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THE RELATIONSHIP BETWEEN THE NUMBER OF SLIDES AND THE DIAGNOSIS IN THYROID FINE NEEDLE ASPIRATIONS

Year 2022, Volume: 29 Issue: 3, 378 - 384, 30.09.2022
https://doi.org/10.17343/sdutfd.1101183

Abstract

Objective
The first method used in the diagnosis of thyroid
nodules is the Bethesda system, which is the most
widely used system to evaluate aspiration. The
adequacy of aspiration applied to symptomatic and
asymptomatic nodules is important for appropriate
follow-up and treatment of the patient. The aim of
the study is to evaluate the relationship between the
number of slides prepared from thyroid nodules and
nodules sampled at the same time, and diagnostic
efficiency.
Material and Method
5092 aspirations from 3747 cases were included
in the study. The age and gender of the cases, the
diameter of the nodules, the number of preparations,
the number of nodules and the diagnosis of all
nodules were noted. The number of preparations and
the number of sampled nodules were categorized and
their relationship with the diagnosis was examined. All
data were analyzed using SPSS 20.
Results
Of the aspirations, 3929 (77.2%) were female and
1163 (22.8%) were male patients, and the mean
age was 52.3 (11-93 years). The diagnostic rate of
aspirations examined with a single preparation was
lower than multiple preparations (p=0.001). Suspicious
group and malignant diagnoses were higher in those
who were examined with multiple preparations, and
the rate of benign diagnosis was higher in those who
were examined with a single preparation (p=0.013).
Considering the diagnostic categories, while benign
diagnoses were more common in aspirations from
multiple nodules, suspicious and malignant diagnoses
were more common in single nodule aspirations.
Conclusion
Ultrasonographic features of the nodule and the
accuracy of the procedure directly affect the diagnosis.
It has been concluded that aspiration from several
areas of the nodule and the preparation of aspirations
with two or more preparations compared to a single
preparation are important both to increase the
diagnosis and to increase the probability of suspicious
and malignant diagnosis.

References

  • 1. Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. Journal of cytology. 2013;30(2):94-9.
  • 2. Rago T, Chiovato L, Aghini-Lombardi F, Grasso L, Pinchera A, Vitti P. Non-palpable thyroid nodules in a borderline iodine-sufficient area: detection by ultrasonography and follow-up. Journal of endocrinological investigation. 2001;24(10):770-6.
  • 3. Udul P. , Barut F. , Özdamar Ş. O. Tiroid Karsinomu Olgularında İnce İğne Aspirasyonu Bulguları. SDÜ Tıp Fakültesi Dergisi. 2018; 25(3): 265-274
  • 4. Burman KD, Wartofsky L. CLINICAL PRACTICE. Thyroid Nodules. The New England journal of medicine. 2015;373(24):2347-56.
  • 5. Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003;9(2):128-36.
  • 6. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. The Journal of clinical endocrinology and metabolism. 2006;91(9):3411-7.
  • 7. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2006;12(1):63-102.
  • 8. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association. 2016;26(1):1-133.
  • 9. Levenson JN, Santaella I, Wachtel MS, Levenson DI. Discordance between cytologic results in multiple thyroid nodules within the same patient. Acta cytologica. 2010;54(5):673-8.
  • 10. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. The Journal of clinical endocrinology and metabolism. 2002;87(5):1941-6.
  • 11. Burch HB, Burman KD, Cooper DS, Hennessey JV, Vietor NO. A 2015 Survey of Clinical Practice Patterns in the Management of Thyroid Nodules. The Journal of clinical endocrinology and metabolism. 2016;101(7):2853-62.
  • 12. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid : official journal of the American Thyroid Association. 2009;19(11):1159-65.
  • 13. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. American journal of clinical pathology. 2010;134(3):450-6.
  • 14. Sahin D, Yilmazbayhan D, Firat P, Hacisalihoglu UP, Kirimlioglu SH, Celenk E, et al. Comparison of conventional cytology and SurePath in split thyroid fine needle aspiration materials. Cytopathology : official journal of the British Society for Clinical Cytology. 2017;28(4):291-8.
  • 15. Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid : official journal of the American Thyroid Association. 2012;22(12):1251-6.
  • 16. Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R, et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. European journal of endocrinology. 2010;162(4):763-70.
  • 17. Nagarajan N, Schneider EB, Ali SZ, Zeiger MA, Olson MT. How do liquid-based preparations of thyroid fine-needle aspiration compare with conventional smears? An analysis of 5475 specimens. Thyroid : official journal of the American Thyroid Association. 2015;25(3):308-13.
  • 18. Rossi ED, Morassi F, Santeusanio G, Zannoni GF, Fadda G. Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results. Cytopathology : official journal of the British Society for Clinical Cytology. 2010;21(2):97-102.
  • 19. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clinic proceedings. 1994;69(1):44-9.
  • 20. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142(6):837-44; discussion 44.e1-3.
  • 21. Mehanna R, Murphy M, McCarthy J, O'Leary G, Tuthill A, Murphy MS, et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013;123(5):1305-9.
  • 22. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009;117(3):195-202.
  • 23. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306-15.
  • 24. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-16.
  • 25. Kim DW. How to do it: ultrasound-guided fine-needle aspiration of thyroid nodules that commonly result in inappropriate cytology. Clinical imaging. 2013;37(1):1-7.
  • 26. Tulecke MA, Wang HH. ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings. Diagnostic cytopathology. 2004;30(1):7-13.
  • 27. Hasteh F, Pang Y, Pu R, Michael CW. Do we need more than one ThinPrep to obtain adequate cellularity in fine needle aspiration? Diagnostic cytopathology. 2007;35(11):740-3.
  • 28. Mihailescu DV, Schneider AB. Size, number, and distribution of thyroid nodules and the risk of malignancy in radiation-exposed patients who underwent surgery. The Journal of clinical endocrinology and metabolism. 2008;93(6):2188-93.
  • 29. Sippel RS, Elaraj DM, Khanafshar E, Kebebew E, Duh QY, Clark OH. Does the presence of additional thyroid nodules on ultrasound alter the risk of malignancy in patients with a follicular neoplasm of the thyroid? Surgery. 2007;142(6):851-7; discussion 7.e1-2.
  • 30. Barroeta JE, Wang H, Shiina N, Gupta PK, Livolsi VA, Baloch ZW. Is fine-needle aspiration (FNA) of multiple thyroid nodules justified? Endocrine pathology. 2006;17(1):61-5.
  • 31. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. The American journal of medicine. 1992;93(4):363-9.
  • 32. Lansford CD, Teknos TN. Evaluation of the thyroid nodule. Cancer control : journal of the Moffitt Cancer Center. 2006;13(2):89-98.
  • 33. Bouhabel S, Payne RJ, Mlynarek A, Hier M, Caglar D, Tamilia M. Are solitary thyroid nodules more likely to be malignant? Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2012;41(2):119-23.

