The diagnostic utility of the ultrasound TIRADS and Bethesda System of reporting thyroid cytology in thyroid nodule smaller than 4.0 cm: A retrospective analysis

This is the authors' abstract. We don't add key points for this paper.

Thyroid nodules (TNs) are a common clinical issue, prevalent in the general population. Fine-needle aspiration cytology (FNAC) is a vital diagnostic tool for the initial evaluation of TNs. This study aimed to determine the cytopathological patterns of thyroid nodules using the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and to assess the diagnostic role of both FNAC and ultrasonography in TNs <4 cm in diameter. This study included 100 FNAC samples from thyroid nodules. Patients underwent ultrasonographic examination, with findings reported according to the European Thyroid Imaging Reporting and Data System. FNAC samples were stained using Diff-Quik and Papanicolaou stains, cytologically examined, and reported according to TBSRTC. Histopathological assessment was performed using hematoxylin and eosin staining of the corresponding excised biopsies. The patterns were analyzed and the results correlated. The mean age of the participants was 46.2 ± 12.7 years, with females comprising 89% of the cases. About half (51%) of the nodules were in the right lobe. The diameter of the nodules ranged from 8 to 40 mm, with a mean diameter of 20.3 mm. Normal thyroid-stimulating hormone levels were observed in 74% of cases with no significant association between thyroid-stimulating hormone levels and nodule characteristics. Among the 100 FNACs, 54% were categorized as Bethesda II, 25% as Bethesda III, 8% as Bethesda IV, and 2% as Bethesda V. A significant correlation was found between cytopathological diagnoses and both ultrasonographic (P = .001) and histopathological (P = .05) diagnoses. We concluded that the benign conditions were the most common cytopathological findings. FNAC reporting using TBSRTC demonstrated a strong correlation with ultrasonographic and histopathological diagnoses, confirming its reliability and high diagnostic value in evaluating small thyroid nodules.