A Comparison of the Diagnostic Efficiency of Guided Fine Needle Aspiration Cytology Versus Conventional Fine Needle Aspiration Cytology of the Thyroid

  • Manoj SharmaEmail author
  • Sadhana Mahore
Original Article


Fine needle aspiration cytology (FNAC) is possibly the most useful investigation for the thyroid. However, conventional FNAC (C-FNAC) is limited by a high rate of inadequate samples. Ultrasound guided FNAC (US-FNAC) has been proposed as an alternative. This study aims to estimate the measures of diagnostic accuracy of FNAC as well as to compare US-FNAC against C-FNAC. Patients who underwent FNAC at our for a period of 5 years were selected. This comprised of 237 C-FNAC cases and 173 US-FNAC cases. Out of these 410 cases, 129 cases had cyto-histological correlation. The proportion of inadequate samples, malignant cases as well as indeterminate cases were compared between US-FNAC and C-FNAC. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios for positive and negative results and odds ratio were estimated for overall FNAC as well as US-FNAC and C-FNAC patients. US-FNAC has a significantly lower proportion of inadequate samples (0.58 vs. 15.19%), as well as a lower proportion of indeterminate samples (1.7 vs. 7.6%) and a higher proportion of malignant cases (6.4 vs. 2.1%). When the inadequate samples were excluded, the results for tests of diagnostic effectiveness for overall FNAC, US-FNAC and C-FNAC respectively ranged between 66.67 and 80% for sensitivity, between 86.05 and 100% for specificity, between 45.45 and 100% for PPV and between 97.37 and 98.7% for NPV. FNAC is a useful test for differentiating malignant from benign lesions. When inadequate samples are excluded, both US-FNAC and C-FNAC are accurate diagnostic tests. However, US-FNAC is a more useful test since it results in a lower number of inadequate samples. Also, US-FNAC results in a greater yield of malignancy and a lower percentage of indeterminates, possibly due to additional information received from ultrasound examination.


Fine needle aspiration Cytodiagnosis Thyroid diseases Thyroid nodules Sensitivity and specificity 


Compliance with Ethical Standards

Conflict of interest

Dr. Manoj Sharma and Dr. Sadhana Mahore declare they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained for the procedure from all individual participants included in the study.