TİROİD İNCE İĞNE ASPİRASYONLARINDA İNCELENEN PREPARAT SAYISI İLE TANI ARASINDAKİ İLİŞKİ

Year 2022, Volume: 29 Issue: 3, 378 - 384, 30.09.2022
https://doi.org/10.17343/sdutfd.1101183

Abstract

Amaç
Tiroid nodüllerinin tanısında kullanılan tek yöntem
olan ince iğne aspirasyonunu değerlendirmede en
yaygın kullanılan sistem Bethesda sistemidir. Semptomatik
ve asemptomatik nodüllere uygulanan ince
iğne aspirasyonunun yeterliliği hastanın uygun takip
ve tedavisi için önemlidir. Çalışmanın amacı tiroid nodüllerinden
yapılan aspirasyonlarda hazırlanan preparat
sayısı ve aynı anda örneklenen nodül sayısı ile
tanısal yeterlilik arasındaki ilişkiyi değerlendirmektir.
Gereç ve Yöntem
3747 olguya ait 5092 ince iğne aspirasyonu çalışmaya
alındı. Olguların yaş ve cinsiyeti, nodül çapı, nodül
başına örneklenen preparat sayısı, aynı seansta örneklenen
nodül sayısı ve tüm nodüllerin tanıları not
edildi. Preparat sayısı ve örneklenen nodül sayısı
parametreleri kategorize edilerek tanı ile arasındaki
ilişkiye bakıldı. Tüm veriler SPSS 20 programı kullanılarak
analiz edildi.
Bulgular
İnce iğne aspirasyonlarının 3929’u (%77,2) kadın,
1163’ü (%22,8) erkek hastalardan yapılmıştı ve yaş
ortalaması 52,3 (11-93 yaş) idi. Tek preparat ile incelenmiş
aspirasyonlarda tanısallık oranı multipl preparat
ile incelenenlere göre daha düşük idi (p=0,001).
Multipl preparat ile incelenenlerde kuşkulu grup ve
malign tanıları daha fazlaydı, tek preparat incelenenlerde
ise benign tanı oranı daha yüksek idi (p=0,013).
Tanı kategorilerine bakıldığında ise multipl nodülden
yapılan aspirasyonlarda benign tanılar daha fazlayken,
tek nodül aspirasyonlarında kuşkulu ve malign
tanı daha fazla idi.
Sonuç
Aspirasyon yapılan nodülün ultrasonografik özellikleri
ve yapılan işlemin doğruluğu tanıyı doğrudan etkilemektedir.
Nodülden yapılan aspirasyonlarda nodülün
birkaç alanından aspirasyon yapılması ve aspirasyonların
tek preparata kıyasla iki ya da daha fazla
preparat ile hazırlanmasının hem tanısallığı artırmak
hem de kuşkulu ve malign tanı olasılığını artırmak için
önemli olduğu sonucuna varıldı.

References

  • 1. Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. Journal of cytology. 2013;30(2):94-9.
  • 2. Rago T, Chiovato L, Aghini-Lombardi F, Grasso L, Pinchera A, Vitti P. Non-palpable thyroid nodules in a borderline iodine-sufficient area: detection by ultrasonography and follow-up. Journal of endocrinological investigation. 2001;24(10):770-6.
  • 3. Udul P. , Barut F. , Özdamar Ş. O. Tiroid Karsinomu Olgularında İnce İğne Aspirasyonu Bulguları. SDÜ Tıp Fakültesi Dergisi. 2018; 25(3): 265-274
  • 4. Burman KD, Wartofsky L. CLINICAL PRACTICE. Thyroid Nodules. The New England journal of medicine. 2015;373(24):2347-56.
  • 5. Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003;9(2):128-36.
  • 6. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. The Journal of clinical endocrinology and metabolism. 2006;91(9):3411-7.
  • 7. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2006;12(1):63-102.
  • 8. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association. 2016;26(1):1-133.
  • 9. Levenson JN, Santaella I, Wachtel MS, Levenson DI. Discordance between cytologic results in multiple thyroid nodules within the same patient. Acta cytologica. 2010;54(5):673-8.
  • 10. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. The Journal of clinical endocrinology and metabolism. 2002;87(5):1941-6.
  • 11. Burch HB, Burman KD, Cooper DS, Hennessey JV, Vietor NO. A 2015 Survey of Clinical Practice Patterns in the Management of Thyroid Nodules. The Journal of clinical endocrinology and metabolism. 2016;101(7):2853-62.
  • 12. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid : official journal of the American Thyroid Association. 2009;19(11):1159-65.
  • 13. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. American journal of clinical pathology. 2010;134(3):450-6.
  • 14. Sahin D, Yilmazbayhan D, Firat P, Hacisalihoglu UP, Kirimlioglu SH, Celenk E, et al. Comparison of conventional cytology and SurePath in split thyroid fine needle aspiration materials. Cytopathology : official journal of the British Society for Clinical Cytology. 2017;28(4):291-8.
  • 15. Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid : official journal of the American Thyroid Association. 2012;22(12):1251-6.
  • 16. Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R, et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. European journal of endocrinology. 2010;162(4):763-70.
  • 17. Nagarajan N, Schneider EB, Ali SZ, Zeiger MA, Olson MT. How do liquid-based preparations of thyroid fine-needle aspiration compare with conventional smears? An analysis of 5475 specimens. Thyroid : official journal of the American Thyroid Association. 2015;25(3):308-13.
  • 18. Rossi ED, Morassi F, Santeusanio G, Zannoni GF, Fadda G. Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results. Cytopathology : official journal of the British Society for Clinical Cytology. 2010;21(2):97-102.
  • 19. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clinic proceedings. 1994;69(1):44-9.
  • 20. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142(6):837-44; discussion 44.e1-3.
  • 21. Mehanna R, Murphy M, McCarthy J, O'Leary G, Tuthill A, Murphy MS, et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013;123(5):1305-9.
  • 22. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009;117(3):195-202.
  • 23. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306-15.
  • 24. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-16.
  • 25. Kim DW. How to do it: ultrasound-guided fine-needle aspiration of thyroid nodules that commonly result in inappropriate cytology. Clinical imaging. 2013;37(1):1-7.
  • 26. Tulecke MA, Wang HH. ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings. Diagnostic cytopathology. 2004;30(1):7-13.
  • 27. Hasteh F, Pang Y, Pu R, Michael CW. Do we need more than one ThinPrep to obtain adequate cellularity in fine needle aspiration? Diagnostic cytopathology. 2007;35(11):740-3.
  • 28. Mihailescu DV, Schneider AB. Size, number, and distribution of thyroid nodules and the risk of malignancy in radiation-exposed patients who underwent surgery. The Journal of clinical endocrinology and metabolism. 2008;93(6):2188-93.
  • 29. Sippel RS, Elaraj DM, Khanafshar E, Kebebew E, Duh QY, Clark OH. Does the presence of additional thyroid nodules on ultrasound alter the risk of malignancy in patients with a follicular neoplasm of the thyroid? Surgery. 2007;142(6):851-7; discussion 7.e1-2.
  • 30. Barroeta JE, Wang H, Shiina N, Gupta PK, Livolsi VA, Baloch ZW. Is fine-needle aspiration (FNA) of multiple thyroid nodules justified? Endocrine pathology. 2006;17(1):61-5.
  • 31. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. The American journal of medicine. 1992;93(4):363-9.
  • 32. Lansford CD, Teknos TN. Evaluation of the thyroid nodule. Cancer control : journal of the Moffitt Cancer Center. 2006;13(2):89-98.
  • 33. Bouhabel S, Payne RJ, Mlynarek A, Hier M, Caglar D, Tamilia M. Are solitary thyroid nodules more likely to be malignant? Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2012;41(2):119-23.
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Ayça Tan 0000-0003-4450-5425

Aydın İşisağ This is me 0000-0002-2362-1614

Publication Date September 30, 2022
Submission Date April 10, 2022
Acceptance Date August 11, 2022
Published in Issue Year 2022 Volume: 29 Issue: 3

Cite

Vancouver Tan A, İşisağ A. TİROİD İNCE İĞNE ASPİRASYONLARINDA İNCELENEN PREPARAT SAYISI İLE TANI ARASINDAKİ İLİŞKİ. Med J SDU. 2022;29(3):378-84.

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