Kapre, Neeti1; Kapre, Madan1; Khandelwal, Raju2; Ravi, R3; Vaidya, Abhishek4; Raje, Dhananjay5
1 Head-Neck Surgeon & Director, Neeti Clinics, Nagpur
2 Director, Advanced Imaging Centre, Nagpur
3 Director, R, Ravi Pathology Lab, Nagpur
4 Head-Neck Oncosurgeon, Neeti Clinics, Nagpur; Asst. Professor, Head-Neck, NKPSIMS, Nagpur
5 Head, Data Analysis Group, MDS Bioanalytics, Nagpur
Background: Recent times have seen surge in incidence of thyroid disease, attributed majorly to overzealous diagnosis. However, diagnostic modalities for thyroid often fall short of identifying malignancy. Precise diagnosis is important to allow safe execution of efficient thyroid surgery.
Aims: To determine correlation of clinical examination, USG, FNAC in predicting malignant potential in thyroid disease; and to construct risk equation based on these three modalities to arrive at pre-treatment diagnostic scoring-system.
Methodology: Prospective observational study where three independent observations by clinician, radiologist (Ultrasound-TIRADS score) and pathologist (FNAC-Bethesda classification) are compared against gold standard of histopathology to assess their ability to determine malignant potential of thyroid lesions before surgery. Sixty-six patients were included and agreement between three tests was determined using Fleiss Kappa, while agreement between each test and histopathology was determined using Cohen’s Kappa.
Results: Of 66 patients, there were 44(66.7%) female with mean age 41.34±12.45 years, while 22(33.3%) males with mean age of 44.27±12.03 years. Percentage of malignant lesions as diagnosed on clinical, imaging and cytology were 4.5%, 28.8% and 9.1% respectively. Fleiss kappa indicated slight agreement amongst three methods(0.177), which was statistically significant(p=0.0009). Pair wise agreement between three methods was also obtained using Cohen’s Kappa. Coefficient values for clinical & USG, clinical & FNAC and USG & FNAC were 0.095(p=0.206), 0.067(p=0.49) and 0.386(p<0.0001) respectively. Comparison of each method with histopathology was performed, and sensitivity-specificity found out.
Conclusion: Elegant and efficient pre-operative diagnosis in thyroid is need-of-the-hour. Agreement between three methods was mainly contributed by moderate agreement. The study will next bring out a pre-treatment scoring-system.