Clinical, Ultrasonographic, and Cytopathological Evaluation of Thyroid Swelling: A Cross-Sectional Study

Open Access

Abstract

Background: Thyroid swellings present a frequent clinical challenge, spanning benign goiters to aggressive malignancies. Accurate preoperative differentiation is vital to optimize surgical strategy and curtail unnecessary thyroidectomies, yet concordance among clinical, imaging, and cytological data remains underexplored in resource-limited contexts. Objective: To evaluate the diagnostic utility of clinical examination, ultrasonography, and fine-needle aspiration cytology in characterizing thyroid swellings. Methods & Materials: This prospective cohort study enrolled 53 patients presenting with thyroid swellings at the Department of Otolaryngology, Community Based Medical College Hospital Bangladesh, Mymensingh, from January 2024 to December 2025 via purposive sampling. Each participant underwent standardized clinical assessment, high-resolution ultrasonography, and ultrasound-guided fine-needle aspiration cytology. Cytological results were classified per the Bethesda System. Data were analyzed using SPSS version 23.0. Results: Among 53 patients (mean age 45.2±12.6 years; 37 females), ultrasonography detected solid nodules in 34 cases and cystic components in 19. Cytologically, benign lesions (Bethesda II) constituted 64.2% (n=34), while malignant or suspicious (Bethesda V-VI) accounted for 15.1% (n=8). USG demonstrated 87.5% sensitivity and 82.2% specificity against cytology, with significant predictors including microcalcifications and irregular margins (p<0.05). Conclusion: Clinical assessment alone remains insufficient for comprehensive thyroid characterization. USG and FNAC demonstrate substantial concordance, with USG serving as a reliable non-invasive diagnostic adjunct. Bethesda categorization effectively stratifies malignancy risk, thereby guiding timely surgical referrals in low-resource settings.