The Influence of Fine Needle Aspiration Results on the Selection of Surgical Procedure for Nodular Goitre

Original article


Senussi Zaidan, Mohamed Muftah, Abdulaziz El Rabty, Nuriedin Naji.

Department of General Surgery, Tripoli Medical Centre Tripoli, Libya

JMJ 2010,Vol.10, No.1: 26-29


Preoperative selection of the type of surgical procedure for nodular goitre depends on the type of thyroid pathology, fine needle aspiration cytology(FANC) is considered to be the most important procedure in differentiation between benign and malignant nodules. This study was planned to assess the influence of FNAC on the selection of the best surgical procedures preoperatively. Methods: Data were collected from 112 patients suffering from nodular thyroid disease who underwent FNA and surgical treatment in Tripoli Medical Centre, between January 2006 and March 2007. The surgical procedure was planned according to the preoperative diagnosis which was obtained by gathering the data regarding the clinical presentation, thyroid Ultra samography or isotope scans, and the result of FNA cytology. Lobectomy, near total thyroidectomy, and total thyroidectomy with or without neck dissection were the operation types designated for these patients. The postoperative histopathological results were compared with the preoperative FNA cytological diagnosis to know the Fine Needle Aspiration false negative results and the need for reoperation. Results: According to FNA results 88 patients had colloid goitre, follicular neoplasm in fourteen cases and papillary carcinoma in five cases. The postoperative histopathological results were follicular adenoma in ninteen cases, Hurthle cell adenoma in two patients, Hashimoto thyroiditis in four cases, follicular carcinoma in three patients, Hurthle cell carcinoma in one patient, papillary carcinoma in seven patients and the remainder (76 cases) were colloid goitre. The patients who were diagnosed as having benign pathology by FNA and then proved to be malignant after histopathological studies were reoperated. Conclusions: FNA might help in planning the surgical procedure for thyroid pathology but false- negative results are still high and can influence the final outcome of the surgical procedure. The role of FNA in exclusion of thyroid cancer should be re-evaluated and the use of frozen section biopsy should be advised. Finally postoperative histopathology of the thyroid tissue remains the only available method in the final diagnosis of unexpected cancer and the need for reoperation depends on its result.

Keywords: Fine Needle Aspiration Cytology (FNAC), Follicular thyroid neoplasm, Colloid goitre.