Document Type : Research Article
Thyroid nodules are common entities, frequently discovered in clinical practice, either during physical examination, but also incidentally, during various imaging procedures. They are clinically important primarily due to their malignant potential. The literature indicates that the incidence of nodules is around four times higher in women than men.
Material and Methods : A total of 90 patients with thyroid nodules which were referred to Department of Pathology and Radio-diagnosis and underwent USG guided FNAC and TIRADS scoring were included. USG guided FNAC were examined and categorized according to Bethesda system. The Bethesda categories were correlated with TIRADS scoring in all 90 cases and with histopathological findings in 22 cases.
Results: A total of 90 patients were included out of which 83 were females. These thyroid nodules are predominantly found in females with right lobe preponderance in approximately 50% cases and in third–fifth decade of life. A total of 14 were categorized under TIRADS 1, 25 were categorized under TIRADS 2, 6 were categorized under TIRADS 3, 29 were categorized under TIRADS 4 and 16 were categorized under TIRADS 5. Out of the 90 nodules, 46 were categorized under Bethesda II, 6 were categorized under Bethesda III, 21 were categorized under Bethesda IV, 7 were categorized under Bethesda V and 10 were categorized under Bethesda VI. Proportion of risk of malignancy as TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 were 4.0%, 83.3%, 82.8% and 87.5%, respectively. In the present study, 86.36% sensitivity, 84.78% specificity, 84.44% PPV, and 86.67% NPV derived. Significant association was noticed between TIRADS and Bethesda system of classification (P < 0.001). On Histopathological diagnosis of 22 thyroid cases, sixteen out of 22 nodules (72.7%) were proven to be malignant by postoperative histopathological examination. On histopathological and Bethesda comparison, 93.75% sensitivity, 16.67% specificity, 75.00% PPV, and 50.00% NPV were observed (P <0.001). Concordence between Bethesda classification and TIRADS scoring system of USG guided FNAC of the lesions showed very good association in both benign (84.7%) and malignant (86.3%) lesion (p < 0.001).
Conclusion: The thyroid ultrasound report using the TIRADS criteria has a good concordance with the Bethesda cytology findings using USG guided FNAC. Correct interpretation by the two diagnostic modalities helps the clinician to stratify the thyroid nodules and reduce the risk of unnecessary invasive procedures in patients with low TIRADS score (TIRADS I AND 2) and nodules with high TIRADS score (TIRADS 4 and 5) should undergo USG guided FNAC and if Bethesda categories were suspicious of carcinoma or carcinoma should undergo surgery