Classification of thyroid lesions in patients attending fine needle aspiration clinic in Makerere University Pathology Department, Mulago

Abstract

Background: Thyroid lesions occur at any age and in both genders with vast majority occurring randomly. However, occurrence is different in different geographical areas and in different age and sex groups. With the increasing incidence rates of thyroid lesions over recent years although most are benign, approximately 10%-15% prove malignant. In Uganda, lack of such data contributes to a low index of suspicion among clinicians resulting into delayed diagnosis of these lesions leading to poor prognosis. This research sought to classify the thyroid lesions in Uganda thereby providing data that will contribute to patient management as a whole: Aim and Objective: To classify cytologically-diagnosed thyroid lesions between 2012 and 2016 at Makerere University Pathology Department, Mulago. Methodology: This was a retrospective laboratory based study, conducted at Makerere University Pathology Department, Mulago. (Kampala) using cases related to period between 2012 and 2016. A total of 170 cases of fine-needle aspirations of the thyroid were retrieved from the archives and independently categorized into groups according to Bethesda reporting system guidelines. All cases that passed selection criteria had their social demographics to include sex and gender noted and the final diagnosis. The data was then entered and analysis done on SPSS. Results: Of the 170 patients, 158 (92.8%) were females and 12 (7.1%) were males. The mean age at diagnosis of patients was 45years in males and 42 years in females with majority in the age bracket of 40-49 (40/170) and 30-39(36/170). Benign cases were most detected (132/170) followed by inflammatory(16/170) and finally malignant(14/170). Colloidal nodule (41%) was most prevalent among the benign cases, followed by Follicular adenoma (25.9%). Malignant category was dominated by papillary carcinoma (7.1%), then follicular carcinoma at (1.2%) Inflammatory category had lymphocytic thyroiditis (5.9%) being highest, followed by acute thyroiditis (1.8%). The suspicious category (SFN & SUSPICIOUS FOR MALIGNANCY) had list prevalence with each accounting for 1.8% and 2.9% respectively. Sex was associated with diagnosis unlike age with p values p (0.035) & p (0.312) respectively. Conclusion: The classification findings are consistent with several other findings in published literature with benign classification found to be the majority followed by inflammatory and then malignant. However Occurrence of malignancy was found to be lower than published though still remains x significant. Sex and age were found to be associated with diagnosis with the female sex being most affected gender as well as being of older age 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.