Online ISSN: 2515-8260

Keywords : Bethesda

Concordance Between Cytological Bethesda And Ultrasound Based Ti-Rads Reporting Systems In Thyroid Nodules

Dr. Manmohan, Dr. Monika B. Gathwal, Dr. Chiranjeev Gathwal, Dr. Deepti Agarwal, Dr. Naveen Sharma, Dr. Swaran Kaur

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 4, Pages 1409-1418

Thyroid nodules are common entities, frequently discovered in clinical practice, either during physical examination, but also incidentally, during various imaging procedures. They are clinically important primarily due to their malignant potential. The literature indicates that the incidence of nodules is around four times higher in women than men.
Material and Methods : A total of 90 patients with thyroid nodules which were referred to Department of Pathology and Radio-diagnosis and underwent USG guided FNAC and TIRADS scoring were included. USG guided FNAC were examined and categorized according to Bethesda system. The Bethesda categories were correlated with TIRADS scoring in all 90 cases and with histopathological findings in 22 cases.
Results: A total of 90 patients were included out of which 83 were females. These thyroid nodules are predominantly found in females with right lobe preponderance in approximately 50% cases and in third–fifth decade of life. A total of 14 were categorized under TIRADS 1, 25 were categorized under TIRADS 2, 6 were categorized under TIRADS 3, 29 were categorized under TIRADS 4 and 16 were categorized under TIRADS 5. Out of the 90 nodules, 46 were categorized under Bethesda II, 6 were categorized under Bethesda III, 21 were categorized under Bethesda IV, 7 were categorized under Bethesda V and 10 were categorized under Bethesda VI. Proportion of risk of malignancy as TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 were 4.0%, 83.3%, 82.8% and 87.5%, respectively. In the present study, 86.36% sensitivity, 84.78% specificity, 84.44% PPV, and 86.67% NPV derived. Significant association was noticed between TIRADS and Bethesda system of classification (P < 0.001). On Histopathological diagnosis of 22 thyroid cases, sixteen out of 22 nodules (72.7%) were proven to be malignant by postoperative histopathological examination. On histopathological and Bethesda comparison, 93.75% sensitivity, 16.67% specificity, 75.00% PPV, and 50.00% NPV were observed (P <0.001). Concordence between Bethesda classification and TIRADS scoring system of USG guided FNAC of the lesions showed very good association in both benign (84.7%) and malignant (86.3%) lesion (p < 0.001).
Conclusion: The thyroid ultrasound report using the TIRADS criteria has a good concordance with the Bethesda cytology findings using USG guided FNAC. Correct interpretation by the two diagnostic modalities helps the clinician to stratify the thyroid nodules and reduce the risk of unnecessary invasive procedures in patients with low TIRADS score (TIRADS I AND 2) and nodules with high TIRADS score (TIRADS 4 and 5) should undergo USG guided FNAC and if Bethesda categories were suspicious of carcinoma or carcinoma should undergo surgery


Sherihan AboElyazed Mohamed; Mohamed Reda Halawa; Yara Mohamed Eid; Maram Mohamed Maher; Lamyaa Salem; Salah Hussein Elhalawany

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 9, Pages 325-334

Background: The Prevalence of thyroid nodules is rising nowadays, luckily most of
them are benign. The risk of malignancy 5-15%, which necessitates the ultimate need to
accurately distinguish benign from malignant nodule to avoid unnecessary
thyroidectomy with risk of recurrent laryngeal nerve injury, postoperative
hypothyroidism and lifetime thyroid replacement therapy, and other complications
related to surgery and anaesthesia. Recent evidence suggests that circulating miRNA
might have probable advantage as diagnostic or prognostic markers for numerous
cancers. Given their reproducible and constant presence in sera, miRNA profiles have
emerged as a non-invasive method to categorise a wide variety of human cancers. This
study aimed to evaluate a possible relationship between the expression level of
circulating miRNA-222 and the histological outcome of euthyroid patients undergoing
thyroidectomy for thyroid nodules with indeterminate FNAC. This study included 45
euthyroid patients with inderteminate thyroid nodules diagnosed with ultrasound and
FNAC which planed for thyroidectomy. Quantitative assay of serum micro RNA-222
expression by quantitative Real-Time polymerase chain reaction (qRT-PCR) performed
preoperatively, and results compared with postoperative histopathology.
Results: The incidence of thyroid nodules was predominant in female gender in benign
group and malignant group. Risk of malignancy increases as TI-RADS and Bethesda
scores increases. Also, larger nodule in size has a more risk of malignancy (p= 0.027).
Expression level of circulating miRNA-222 in serum can’t differentiate between benign
and malignant patients where there was no significant difference between them
statistically (p=0.905). Circulating miRNA-222 was a poor predicator for malignant
nodules with sensitivity of 50%, specificity of 32.43%, with high negative predictive
value (NPV=75%).
Conclusion: Although circulating miRNA-222 has been identified as novel minimally
invasive biomarker for preoperative prediction of malignant nodules, but in our study,
it did not show a value as a tool for discrimination of malignant nodules. Ultrasound
remained important procedure in preoperative prediction and management of thyroid
nodules especially when correlating to nodule size which had positive correlation with
malignancy in our study.