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Research Article | DOI: https://doi.org/10.31579/2768-2757/071
1 ENT specialist, Command Hospital Air Force, Bangalore.
2 Professor and Head of ENT, Command Hospital Air Force, Bangalore.
3 Resident Radiology, Command Hospital Air Force, Bangalore.
4 Graded Specialist Pathology Command Hospital Western Command, Chandimandir, Panchkula.
*Corresponding Author: Angshuman Dutta, Professor and Head of ENT, Command Hospital Air Force, Bangalore.
Citation: Kalani P., Dutta A., Tiwari J., Kumar S., (2023), A Study to Evaluate Bethesda Grading in Fnac of Thyroid Swellings, Journal of Clinical Surgery and Research, 4(2); DOI:10.31579/2768-2757/071
Copyright: © 2023, Angshuman Dutta. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 04 April 2023 | Accepted: 12 April 2023 | Published: 21 April 2023
Keywords: bethesda; fine needle aspiration cytology; histopathology
Background: FNAC is a commonly used diagnostic test for preoperative evaluation of thyroid swelling. However, FNAC reporting has its own limitations. The Bethesda classification system was created to guide cytopathological diagnoses and to help identify important correlations with malignancy in the final histological study.
The present study was undertaken to correlate the FNAC findings in thyroid swellings using Bethesda grading with histopathology.
Methodology: This is a prospective study design done in100 patients of thyroid nodules undergoing surgery. The findings of FNAC as per Bethesda grading and histopathology was correlated and the data analyzed statistically.
Results: Fine Needle Aspiration Cytology using Bethesda gradinghad a sensitivity of 88.24% and specificity of 96.39%. The accuracy of FNAC was 95% positive predictive value was 83.33%and negative predictive value was 97.56%.
Conclusion: FNAC using Bethesda grading in evaluation of thyroid nodule was extremely reliable with a high specificity 96.39% making it a reliable tool in the diagnosis of a thyroid swelling.
FNAC is a well-established procedure and is a valuable tool in the diagnosis and management of a patient with thyroid lesions [1] A major goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harbouring malignancy in the nodule [2].
The Bethesda system for reporting thyroid cytopathology (TBSRTC) [3] was introduced in 2007 in an attempt to standardize international terminology and to categorize morphological criteria in fine-needle aspirations from patients with thyroid nodules. FNAC is currently the preferred screening test for guiding the diagnosis and treatment of thyroid nodules [4].
TBSRTC is a unified system that complements cytological findings from thyroid FNA and represents a consensus among multiple experts in different areas of medicine.[5] TBSRTC establishes six diagnostic categories for FNA results and assigns a malignancy risk and recommendations for patient management for each category [6]. Global studies of the incorporation of TBSRTC in diagnostic algorithms for patients with thyroid nodules have concluded that TBSRTC reduces unnecessary thyroidectomies while also ensuring the quality of thyroid malignancy detection [7].
The present study is undertaken to compare the diagnostic efficacy of FNAC using Bethesda grading in correlation with histopathology in euthyroid patients having thyroid swelling. The study aims to address the pitfalls in the evaluation of thyroid swelling histology.
To correlate clinical examination, FNAC vis a vis histopathology in the management of thyroid swelling. The aim is to analyse the cytoarchitecture of clinically palpable thyroid nodule using Bethesda grading and compare results with histopathological examination and to assess its sensitivity and specificity.
To find out the utility of using BETHESDA grading for FNAC in the evaluation of thyroid swellings with comparison to histopathology which is the gold standard.
Study setting: This observational study was conducted in the department of ENT at in 100 patients undergoing thyroidectomy over a period of 1 year
Inclusion Criteria:
Exclusion criteria
Where thyroidectomy is part of other procedures like laryngectomy
Ethical considerations: Study was approved by institutional human ethics committee. Informed written consent was obtained from all the study participants.
Methodology: After obtaining the informed written consent all the participants were evaluated by through clinical history, clinical examination and FNAC before undergoing thyroidectomy.
Procedure for FNAC: Patient underwent fine-needle aspiration with 23-guage needle and 10-mL syringe. Fixation in 95% alcohol and one air dried smear from each needle was prepared. Smears staining were done by Papanicolaou and Giemsa method. Finding was recorded as per Bethesda grading for thyroid swelling. Post-surgery histopathology report was collected and compared to FNAC.
FNAC was considered as primary outcome variables. Histopathology was considered as gold standard. FNAC features was considered as screening tests. The sensitivity, specificity, predictive values and diagnostic accuracy of the screening test along with their 95% CI were presented. Reliability of the screening test was assessed by kappa statistic along with its 95% CI and p Value.
