The present study was designed to evaluate applicability of combination
of clinical examination, neck conventional ultrasonography (US) and
US-guided fine needle aspiration cytology (FNAC) as a strategy for assessment
of thyroid swellings and differentiating between malignant and
benign thyroid lesions. The study includf,d 50 patients (5 mnles and 45
femalPs with a mean age of 37.1±6.9 years) with nodular thyroid swelling.
All patients underwent complete history taking, full clinical examination,
neck US and US-guided FNAC. AU patients underwent thyroiclectomy
and excised specimens were examined his topathologically. All
patients passed smooth infra- and postoperative course apart from 4 cases
that developed postoperative hematorna collection, one of them required
evacuation. His topathological examination defined 5 (10%) papillary
and one (2%) follicular carcinoma and 44 (88%) benign nodules.
Clinical examination detected 14 patients (28%) with criteria of suspicious
malignancy while the other 36 patients showed no criteria of suspicious
malignancy. Clinical diagnosis could define malignant thyroid lesions
with sensitivity 66.7%, specificity 77.3% and accuracy 76%. The receiver
operating characteristic (ROC) curve analysis for the diagnostic yield of
clinical findings for differentiating between malignant and benign thyroid
lesion as judged by the area under the curve (AUC) showed AUC=0.652.
Conventional US diagnosis depending on US signs of malignancy revealed
that 2 malignant lesions were solid, hypoechoic nodules with
blurred margins, no halo sign and with fine calcification, another 2 malignant
nodules were solid, isoechoic nodules with blurred margins, no halo
sign and with coarse calcification, whereas the remaining 2 malignant nodules were solid, hypoechoic nodules with well-defined margins,
present halo sign and with coarse calcification. ROC curve analysis for
the diagnostic yield of each US finding separately showed that presence
of fine calcification had the highest diagnostic yield (AUC=0.739), presence
of blurred margin and absent halo sign (AUC=0.72), internal echogenecity
(AUC=0.667) and echostructure (AUC=0.527). Fine needle aspiration
was carried out successfiully in 48 patients with a success rate of
96% and diagnosed 4 specimens as papillary carcinoma, 5 as follicuinr
neoplasm and 39 specimens as hyperplastic nodules. FNAC could diagnose
malignancy with sensitivity 83.3%, specificity 90.5% and accuracy
rate of 89.696 and ROC curve analysis for the diagnostic yield of FNAC
showed AUC=0.871. It could be concluded that the combined depenriPnce
on clinical judgment, the result of US-guided FNAC and the presence of
blurred margin of the nodule associated with absence of Halo sign and
micro-calcification using conventional neck US provided the most significant
diagnostic yield for differentiating between malignant and benign
thyroid lesion |
