fine needle aspiration cytology ( fnac ) has been applied routinely as a useful and indispensable method to diagnose thyroid lesions .
however , it is still quite difficult to establish a precise diagnosis of follicular lesions of the thyroid preoperatively by cytology .
the present study was undertaken to analyse the usefulness of quantitative estimations of various cytological nuclear features in specimens obtained by preoperative fnac that were confirmed by histopathological examination .
the study was conducted on 36 patients who presented to the surgical outpatient department with thyroid lesions .
all 36 cases were subjected to fine needle aspiration ( fna ) and tissue sections were obtained subsequently . a concise clinical history , examination , and details of relevant investigations were also obtained . these were helpful in reaching a probable clinical diagnosis as well as in cytohistological evaluation and formulations of the pathological diagnosis .
the data included 10 cases each of adenomatoid goiter , follicular neoplasm , papillary carcinoma , 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma .
their ages ranged from 28 to 50 years ( average 45 years ) , and there were nine females and one male .
the stained smears were examined with a standard microscope connected to a computerised video system and analyzed with image analyzer proplus v software . using 200 magnifications , three to five fields of vision
were sampled randomly and a minimum of 10 nuclei per case were measured automatically and calculated .
overlapping of the cells , oddly shaped nuclei and degenerative cells were excluded from the study .
the mean nuclear area and the mean nuclear perimeter [ figure 1 ] were measured by the calculations of pixels corresponding to the nuclei for the evaluation of the nuclear size in each case . to determine the variation in shape , the circular rate and the largest to the smallest dimension ratio of the nuclei ( ls ratio ) were calculated [ figure 2 ] . in a round circle ,
if the object is elliptical , the circular rate becomes < 1 ; in contrast , the ls ratio is higher than 1 .
the coefficient of variation of the nuclear area ( nacv ) was calculated by expressing the variation in size in an individual case .
statistical differences were determined by the analysis of variance ( anova ) test , both within the group and in between the groups .
aspirate showing thyroid follicular epithelial cells highlighting nuclear perimeter ( h and e ,  200 ) aspirate showing thyroid follicular epithelial cells highlighting the largest to smallest ( l / s ) ratio ( h and e ,  200 )
the study examined 10 cases each of adenomatoid goiter , follicular neoplasm , papillary carcinoma , 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma .
all clinical data , including the patient 's age , gender and tumor size , revealed no statistically significant difference among the five groups . among the parameters for the quantitative morphometrics of nuclei , the mean nuclear diameter and the perimeter were higher in anaplastic carcinomas and were the least for follicular neoplasms .
the circular rate was significantly higher in the group with adenomatous goiter than with follicular neoplasm ( p < 0.05 ) .
the adenomatous goiter patients had a higher ls ratio than the patients with follicular neoplasm ( p < 0.05 ) .
the nacv value was 44.24  7.76% in adenomatous goiter , 24.02  4.11% in follicular neoplasm and 66.17  13.88% in papillary carcinoma which showed significant differences between all the groups ( p < 0.0001 ) .
the data of the nuclear parameters are shown in tables 2 and 3 and figures 36 .
clinical characteristics of patients chart depicting nuclear area among variants ( ag  adenomatoid goiter ; fn  follicular neoplasm ; pc  papillary carcinoma ; mc  medullary carcinoma ; ac  anaplastic carcinoma ) chart depicting perimeter among variants ( ag  adenomatoid goiter ; fn  follicular neoplasm ; pc  papillary carcinoma ; mc  medullary carcinoma ; ac  anaplastic carcinoma ) chart depicting circular rate among variants ( ag  adenomatoid goiter ; fn  follicular neoplasm ; pc  papillary carcinoma ) chart depicting ( l / s ) largest to smallest ratio among variants ( ag  adenomatoid goiter ; fn  follicular neoplasm ; pc  papillary carcinoma ; mc  medullary carcinoma ; ac  anaplastic carcinoma )
however , it is difficult to establish a precise diagnosis of follicular lesions of thyroid preoperatively by cytology .