Fischer test was used to test statistical significance.
P value less than 0.05 was considered statistically significant. IBM SPSS version 22 was used for statistical analysis.
Age group was 19 to 82 yrs. Mean 47.44 Median IQR48.50 (38.00 -56.00) Males 25(25%) and females 75 (75%)
Table 1: Descriptive analysis of Bethesda in the study population (N=100)
Among the study population, (4%) had BETHESDA 1, (47%) had BETHESDA 2, (32%) had BETHESDA 3, (6%) had BETHESDA 4 (8%) had BETHESDA 5and (4%) Bethesda 6.
Table 2: Descriptive analysis of Histopathology in the study population (N=100)
Table 3: Descriptive analysis of FNAC in the study population (N=100)
Table 4: Descriptive analysis of HPE in the study population (N=100)
Table 5: Comparison of HPE with FNAC (N=100)
×2 value 68.5, P Value (Fischer’s Exact test) :<0>
Table 6: Correlation between FNAC/Histopathology
Table 7: Predictive validity of FNAC in predicting HPE malignancy (N=100)
Thyroid diseases are the most common endocrine abnormality across the globe. The diagnosis of these diseases is made through clinical evaluation, ultrasonogram, thyroid function tests, fine needle aspiration cytology (FNAC), histopathology and radionuclide scan. FNAC is a well-established procedure and is a valuable tool in the diagnosis and management of a patient with thyroid lesions [8]. FNAC is a valuable adjunct to preoperative screening in the diagnosis of thyroid nodules and in most cases, it can distinguish between neoplastic and non-neoplastic lesions [9] However, FNAC has its own limitations especially in cases where the differentiation between follicular adenoma and carcinoma is difficult. Therefore, the present study correlated the clinical profile, FNAC findings using Bethesda grading with histopathology.
The main purpose of TBSRTC was to eliminate the ambiguity and to follow uniformity in the reporting of thyroid FNAs thereby enabling ease of communication among pathologists and clinician and to plan appropriate treatment for the patients. It consists of a six-category classification system associated with increased risk of malignancy. This classification system ensures the uniformity of information shared among pathologists, clinicians, and surgeons, and it provides better correlations between malignancy and cytological results, thus enabling more appropriate management. “The Bethesda System for Reporting Thyroid Cytopathology” (TBSRTC) includes definitions, diagnostic/morphologic criteria, explanatory notes, and a brief managementplanforeachdiagnosticcategoryisasixcategoryschemeofthyr idcytopathologyreporting. Each category has an implied cancer risk, which ranges from 0% to 3% for the “benign” category to virtually 100% for the “malignant” category. It uses three categories, AUS/FLUS, SFN/HurthlecellneoplasmandSFM, to report thyroid aspirates that fall between benign and malignant. As a function of these risk associations, each category is linked to evidence based clinical management guidelines.
A retrospective study done by Arul P et al [10] in which total number of 483 thyroid FNACs out of which 209 cases of Solitary thyroid nodule (STN) were chosen for this study. FNACs diagnoses were compared with histopathological diagnoses. Among 209 FNACs, 88 (42.1%) had non-neoplastic lesions, 6 (2.9%) had atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS), 52 (24.9%) had follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), 33 (15.8%) were suspicious for malignancy and 18 (8.6%) had malignant cytology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC in STN cases were 94.4%, 97.6%, 95.8%, 98.1% and 93.2% respectively. Study concluded that FNAC reporting using Bethesda system for reporting thyroid cytopathology highly correlated with the histopathological diagnosis and results were comparable with published data. The FNAC diagnosis helps in triaging patients with STN and identifies those who require surgical intervention. It is a simple, convenient, cost effective, sensitive, specific, safe and accurate initial diagnostic method for the preoperative evaluation of STN.
In our study among the study population, (32%) had BETHESDA III Atypia of undetermined significance, (6%) had BETHESDA IV suspicious for follicular neoplasm (8%) had BETHESDA V suspicious for malignancy and 4
The Bethesda system for thyroid cytology correlates adequately with final histopathological diagnosis in our study. In conclusion, for the interpretation of aspiration cytology of thyroid lesions TBSRTC is a useful tool that enhances the diagnostic accuracy of FNA, exhibits an adequate diagnostic correlation with the final histopathological examination and enables a comparison of results between different institutions.
Nil
Nil
Study was approved by Institutional Ethical Committee
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