sharma DR, Sharma D. Diagnostic accuracy of fine-needle aspiration cytology of thyroid gland lesions: A study of 200 cases in Himalayan belt. J Cancer Res Ther. 2017;13(3):451-5.

Hawkins F, Bellido D, Bernal C, Rigopoulou D, Valdepenas MR. Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease. J Cancer. 1987;59:1206-9.






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