the potential significance of this technique is to distinguish between benign , borderline and malignant lesions , for objective grading of invasive tumors , prediction of prognosis and therapeutic response .
morphometry has been described for more than a century because the histological characteristics of normal and abnormal cells have been used as a measure of prognosis and as a way of predicting the cause of the disease . while adaptation of quantitative morphometric analysis as a clinical tool has been discussed in the literature for over 30 years
, the usefulness of this approach has helped in cytological grading of breast lesions , but has not yet received widespread acceptance in thyroid lesions owing to limited references and subjectivity.[16 ] rajesh et al . studied histopathologically proven 19 cases of lobular carcinoma , 30 cases of ductal carcinoma , 10 cases of borderline lesions and 20 cases of benign breast lesions .
anova showed that morphometric data may be useful in distinguishing invasive lobular carcinoma from infiltrating ductal carcinoma on cytological smears .
however , data were not helpful in distinguishing benign and borderline lesions from invasive lobular carcinoma .
nuclear area ( na ) and nacv were compared with prognostic factors and this analysis reflected the chemosensitivity and the risk of recurrence .
there are studies where morphometry has been applied to other organs like nasopharynx , skin , urinary bladder and colon . in our study
, we evaluated 10 cases each of adenomatoid goiter , follicular neoplasm , papillary carcinoma , 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma .
the circular rate was significantly higher in the group with adenomatous goiter than with follicular neoplasm .
also reported that nuclear features were not helpful in differentiation of follicular carcinomas from adenomas .
nagashima et al . also evaluated variation in nuclear size by using nacv which showed significant differences among follicular carcinomas , adenomas and adenomatous goiters . in our study , the circular rate was higher in papillary carcinoma when compared to medullary carcinoma , which was not documented in any of the studies .
fernandez - lopez et al . evaluated in their study , the prognostic value of the colorectal cancer in 90 patients .
it was noticed that the patients with greater nuclear diameters also had a significant poor prognosis than the patients with cells of smaller diameter .
this study asserted that the variations could be related to the survival of these patients .
analyzed nuclear parameters like nuclear area , axis minor , diameter minor , radius minor , perimeter area in oligodendroglioma and found it to be statistically significant with regard to grading of oligodendrogliomas .
studies including larger series of cases investigating detailed nuclear morphometric analysis of subtypes of thyroid carcinoma with longer periods of observation are required in order to demonstrate the association between clinical outcome and morphometric parameters and in order to standardize the morphometric method by giving a suitable cut - off value of nacv in thyroid lesions .
when correctly applied with appropriate cutoffs , morphometry can help in preoperative assessment and may act as an adjunct to morphological features in thyroid lesions .
 aim : to evaluate the cytomorphometric features in fine needle aspiration cytology ( fnac ) of thyroid lesions.materials and methods : fnac of 36 thyroid cases was reviewed . 
 the study included 10 cases each of follicular lesion , adenomatous goiter , papillary carcinoma , 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma . 
 their ages ranged from 28 to 50 years , and there were nine females and one male . 
 morphometric analysis was done on aspiration smears from 36 thyroid lesions . 
 hematoxylin and eosin stained smears were examined using image analyzer proplus v software . 
 morphological parameters measured included mean nuclear diameter , mean nuclear perimeter , mean nuclear area , circular rate , largest to smallest dimension ratio ( ls ratio ) and coefficient of variation of nuclear area ( nacv).statistical analysis : statistical evaluation was carried out using the analysis of variance ( anova ) test for the five variables , both within the group and in between the groups . 
 the result was considered significant when p < 0.05.results:the follicular carcinomas had higher ls ratio than patients with adenomatous goiters . 
 mean nuclear diameter and the mean nuclear perimeter were higher in anaplastic carcinomas when compared to other subtypes and were the least for follicular neoplasms.conclusion:when correctly applied , quantitative estimation of cytological nuclear features can play an important role in preoperative assessment and can complement morphological features in thyroid lesions . 
Introduction
Materials and Methods
Results
Discussion
Conclusions