Role of clinical assessment, investigation, radiology and fnac in preoperative diagnosis of thyroid carcinoma

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Author: 
Dr. Qasim Hamza Eriby, Dr. Mounis Mahdi Salih and Dr. Ahmed Waleed Ibrahim
Abstract: 

Background: Goiter is defined as an enlargement of the thyroid gland and it had been recognized since 2700B.C. Thyroid cancer is responsible for six deaths per million persons annually. Most patients present with a palpable swelling in the neck. The finding of a clinically solitary non toxic thyroid nodule has usually being a strong indication for surgery because it is considered to be a highly suspicious sign of carcinoma.
Aim of study: To evaluate the role and accuracy of history taking, physical examination and FNAC in the pre-operative diagnosis of thyroid cancer.
Methods: This prospective study was conducted at Al Yarmouk Teaching Hospital over a period of twenty three months involving 87 cases with thyroid enlargement with features suggesting thyroid cancer. The diagnosis of thyroid cancer was made on history, physical examination, and FNAC finding. Data was studied, categorized in tables according to history, examination, and FNAC findings, then assessed and analyzed. The details of histopathological results where recorded and compared to the initial FNAC results.
Results: A total of 87 patients with mean age of 41.7±7.4 years were enrolled in this study, the malignant nodule of more than 2 cm was significantly differed from benign one as well as the percentage of irregular edge of malignant tumor was significantly higher than those of benign one. Our study revealed a significant association between FNAC finding and histopathological finding (p=0.01), where the result showed 65 (84.4%) out of 68 (78.2%) of patients who were labeled as malignant by FNAC was also labeled as malignant by histopathological examination (sensitivity of FNAC = 84.4%) and 7 (70.0%) out of 19 (21.8%) who were labeled as benign by FNAC were also labeled as benign by histopathological results (specificity of FNAC = 70%).
Conclusion: In our study, history and examination are the first measure in the evaluation of solitary thyroid nodule. The evaluation of thyroid FNAC samples are highly correlated with the results of histopathological diagnosis. FNA biopsy is the preferred diagnostic test in all patients with thyroid nodules. It is safe, simple, reliable, and cost-effective mean for differentiation between malignant and benign nodules.

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