Detection of Thyroid Malignancy among Thyroid Swellings in Zagazig University Hospitals

Purpose: Clinically, Thyroid nodules (TNs) are rather a common disease occurs in 4-7% of the adult population based on palpation and of 20-76%, based on ultrasound examination. The main risk of such nodules is the possibility of malignancy. The routine management of these nodules was surgical excision to allow a final tissue diagnosis. Wide spectrum of procedures were used to manage such cases and in some instances completion thyroidectomy may be needed if malignancy was discovered in histopathology what means more morbidity to the patients, as thyroid surgery even with the best hands is attended with considerable morbidity. On the other hand the incidence of tissue diagnosed cancer in these nodules ranged from 12-20 %. It is therefore logic to propose a more selective policy for patients with thyroid nodules who must be subjected to surgery. It was to detect frequency of thyroid malignancy among patients with thyroid nodules scheduled for surgery and to evaluate the accuracy of the preoperative diagnostic tools in diagnosing malignancy in relation to the gold standard investigation i.e. postoperative histopathology.Methods: One hundred patients with thyroid nodules were enrolled in this study from Jul. 2013 to Jun. 2015, they included 30 (30%) males and 70 (70%) female with mean age of 40.77±14.9. Complete diagnostic evaluations were carried out for all patients but sonar guided FNAC was done only for 80 patients and the remaining 20 patients refused it. The suitable thyroid surgery was carried out after making the preoperative diagnosis. All operative specimens were sent for histopathological examination which was then compared to the preoperative diagnosis. All cases were operated upon in General Surgery department, Faculty of medicine, Zagazig University Hospitals, Zagazig, Egypt. Statistical analysis: SPSS version 20. Results: In total number of 100 patients with thyroid swellings who passed thyroid surgery, it was found that the highest frequency of thyroid swellings occurred in the age group ( 31- 40 years ) (32%) while the lowest one occurred in the age group under 20 years (1%). Histologically, thirty nine cases (39%) were found to be malignant and the remaining 61 cases (61%) were non- malignant thyroid swellings and the most frequent form of malignancy was Papillary carcinoma 31 patients (79.47%) followed by follicular carcinoma 4 patients (10.25%) and the most frequent benign lesion was colloid nodules in 33 patients (54.09%). The sensitivity of US was (87%) and its specificity was (3.3%) and its accuracy was (36.0%) while the sensitivity of FNAC was (96.5%) and specificity (76.4%) and its accuracy was (83.7%).Conclusion: There is a quite high incidence of malignancy in patients suffering from thyroid nodules. Ultrasound has an important role in evaluating thyroid nodules but more crucial if used as a guide to FNAC. FNAC especially if sonar guided is a good and trustful tool in diagnosing thyroid malignancy as it proved to be safe, easy, highly sensitive and accurate. So, all thyroid swellings should be carefully examined and thoroughly investigated for malignancy considering FNAC.