Pre-Operative Diagnosis of Suspicious Thyroid Nodules: An Integrated Multidisciplinary Approach

Abstract

Background Despite the increase in thyroid tumor incidence, the malignancy rate is low. This increased incidence poses a substantial burden on the healthcare system. The costs associated with surgery and limited theater facilities restrict addressing of all thyroid tumors surgically. Effective modes of preoperative diagnosis are essential for efficient disease prognosis and treatment. Unnecessary surgeries on benign nodules and completion thyroidectomies are reported due to inaccuracies of preoperative diagnostic methods. Therefore, this study aimed to compare the efficacy of preoperative diagnostic methods such as the Thyroid Imaging Reporting and Data System (TIRADS), Bethesda classification, and immunocytochemistry in predicting malignancy. Methods A descriptive cross-sectional study was conducted enrolling 106 radiologically malignancy-suspected patients. TIRADS for Ultrasound scan and Bethesda classification for fine needle aspiration cytology (FNAC) reporting were used. Immunocytochemistry was performed using a panel of immune markers consisting of CD-56, HBME-1, and CK-19. All patients were followed up for 2 years. The results were analysed using R version 4.3.1. Results The majority of the participants were females (n = 84, 79.2%). The ages ranged from 15–76 years (47.20 ± 12.90). Significant associations were observed between the TIRADS classification and Bethesda classification (p = 0.00009). Additionally, significant associations were observed between TIRADS (p = 0.046), Bethesda (p = 0.00143), immunocytochemistry (p = 0.0000), and malignant status of the patients at follow-up. The combined use of the Bethesda system and TIRADS significantly improved the malignant predictability of patients. Immunocytochemistry showed 100% concordance with patient status at follow-up. Conclusion The effectiveness of preoperative diagnosis of thyroid tumors can be increased by the combined use of preoperative techniques such as the TIRADS classification system and the Bethesda system. Immunocytochemistry can be used as a stand-alone technique to predict the malignancy of thyroid nodules.