The role and limitations of fine-needle aspiration cytology in thyroid nodule diagnosis

Omri Malika El; Nawress Thabet; Habib Rouatbi; Mouna Belakhdher; Jihene Houas; Monia Ghammam; Abir Meherzi; Hamza Elfekih; Wassim Kermani; Mohamed Abdelkafi

doi:10.1530/endoabs.110.EP1435

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Endocrine Abstracts (2025) 110 EP1435 | DOI: 10.1530/endoabs.110.EP1435

ECEESPE2025 ePoster Presentations Thyroid (198 abstracts)

The role and limitations of fine-needle aspiration cytology in thyroid nodule diagnosis

Malika El Omri ¹ , Nawress Thabet ¹ , Habib Rouatbi ¹ , Mouna Belakhdher ¹ , Jihene Houas ¹ , Monia Ghammam ¹ , Abir Meherzi ¹ , Hamza Elfekih ² , Wassim Kermani ¹ & Mohamed Abdelkafi ¹

Author affiliations

¹Farhat Hached Hospital, Department of ENT and Head and Neck Surgery, Sousse, Tunisia; ²Farhat Hached Hospital, Department of Endocrinology, Sousse, Tunisia.

JOINT3513

Background: Fine-needle aspiration cytology (FNAC) is the gold standard for evaluating thyroid nodules, offering a minimally invasive and ultrasound-guided approach to distinguishing benign from malignant lesions. This technique plays a critical role in optimizing patient management by guiding therapeutic decisions and minimizing unnecessary surgeries.

Objective: To assess the diagnostic accuracy of FNAC in the management of thyroid nodules and identify its limitations.

Methods: This retrospective cross-sectional study analyzed FNAC results from patients who underwent thyroid nodule surgery at our ENT Department over a five-year period (January 2018 – December 2022).

Results: A total of 333 patients were included, with a mean age of 47.45 years and a strong female predominance (male-to-female ratio of 1:5.8). The primary mode of detection was a palpable cervical mass (57.35%), while 15.6% were incidental findings. Multinodular goiters were more prevalent (61.6%) than solitary nodules (38.4%). Ultrasound classification revealed that 52% of nodules were categorized as EU-TIRADS <4, while 48% were classified as EU-TIRADS ≥4. FNAC was performed on 75 patients (22.5%). The results were distributed as follows: 14.7% non-diagnostic (Bethesda I), 44% benign (Bethesda II), 10.7% atypia/follicular lesion of undetermined significance (Bethesda III), 6.6% follicular neoplasm/suspicious for follicular neoplasm (Bethesda IV), and 24% suspicious for malignancy (Bethesda V). No cases were classified as Bethesda VI (malignant). Final histopathological analysis confirmed benign pathology in 48 cases, with FNAC correctly identifying 23 (TN = 47.9%). Among 27 malignant cases, FNAC correctly diagnosed 17 (T P = 70.8%). The overall diagnostic efficacy of FNAC was 53.3%.

Conclusion: FNAC remains a crucial diagnostic tool for thyroid nodules, but its performance can be enhanced through systematic ultrasound guidance to reduce false-negative rates. Optimizing this technique within a multidisciplinary framework would refine diagnosis and improve patient management.