Diagnostic accuracy of fine needle aspiration biopsy versus postoperative histopathology for diagnosing thyroid malignancy

Abstract

Introduction: Ultrasound-guided fine needle aspiration biopsy (FNAB) is currently widely used for the initial screening of patients with thyroid nodules enabling prevention of unnecessary surgery. The purpose of this study was to retrospectively analyse the diagnostic accuracy of thyroid FNAB compared with postoperative histopathology of a large cohort from Azerbaijan. Methods: We evaluated the FNAB results of 738 patients who underwent thyroid surgery at the National Centre of Oncology in Azerbaijan. The measures of diagnostic accuracy were calculated for the ultrasound-guided preoperative FNAB results (based on the six diagnostic categories of the Bethesda classification) compared with postoperative histopathologic results (benign or malignant) for correspondent areas. Results: Considering both DC V and DC VI categories (387 cases) as ‘cytologic-positive’ and DC II category (72 cases) as ‘cytologic-negative’, we found 14 false-positive and 10 false-negative results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 97.4%, 86.1%, 96.4%, 81.6% and 94.8%, respectively. Conversely, when considering only the DC VI category as ‘cytologic-positive’, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNA were 93.2%, 100%, 100%, 81.6% and 97.1%, respectively. Conclusions: The results of our cohort demonstrated high levels of diagnostic accuracy, supporting FNAB's role as a reliable diagnostic tool in the preoperative evaluation of thyroid nodules. The sensitivity, specificity, NPV, PPV and accuracy of thyroid FNAB in our institution were comparable with those of other institutions.