Predictive Value of Fine Needle Aspiration Cytology Versus Ultrasound TI-RADS In Solitary Thyroid Nodule Comparing With Gold Standard Histopathology Report

Danyal Zahoor, Zahid Mehmood, Ghansham Rawtani, Hazrat Bilal, Abdul Qudoos, Muhammad Haris

Abstract

Objective

To find the predictive value of fine needle aspiration cytology (FNAC) versus ultrasound TI-RAD in solitary thyroid nodules keeping histopathology report as the gold standard.

Study design

Cross sectional study.

Place & Duration of study

Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC) Karachi, from February 2023 to December 2023.

Methods

A prospective observational cross sectional study was conducted on patients with solitary thyroid nodule. Patients’ aged 18 years and above with  normal TSH (euthyroid) and free T4 levels, were included. The study incorporated TI-RADS scores based on radiological findings and Bethesda classification for cytopathology examination. Clinical, radiological, cytological, and histopathological features were analyzed. The comparison between FNAC, TI-RADS, and biopsy results was carried out to find diagnostic accuracy.

Results

A total of 360 patients with the mean age of 41.69±9.41 years were enrolled. Most of the patients were between 40 to 60 years (59.4%) of age and predominantly females (68.9%). TI-RADS 4 (45.3%) and TI-RADS 3 (30.3%) were the predominant categories in radiological findings. Bethesda 2 (60.3%) dominated cytopathology results. FNAC showed high sensitivity (98.51%) but lower specificity (27.17%), while TI-RADS exhibited slightly better specificity (44.57%). The prevalence rates of benign cases were significantly higher for both FNAC and TI-RADS.

Conclusion

The association between FNAC versus ultrasound TI-RAD in solitary thyroid nodules compared with final biopsy results emphasizes the importance of this combined diagnostic strategy for timely clinical decision-making.

Key words

Solitary thyroid nodule, TI-RAD ultrasound, FNAC, Thyroid malignancy, Goiter.