Cytomorphological Study of Thyroid Lesions According to Bethesda System and Its Correlation with Radiological and Thyroid Function Tests

Background: FNAC is a useful diagnostic tool which is inexpensive, easy to use, safe, minimally invasive & easily available time saving OPD procedure. The 6 tier Bethesda system offers consistent terminology for thyroid reports and permits improved discussion and comprehension between the clinician and the pathologists. It has been found that FNAC along with thyroid hormone profile helps us at arriving to an accurate diagnosis. FNAC also helps to minimize the incidence of thyroidectomy and to choose treatment for the patient. To differentiate benign and malignant thyroid swelling ultrasound is safe and cost effective investigation of choice. The American College of Radiology has recommended the ACR- TIRADS reporting system for thyroid swellings on ultrasound. Thyroid function test findings can be used to predict the physiological status of thyroid lesions, and imaging cytological correlation can assist minimize inaccurate findings from fine needle aspiration of thyroid nodules. Materials & Methods: For this hospital-based prospective study at Silchar Medical College and Hospital, 120 fine-needle aspirated tests of thyroid nodules were collected over a period of one year. The classification of all diagnoses resulting from fine needle aspiration cytology took into account factors such as age, gender, cytological results (TBSRTC), and radiological abnormalities (TIRADS). These will be correlated with the findings of thyroid function testing. Results: The 120 thyroid lesions that were assessed were distributed as follows: 3.17% were classified as Non-Diagnostic (ND), 1.17% as Suspicious for Malignancy (SFM), 4.17% as Follicular Neoplasm (FN), 85.83% as Benign, and 0.83% as Atypia of Undetermined Significance (AUS). Most individuals classified as category II had abnormal Thyroid Function Tests (TFT). In category VI, all 5 cases were euthyroid, with no cases showing altered TFT. Among the 15 cases of thyroiditis, most were hypothyroid. Out of 120 cases, highest distributions of cases were in TIRADS 2 followed by TIRADS 3(USG). Conclusion: The combined use of FNAC with the Bethesda system, TI-RADS, and TFTs helps pathologists and clinicians by providing a comprehensive evaluation of thyroid nodules. This approach allows for accurate differentiation between cancerous and benign growths which aids in assessing the need for further investigation. It not only standardizes the diagnostic criteria but also offers clinicians clear management guidelines, whether that be follow-up FNAC or proceeding to surgery. By integrating cytological, radiological, and functional assessments, unnecessary surgeries can be avoided, as only nodules with a high risk of malignancy or significant abnormalities are selected for surgical intervention, ensuring more precise and effective patient care.