Study of Fine Needle Aspiration Cytology (FNAC) of Thyroid Gland According to the Bethesda System.

Background:  Fine needle aspiration cytology (FNAC) of thyroid gland is a powerful diagnostic tool for thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classifies thyroid FNAC findings into six categories. It is a standardized, simple, and convenient method of reporting which also provides guidelines for management.

Aims And Objectives:  To study the cytomorphology of thyroid lesions and classify them as per TBSRTC. Determine the epidemiology and distribution of various thyroid lesions in our tertiary care hospital. Correlation of cytopathology with histopathological diagnosis in cases which were operated in our hospital.

Methods And Material:  This is a prospective analytical study of 105 patients with clinically enlarged thyroid gland presenting at G.K. General Hospital, Bhuj during July 2018 to August 2020. FNAC smears of these patients were studied and correlated with histopathology wherever available.

Results:  Out of a total 105 cases, 94 were non-neoplastic, eight were neoplastic, and three were unsatisfactory for evaluation. There were 94 cases in the benign category (category II), with colloid goiter being the most common cytological diagnosis (38 cases). There were no cases in categories III and V, respectively. On cytology, two cases in category IV were diagnosed as follicular neoplasm. Category VI had six cases comprising papillary carcinoma of thyroid (five cases) and medullary carcinoma of thyroid (one case). Out of a total 105 cases, 55 patients were operated in our center and hence their cytopathological findings were correlated with histopathological findings. Out of 55 operated cases, 45 cases (81.8%) had benign lesion and 10 cases (18.2%) were malignant. The sensitivity of FNAC was 70% and specificity was 100%.

Conclusions:  Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. The Bethesda system is very useful for a standardized and reproducible system of reporting thyroid FNAC. It satisfactorily correlates with the histopathological diagnosis and helps in comparing results amongst various institutes.