Clinico-radiological, radio-histopathological and cyto-histopathological correlation of various thyroid lesions

Adequacy of thyroid aspirate comprise 5-6 groups of thyroid follicular epithelial cells. Each of the groups consists of ten or more cells on at least two smeared slides. Ultrasonography followed by fine needle cytology (FNC) can be used as a cost-effective, first line tool for diagnosis of thyroid lesions. Aims were: a) To study clinico-radiological, radio-pathological and cyto-histopathological correlation in the diagnosis of variety of thyroid lesions. b) To study the diagnostic parameters for cytological diagnosis of thyroid lesions. 295 cases of thyroid lesions were studied for a period of two years at a tertiary care hospital in Nagpur, Maharashtra. Clinical data, clinical diagnosis were filled in case proforma. Radiological diagnosis was documented with radiological diagnosis before performing thyroid FNC. The final Bathesda based cytological diagnosis was categorised based on cyto-morphology. Histopathology report of the cases which were operated was correlated with the cytological diagnosis and the radiological diagnosis. The data was entered into Microsoft excel 2016 and analysed. For each correlation; sensitivity, specificity, positive predictive value, diagnostic accuracy was calculated by appropriate formula manually. On comparison of nodularity on clinical examination with USG thyroid examination, the ?2-value and p-value was highly significant showing that USG thyroid was better in diagnosing solitary thyroid lesions than clinical examination, after clinico-radiological study. Based on radio-histopathological correlation of cases, the diagnostic parameters were: Sensitivity- 70%, Specificity- 91.3%, Positive predictive value- 70%, Accuracy or Efficacy-86.5%, False positive rate- 6.74%, False negative rate- 6.74%. Based on cyto-histopathological correlation of cases, the diagnostic parameters were: Sensitivity- 80%, Specificity- 98.44%, Positive predictive value- 94.11%, Accuracy or Efficacy- 94.05%, False positive rate- 01.19%, False negative rate- 4.76%. Diagnostic parameters were thus better on cyto-histopathology correlation than on radio-histopathological correlation. A systematic, sequential, multi-modality approach of clinical examination, radiological diagnosis followed by cytological reporting is the need of the hour. This is important to triage operative neoplastic thyroid lesions from non-neoplastic thyroid cases which are generally not subjected to operative procedures.