Chakraborty Suvamoy, Balakrishnan Manu C, Raphael Vandana, Tamuli Prachurya, Deka Anuradha
Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
South Asian J Cancer. 2022 Nov 2;12(2):166-172. doi: 10.1055/s-0042-1757776. eCollection 2023 Apr.
Suvamoy Chakraborty Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017-2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively ( -value < 0.001, Fischer's exact test). A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.
苏瓦莫伊·恰克拉波蒂 甲状腺肿是临床上最常见的病症之一（发病率高达60%），甲状腺恶性肿瘤是最常见的内分泌恶性肿瘤之一。美国甲状腺协会主张各中心需对细针穿刺活检（FNAC）的贝塞斯达系统进行验证。印度人群中贝塞斯达分类的恶性风险有限。
由于FNAC的有效性存在差异，本研究旨在探讨FNAC在评估甲状腺结节中的作用，估计印度东北部人群甲状腺结节的恶性风险，并将FNAC结果与组织病理学检查（HPE）结果相关联。
2017年至2020年期间，共有110例甲状腺结节患者前往耳鼻咽喉科就诊。检索病例记录，其中只有66例患者同时有FNAC和HPE报告。对这66例患者的FNAC进行了研究。
使用STATA V14软件进行数据分析。采用费舍尔精确检验来确定贝塞斯达系统在诊断甲状腺恶性肿瘤中的相关性。使用kappa统计量计算FNAC和HPE之间的百分比一致性。报告了FNAC在诊断甲状腺恶性结节中的诊断有效性。
FNAC诊断甲状腺恶性肿瘤的敏感性、特异性、阳性预测值和阴性预测值分别为52%、94.3%、89%和69%。在我们的研究中，贝塞斯达I至VI类别的恶性风险（ROM）分别为20%、25%、67%、40%、78%和100%（ -值<0.001，费舍尔精确检验）。
FNAC的特异性为94.3%，阳性预测值为89%，使其成为我们人群中诊断恶性肿瘤的可靠工具。不确定类别中较高的ROM使得有必要考虑在我们人群中进行甲状腺切除术，无论是否进行术中冰冻切片分析。其他一些印度研究也报告了类似的较高ROM。这些发现可能表明印度人群中贝塞斯达III类和IV类别的ROM增加；然而，这一说法需要来自大型多中心研究的进一步验证，并进行研究以找出风险增加的原因。
