Cureus. 2026 Jul 15;18(7):e112727. doi: 10.7759/cureus.112727. eCollection 2026 Jul.
ABSTRACT
Background Fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) are commonly used techniques for the evaluation of thyroid lesions. Differences in smear quality, cellular preservation, and diagnostic performance between these methods remain a subject of interest. Our study compared FNAC and FNNAC in thyroid lesions using histopathological examination as the reference standard. Methodology A cross-sectional observational study was conducted among 110 patients with clinically palpable thyroid swellings, of whom 75 patients who underwent thyroid surgery with available histopathological examination were included in the final analysis. Both FNAC and FNNAC were performed on the same lesion during the same sitting. Smears were assessed for adequacy, cellular preservation, and diagnostic categorization using the Bethesda System for Reporting Thyroid Cytopathology. Histopathological examination served as the reference standard for cytohistological correlation and assessment of diagnostic performance. Results The mean age of participants was 42.88 ± 13.59 years. Superior smear quality was observed in 55 (73.3%) FNAC samples and 59 (78.7%) FNNAC samples. Bethesda Category II lesions constituted the majority of cases with both techniques. FNNAC reduced the proportion of indeterminate lesions and identified a higher proportion of malignant lesions. Histopathology revealed 53 (70.7%) benign and 22 (29.3%) malignant lesions. FNNAC demonstrated a stronger correlation with histopathological diagnosis and showed better preservation of cellular architecture with less blood contamination. Diagnostic accuracy was numerically higher with FNNAC (63, 84.0%) than with FNAC (58, 77.3%), with corresponding sensitivities of 11 (50.0%) and 9 (40.9%), respectively; however, the difference in diagnostic accuracy was not statistically significant (McNemar’s test, p = 0.228). Conclusions Both FNAC and FNNAC are effective techniques for the cytological evaluation of thyroid lesions. FNNAC demonstrated higher smear quality, improved cellular preservation, higher specificity, and numerically higher overall diagnostic accuracy than FNAC. Although the difference in diagnostic accuracy was not statistically significant, FNNAC may serve as a valuable alternative or complementary technique for improving smear quality in thyroid cytology.
PMID:42603037 | PMC:PMC13475714 | DOI:10.7759/cureus.112727
