Background. The aim of this study is to assess the role of multiparameter analysis of silver (Ag)-stained nucleolar organizer regions (AgNORs) technique on aspiration smears of thyroid swellings to distinguish between benign and malignant lesions. Materials and Methods. Aspiration smears from 166 cases of thyroid swellings were examined. Diagnosis was confirmed by histology in 61 cases. AgNOR staining was done on FNA smears according to silver-staining protocol proposed by the International Committee for AgNOR quantification. Multiparameter analysis of AgNORs such as mAgNOR, pAgNOR, and AgNOR size grade was done on 50–100 cells under oil immersion lens. Results. AgNOR parameter of benign and malignant thyroid lesions was compared and was found to be statistically significant. Out of 157 satisfactory AgNOR stained cases, 148 (94.3%) were benign lesions and 9 (5.7%) cases were malignant lesions. In AgNOR analysis, sensitivity was found to be 83.33%, specificity 100%, PPV 100%, NPV 98.21%, and accuracy was 98.36%. Conclusions. AgNOR analysis in the FNA smears is a simple, sensitive, and cost-effective method for differentiating benign from malignant thyroid swellings. 1. Introduction The prevalence of thyroid nodules in the general population is about 5% by palpation and increases to 10–55% with the use of ultrasonography [1]. Thyroid nodules are common in women and in areas of iodine deficiency [2]. Benign thyroid disease is extremely common compared to small proportion of malignant neoplasm [1]. The distinction of the benign and malignant thyroid nodules is fundamental, as malignancy necessitates surgery [3]. To avoid unnecessary thyroid surgery, a thyroid scan, ultrasonography, and fine needle aspiration cytology (FNAC) are used as diagnostic tools to differentiate malignant from a benign lesion [4]. The major pitfall of FNAC is that it cannot differentiate between the follicular adenoma and follicular carcinoma [2]. This is why these are usually described as follicular neoplasm or thyroid follicular diseases [5]. The only diagnostic criteria of follicular neoplasm are the presence of vascular and capsular invasion that can be ascertained histologically [6]. Various attempts have been made to improve the diagnostic accuracy of FNAC, including morphometric study, DNA measurement, immunohistochemical and enzyme techniques for thyroid cancer with varying degree of success. It is well known that the silver staining technique for nucleolar organizer regions (AgNORs) has been successfully applied to a wide variety of neoplastic lesions on pathological
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