Aim: The present study is undertaken to see the distribution of various benign thyroid lesions by free hand guided FNAC in a study population in northern India and compare the same with ultrasound- guided FNAC. Introduction: Clinical examination, although very accurate in most cases of thyroid lesion, is inadequate in some areas especially, in staging and in detecting the multi-nodularity of the gland. Materials and Methods: The study was conducted in the Postgraduate Department of Pathology of a teaching hospital for a period of 1 year. It was a prospective hospital based Study. In each case, a brief clinical history and physical examination along with evaluation of relevant investigation was carried out. Patient were explained about whole of the procedure & the consent for the procedure was taken in all patients. FNAC of thyroid gland was done ,by both Free hand guided and ultrasound guided and the results were correlated using SPSS 11.5 software. Observation: Out of the 139 patients, 87 shows non- neoplastic lesions . In free hand FNAC Colloid goitre was the most common accounting for 49 cases (54.44%), followed by Lymphocytic thyroiditis 12(13.33%), Hashimoto's thyroiditis 7(7.78%), Autoimmune thyroiditis 11 (12.22%) and Thyroglossal cyst 2 (2.2% ).On the other hand,ultrasound guided FNAC showed 87 non- neoplastic lesions, Colloid goitre was the most common accounting for 51 cases (67.61%), followed by Lymphocytic thyroiditis 13 (9.35%), Hashimato thyroiditis 8 (9.86%), Autoimmune thyroiditis 13(9.35%) and Thyroglossal cyst 2 (1.43%). Age of the patients ranged from 18-70yrs with maximum number 16 (31.37%) in the age group of 31-40. Majority of the patients of colloid goitre were female accounting for 12 out of 13 and only one case was male. Cytological diagnosis of Comparison of Non neoplastic lesions results both by USG guided FNAC and Free Hand FNAC shows difference of 3 cases in colloid goitre,1 case in lymphocytic thyroiditis,1 case in Hashimato’s Thyroiditis, 2 cases each of Thyroglossal cyst. Number of unsatisfactory smears were 9 and 3 in free and USG guided FNAC respectively. In USG guided FNAC, Sensitivity was 96.96%, Specificity was 93.3%. Positive predictive value was 96.96%, Negative predictive value was 93.33% and Diagnostic accuracy was 95%.In Free Hand FNAC, Sensitivity was90.0%, Specificity was 80.0%. Positive predictive value was 90.0 %, Negative predictive value was 80% and Diagnostic accuracy was 86.66 Conclusion: The statistical significance of USG-guided FNAC as: Sensitivity 96.96%, Specificity 93.3%, Positive predictive value 96.96%,negative predictive vale 93.33%,diagnostic accuracy 95%.The statistical significance of Free-guided FNAC as: Sensitivity 90%, specificity 80%, positive predictive value 90%, negative predictive vale 80%, diagnostic accuracy 86.66%. The statistical significance shows Ultrasound guided-FNAC had a significantly higher rate of diagnostic accuracy compared to palpable FNAC