  1. 1.
    Garg S, Mohan H, Nagarkar N, Handa U (2008) Role of fine needle aspiration cytology in diagnosis and -management of thyroid lesions: a study on 434 patients. J Cytol 25:13. doi: 10.4103/0970-9371.40652 CrossRefGoogle Scholar
  2. 2.
    Sukumaran R, Kattoor J, Pillai KR et al (2014) Fine needle aspiration cytology of thyroid lesions and its correlation with histopathology in a series of 248 patients. Indian J Surg Oncol 5:237–241. doi: 10.1007/s13193-014-0348-x CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kumar A, Ahuja MM, Chattopadhyay TK et al (1992) Fine needle aspiration cytology, sonography and radionuclide scanning in solitary thyroid nodule. J Assoc Physicians India 40:302–306PubMedGoogle Scholar
  4. 4.
    Bajaj Y, De M, Thompson A (2006) Fine needle aspiration cytology in diagnosis and management of thyroid disease. J Laryngol Otol 120:467–469. doi: 10.1017/S0022215106000703 CrossRefPubMedGoogle Scholar
  5. 5.
    Bagga PK, Mahajan NC (2010) Fine needle aspiration cytology of thyroid swellings: How useful and accurate is it? Indian J Cancer 47:437–442. doi: 10.4103/0019-509X.73564 CrossRefPubMedGoogle Scholar
  6. 6.
    De Vos Tot Nederveen Cappel RJ, Bouvy ND, Bonjer HJ et al (2001) Fine needle aspiration cytology of thyroid nodules: How accurate is it and what are the causes of discrepant cases? Cytopathology 12:399–405. doi: 10.1046/j.1365-2303.2001.00363.x CrossRefPubMedGoogle Scholar
  7. 7.
    Aggarwal SK, Jayaram G, Kakar A et al (1989) Fine needle aspiration cytologic diagnosis of the solitary cold thyroid nodule. Comparison with ultrasonography, radionuclide perfusion study and xeroradiography. Acta Cytol 33:41–47PubMedGoogle Scholar
  8. 8.
    Agrawal S (1995) Diagnostic accuracy and role of fine needle aspiration cytology in management of thyroid nodules. J Surg Oncol 58:168–172. doi: 10.1002/jso.2930580306 CrossRefPubMedGoogle Scholar
  9. 9.
    Chow LS, Gharib H, Goellner JR, van Heerden JA (2001) Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 11:1147–1151. doi: 10.1089/10507250152740993 CrossRefPubMedGoogle Scholar
  10. 10.
    Morgan JL, Serpell JW, Cheng MSP (2003) Fine-needle aspiration cytology of thyroid nodules: How useful is it? ANZ J Surg 73:480–483. doi: 10.1046/j.1445-1433.2003.02670.x CrossRefPubMedGoogle Scholar
  11. 11.
    Carmeci C, Jeffrey RB, McDougall IR et al (1998) Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid 8:283–289. doi: 10.1089/thy.1998.8.283 CrossRefPubMedGoogle Scholar
  12. 12.
    Yokozawa T, Fukata S, Kuma K et al (1996) Thyroid cancer detected by ultrasound-guided fine-needle aspiration biopsy. World J Surg 20:848–853. doi: 10.1007/s002689900129 CrossRefPubMedGoogle Scholar
  13. 13.
    Kelly NP, Lim JC, DeJong S et al (2006) Specimen adequacy and diagnostic specificity of ultrasound-guided fine needle aspirations of nonpalpable thyroid nodules. Diagn Cytopathol 34:188–190. doi: 10.1002/dc.20392 CrossRefPubMedGoogle Scholar
  14. 14.
    Danese D, Sciacchitano S, Farsetti A et al (1998) Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8:15–21. doi: 10.1089/thy.1998.8.15 CrossRefPubMedGoogle Scholar
  15. 15.
    Redman R, Zalaznick H, Mazzaferri EL, Massoll NA (2006) The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules. Thyroid 16:55–60. doi: 10.1089/thy.2006.16.55 CrossRefPubMedGoogle Scholar
  16. 16.
    Stats Direct Statistical SoftwareGoogle Scholar
  17. 17.
    Gupta M, Gupta S, Gupta VB (2010) Correlation of fine needle aspiration cytology with histopathology in the diagnosis of solitary thyroid nodule. J Thyroid Res 2010:379051. doi: 10.4061/2010/379051 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Solymosi T, Toth GL, Bodo M (2001) Diagnostic accuracy of fine needle aspiration cytology of the thyroid. Acta Cytol 45:669–674. doi: 10.1159/000328285 CrossRefPubMedGoogle Scholar
  19. 19.
    Al-Yaarubi S, Farhan H, Al-Futaisi A et al (2011) Accuracy of ultrasound-guided fine-needle aspiration cytology for diagnosis of carcinoma in patients with multinodular goiter. Indian J Endocrinol Metab 15:S132–S135. doi: 10.4103/2230-8210.83352 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Wong KT, Ahuja AT (2005) Ultrasound of thyroid cancer. Cancer Imaging 5:157–166. doi: 10.1102/1470-7330.2005.0110 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cappelli C, Castellano M, Pirola I et al (2007) The predictive value of ultrasound findings in the management of thyroid nodules. QJM 100:29–35. doi: 10.1093/qjmed/hcl121 CrossRefPubMedGoogle Scholar
  22. 22.
    Sipos JA (2009) Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid 19:1363–1372. doi: 10.1089/thy.2009.1608 CrossRefPubMedGoogle Scholar
  23. 23.
    Lin JD, Huang BY, Weng HF et al (1997) Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer. J Clin Ultrasound 25:111–118. doi: 10.1002/(SICI)1097-0096(199703)25:3<111:AID-JCU3>3.0.CO;2-J CrossRefPubMedGoogle Scholar
  24. 24.
    Rago T, Di Coscio G, Basolo F et al (2007) Combined clinical, thyroid ultrasound and cytological features help to predict thyroid malignancy in follicular and Hürthle cell thyroid lesions: results from a series of 505 consecutive patients. Clin Endocrinol (Oxf) 66:13–20. doi: 10.1111/j.1365-2265.2006.02677.x CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  1. 1.Civil HospitalGurgaonIndia
  2. 2.Department of PathologyN.K.P. Salve Institute of Medical Sciences and Lata Mangeshkar HospitalNagpurIndia

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