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25.07.2017 | Original Article

A Comparison of the Diagnostic Efficiency of Guided Fine Needle Aspiration Cytology Versus Conventional Fine Needle Aspiration Cytology of the Thyroid

Zeitschrift:
Indian Journal of Otolaryngology and Head & Neck Surgery
Autoren:
Manoj Sharma, Sadhana Mahore

Abstract

Fine needle aspiration cytology (FNAC) is possibly the most useful investigation for the thyroid. However, conventional FNAC (C-FNAC) is limited by a high rate of inadequate samples. Ultrasound guided FNAC (US-FNAC) has been proposed as an alternative. This study aims to estimate the measures of diagnostic accuracy of FNAC as well as to compare US-FNAC against C-FNAC. Patients who underwent FNAC at our for a period of 5 years were selected. This comprised of 237 C-FNAC cases and 173 US-FNAC cases. Out of these 410 cases, 129 cases had cyto-histological correlation. The proportion of inadequate samples, malignant cases as well as indeterminate cases were compared between US-FNAC and C-FNAC. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios for positive and negative results and odds ratio were estimated for overall FNAC as well as US-FNAC and C-FNAC patients. US-FNAC has a significantly lower proportion of inadequate samples (0.58 vs. 15.19%), as well as a lower proportion of indeterminate samples (1.7 vs. 7.6%) and a higher proportion of malignant cases (6.4 vs. 2.1%). When the inadequate samples were excluded, the results for tests of diagnostic effectiveness for overall FNAC, US-FNAC and C-FNAC respectively ranged between 66.67 and 80% for sensitivity, between 86.05 and 100% for specificity, between 45.45 and 100% for PPV and between 97.37 and 98.7% for NPV. FNAC is a useful test for differentiating malignant from benign lesions. When inadequate samples are excluded, both US-FNAC and C-FNAC are accurate diagnostic tests. However, US-FNAC is a more useful test since it results in a lower number of inadequate samples. Also, US-FNAC results in a greater yield of malignancy and a lower percentage of indeterminates, possibly due to additional information received from ultrasound examination.

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