Comparison between Preoperative Ultrasonography and Fine Needle Aspiration Cytology with Final Postoperative Histopathological Results in Suspicious Thyroid Nodule at Two Referral Hospitals in 2019–2022 Sana’a City, Yemen

Export Objective: This study aimed to examine the correlation and compare the preoperative ultrasound and fine needle aspiration cytology (FNAC) risk stratification with the final postoperative histopathological result in managing indeterminate thyroid nodules. Methods: A prospective observational cross-sectional study was conducted at Al-Thawra Modern General Hospital and Al-Kuwait University Hospital in Sana’a city, Yemen, from July 2019 to December 2022. Patients presenting with thyroid swelling were recruited. Data including demographic information, preoperative characteristics, and postoperative outcomes were collected using a clinical case sheet. The collected data were analyzed using SPSS. Results: A total of 103 patients, with a mean age of 40.39±12.96, participated in the study, with 86 (83.5%) being females, and 17 (16.5%) males. Pathological diagnosis revealed that 53 out of 103 patients (51.5%) had benign nodules, while 50 (48.5%) were diagnosed with malignant nodules. The malignancy rate in nodules with suspicious ultrasound features was significantly higher than that in nodules with benign or nonsuspicious features (60 vs. 17.9%). Nodules with indeterminate FNAC features had a malignancy rate of 48.5%. Both ultrasound and FNAC methods showed significant correlation (P < 0.001) and had a significant strong correlation with the pathology diagnostic method (P < 0.001). In the not-suspicious and mildly suspicious groups, there was a significantly strong correlation between ultrasound, FNAC, and pathology (P < 0.001). In the moderately suspicious group, there was a moderately significant correlation (P < 0.001), while the correlation coefficient was not assessable in the other groups. Conclusions: Both ultrasound and FNAC were effective diagnostic methods, with FNAC demonstrating higher accuracy. Excisional biopsy served as the gold standard diagnostic method to rule out suspicion in ultrasound or FNAC results. Surgical intervention could be avoided for patients with benign nodules observed on ultrasound and average-risk clinical features with small-sized nodules. However, high-risk features on ultrasound required FNAC and surgical biopsy. Triple assessment was found to be indispensable for the management of thyroid nodules.