title: Does fine-needle aspiration cytology optimize the surgical management of thyroid disorders in endemic goiter region?
abstract: OBJECTIVE
  The aim of this study was to determine the diagnostic value of fine-needle aspiration cytology (FNAC) before thyroidectomy in an endemic goiter region.
  
  
  METHODS
  One hundred patients with preoperative FNAC of thyroid nodules who underwent thyroidectomy were recruited. FNAC were classified into five groups. 0, no thyroid cells; 1, normal thyroid cells; 2, degenerative thyroid cells without evidence of malignacy; 3, follicular or oncocytary neoplasia; and 4, malignant thyroid cells. FNAC was compared with postoperative histopathological diagnoses.
  
  
  RESULTS
  Only 76% of the FNAC allowed an adequate cytological examination. In 15 patients (15%), carcinomas were found in the postoperative histopathological diagnosis (including four follicular carcinomas). In the 48 patients of FNAC groups 3 and 4, nine carcinomas (18.7%) were found (including four follicular carcinomas). In the 28 patients of groups 1 and 2, there was only one papillary carcinoma (3.5%). In the 24 patients of group 0, there were two papillary, two follicular, and one anaplastic carcinomas (total of 20.8%). The sensitivity, specificity, and likelihood ratio (LR) of the FNAC for benign nodules were 90%, 40.9%, 0.24, respectively. The LR for malignant nodules was 13.2, and that for follicular neoplasia was 0.55.
  
  
  CONCLUSIONS
  Despite the high prevalence of carcinoma in an endemic goiter region, FNAC disappointed its diagnostic expectation. The lower specificity of FNAC may be caused by a higher prevalence of thyroid nodules in an endemic goiter region or by the absence of a specialized cytopathologist.
authors.affiliation: Department of Visceral-, Thoracic-, and Vascular Surgery, Philipps University of Marburg, Marburg, Germany. hassan@med.uni-marburg.de
authors.forename: Iyad
authors.initials: I
authors.lastname: Hassan
authors.forename: Thomas
authors.initials: T
authors.lastname: Osei-Agymang
authors.forename: E Domínguez
authors.initials: ED
authors.lastname: Fernández
authors.forename: Thomas
authors.initials: T
authors.lastname: Behr
authors.forename: Peter
authors.initials: P
authors.lastname: Barth
authors.forename: Annette
authors.initials: A
authors.lastname: Ramaswamy
authors.forename: Hans Helge
authors.initials: HH
authors.lastname: Mueller
authors.forename: Andreas
authors.initials: A
authors.lastname: Zielke
authors.forename: Matthias
authors.initials: M
authors.lastname: Rothmund
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006042:Goiter / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013959:Thyroid Diseases / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult