Thyroid Lesions Diagnosed by Fine-Needle Aspiration Cytology in Uganda: A Five Year Retrospective Study
Received: 21-Jun-2023 / Manuscript No. DPO-23-103183 / Editor assigned: 23-Jun-2023 / PreQC No. DPO-23-103183 (PQ) / Reviewed: 07-Jul-2023 / QC No. DPO-23-103183 / Revised: 14-Jul-2023 / Manuscript No. DPO-23-103183 (R) / Accepted Date: 14-Jul-2023 / Published Date: 21-Jul-2023 DOI: 10.4172/2476-2024.8.2.218
Abstract
Fine Needle Aspiration Cytology of the thyroid gland has proven to be effective in the categorization of thyroid lesions into benign, atypical, suspicious and malignant categories. However only scanty data has been available regarding the prevalence of thyroid lesions in Uganda. This study aimed at classifying thyroid lesions cytological and to determine their correlation with the social demographic characteristics. A laboratory based retrospective study involving a review of 170 cases was conducted at MAKCHS pathology department between 2012 and 2016. FNA results were independently categorized into 4 groups in accordance to Bethesda system for reporting thyroid cytopathology. The data collected was entered using Epi data software and exported to SPSS for analysis. Out of the 170 cases reviewed, 148 (87.1%) were benign, 3 (1.8%) were suspicious for Follicular Neoplasm, 5(2.9%) were suspicious of malignancy and 14(8.2%) were malignant. Colloidal nodule (41.2%) was most prevalent lesion among the benign cases, followed by Follicular adenoma (25.3%). Malignant category was dominated by papillary carcinoma (7.1%). The peak age group for benign lesions was 40-49 years whereas the peak age group for malignant lesions was 40-49years and 50-59 years age group.
Keywords: Cytology; Fine needle aspiration; Thyroid lesions; Malignant
Abbreviations
FNAC: Fine Needle Aspiration Cytology; FN: Follicular Neoplasm; MakCHS: Makerere University College of Health Sciences; SPSS: Statistical Package for Social Sciences
Introduction
Thyroid disorders are the most common endocrine disorders encountered on the African continent with environmental and nutritional factors often implicated in their occurrence [1]. Screening for thyroid lesions, especially enlarged and /or nodular thyroid disease, is done by Fine Needle Aspiration Cytology (FNAC) in experienced hands of a cytopathologist; a method proven to be easy, fast and accurate [2]. FNAC is able to detect thyroid neoplasms for surgery and to identify non-neoplastic lesions that may be managed conservatively hence reducing the number of diagnostic thyroid surgeries for thyroid nodules by 50%-85% [3]. Whereas this method offers a reliable means of diagnosis in the assessment of thyroid diseases, its utility in Uganda remains limited and scarce information is available regarding the prevalence of thyroid lesions in this country.
Materials and Methods
A retrospective laboratory-based study was conducted on 170 individuals involving a review of FNAC reports for individuals who presented with thyroid nodules between 2012 and 2016 at pathology department of Makerere University College of health sciences. FNAC results were categorized into 4 groups such as benign, suspicious for follicular neoplasm, suspicious for malignancy and malignant categories which are defined by the Bethesda system. The data collected was entered using Epidata software and exported to the Statistical Package for Social Sciences (SPSS) version 17.0 for analysis.
Out of 170 thyroid FNA cases reviewed at the MakCHS pathology laboratory, 158(92.8%) were females and 12(7.1%) were males. Thus the ratio of males to females was 1:13. The mean age at diagnosis was 45 year for males (ranges from 19-67 years) and 42 year for females (ranges from 9-90 years). These findings were summarized as shown in Tables 1 and 2 respectively. Of the 170 cases of thyroid nodules detected among patients, majority of patients were at the age range of 40-49 years 40/170 (23.5%) followed by 30–39 years age group (21.3%).
| Sex | Age | Total | % | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 0–9 | 10–19 | 20–29 | 30–39 | 40–49 | 50–59 | 60–69 | 70+ | |||
| Male | 0 | 1 | 1 | 1 | 5 | 2 | 2 | 0 | 12 | 7.2 |
| Female | 1 | 10 | 25 | 35 | 35 | 28 | 15 | 9 | 158 | 92.8 |
| Total | 1 | 11 | 26 | 36 | 40 | 30 | 17 | 9 | 170 | - |
| % | 0.6 | 6.5 | 15.5 | 21.2 | 23.5 | 17.6 | 10 | 5.3 | - | 100 |
Table 1: Social demographic distribution of study participants.
| Gender/Age | No. | Mean | Median | Mode | Range | Min. | Max. |
|---|---|---|---|---|---|---|---|
| Female | 158 | 42 | 41 | 30 | 81 | 9 | 90 |
| Male | 12 | 45 | 45 | 19 | 48 | 19 | 67 |
Table 2: Gender/age relation of study participants.
Results and Discussion
In this study, the thyroid lesions observed were classified as Benign (87.1%), Suspicious for follicular neoplasm (1.8%), Suspicious for malignancy (2.9%), and malignant (8.2%). The details are shown in Table 3 below. In the suspicious category cases of suspicious for papillary carcinoma were the most commonly diagnosed accounting for 2.9% followed by suspicious for follicular neoplasm constituting 1.8%. Cases of papillary carcinomas were found to be the most diagnosed most diagnosed among the malignant categories accounting 7.6%. These findings were summarized in Table 4. Sex of the patient was found to be moderately associated with specific diagnosis as it showed a P value 0.034 (p<0.05) which was considered statistically significant. More females 158/170 were affected than males 12/170. Age was highly associated with specific diagnosis since it showed P value 0.01 (p<0.05) which was considered statistically significant. These findings were summarized as shown in Table 5.
| Age groups | Benign n(%) | Suspicious for FN n(%) | Suspicious for malignancy n(%) | Malignant n(%) | Total N(%) |
|---|---|---|---|---|---|
| 0–9 | 1(0.6) | 0(0.0) | 0(0.0) | 0(0.0) | 1(0.6) |
| 10–19 | 10(5.9) | 0(0.0) | 0(0.0) | 1(0.6) | 11(6.5) |
| 20–29 | 21(12.4) | 2(1.2) | 2(1.2) | 1(0.6) | 26(15.3) |
| 30–39 | 33(19.4) | 0(0.0) | 1(0.6) | 2(1.2) | 36(21.3) |
| 40–49 | 35(20.6) | 0(0.0) | 2(1.2) | 3(1.8) | 40(23.5) |
| 50–59 | 26(15.3) | 1(0.6) | 0(0.0) | 3(1.8) | 30(17.6) |
| 60–69 | 16(9.4) | 0(0.0) | 0(0.0) | 1(0.6) | 17(10.0) |
| 70+ | 6(3.5) | 0(0.0) | 0(0.0) | 3(1.8) | 9(5.3) |
| Total | 148(87.1) | 3(1.8) | 5(2.9) | 14(8.2) | 170(100.0) |
Table 3: Thyroid lesions diagnosed according to age groups.
| Classification | Sub- Type | Number % |
|---|---|---|
| Benign | Acute thyroiditis | 3 1.8 |
| Lymphocytic thyroiditis | 10 5.9 | |
| Granulomatous thyroiditis | 3 1.8 | |
| Colloid nodule | 70 41.2 | |
| Adenomatous nodule | 10 5.9 | |
| Nodular goiter | 6 3.5 | |
| Follicular adenoma | 43 25.3 | |
| Hurtle cell adenoma | 1 0.6 | |
| Suspicious for follicular neoplasm | Hurthle cell neoplasm | 3 1.8 |
| Suspicious for malignancy | Suspicious for papillary carcinoma | 5 2.9 |
| Malignant | Follicular carcinoma | 1 0.6 |
| Hurthle cell carcinoma | 1 0.6 | |
| Anaplastic carcinoma | 1 0.6 | |
| papillary carcinoma | 13 7.6 | |
| Total | - | 170 100 |
Table 4: Specific diagnosis of the study participants.
| Demographic | Value | df | P value |
|---|---|---|---|
| Age | 144.6 | 2362 | 0.01 |
| Sex | 23.691 | 13 | 0.034 |
Table 5: Chi-square test for association of social demographics with specific diagnosis.
Thyroid nodules are common entities, frequently discovered in clinical practice, either during physical examination, but also incidentally, during various imaging procedures [4]. Fine Needle Aspiration (FNA) of thyroid is a cost-effective, simple, diagnostic tool in the initial screening of patients with thyroid lesions [5]. Its role is to classify the examined lesion as malignant, suspicious, or benign and, thus, to select the patients who would be treated surgically [6]. In this retrospective study, cases of thyroid lesions were predominant in females accounting for 158(92.8%) which was in concordance with studies done by Melak, et al., and Masereka, et al., [7,8]. This is possibly because of good health seeking behaviour exhibited by females as compared to the males. Benign lesions were most commonly diagnosed with a percentage of 77.6% was congruent to the study done by Nassanga, et al., and Sharma, et al., [9,10]. Colloidal nodule represented majority of benign cases which was similar to studies done by Sinna, et al., [11]. Papillary carcinoma was the most commonly reported lesion in the malignant category which is contrary to studies done by Shirish, et al., [12] which reported follicular carcinoma as the most predominant lesion. This is probably because the present study comprised of a smaller sample size (n=170) in comparison to the latter study (n=606). Significant association was observed between sexes (P=0.035) with the female sex being the most affected.
Conclusion
The present findings are consistent with those published in other literature with benign lesions showing predominance. An association between age and thyroid lesions was also observed (P=0.01) with the malignancy being observed in older patients as compared to young adults and mean age at diagnosis of malignancy was 61 years which is similar to the findings. This is probably attributed to the natural history of thyroid malignancy, genetic factors and environmental factors. However, the occurrence of malignancy was found to be lower than published though still remains significant. Sex and age were found to be associated with diagnosis with the females being most affected gender as well as those in the older group.
Recommendation
More research done in future with detailed socio demographic information and findings is crucial to determine the utmost classification and clinical feature for thyroid lesions which will aid in raising the index of suspicion among clinician. Also use of bio markers in proper diagnosis of thyroid lesion is necessary as it will aid proper classification of the lesions.
Declarations
Consent to participate
The permission to carry out this study and disseminate its findings was obtained from the head of department pathology of Makerere University College of Health Sciences and the Institutional Review Board (IRB) of School of Biomedical Sciences. Informed consent was waived by the IRB.
Ethical consideration
All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Availability of data and materials
The Data is available in hard copies. The datasheets used and/or analyzed during the current study available from the corresponding author on reasonable request.
Competing interest
Authors declare no conflict of interest.
Funding
There was no source of funding for this study.
Authors contribution
G.E.D designed the study, participated in data collected data, managed and analyzed it. R.L, P.B and D.B.A was responsible for data analysis, manuscript development, and reading of manuscript. M.B was responsible for drafting the manuscript. All authors have read and approved the final manuscript.
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Citation: Denis GE, Lukande R, Bukirwa P, Abila DB, Boaz M (2023) Thyroid Lesions Diagnosed by Fine-Needle Aspiration Cytology in Uganda: A Five Year Retrospective Study. Diagnos Pathol Open 8:218. DOI: 10.4172/2476-2024.8.2.218
Copyright: © 2023 Denis GE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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