Abstract
Amaç: Tiroid nodülleri anamnez, fizik muayene, serum tiroid uyarıcı hormon düzeyi, ultrason ve ince iğne aspirasyon biyopsisi ile değerlendirilir. Tiroid nodüllerinin yönetiminde en önemli nokta gereksiz tiroidektomilerden kaçınırken tiroid kanserinin atlanmamasıdır. Bu çalışmanın amacı tiroid nodüllerinin yönetminde ince iğne aspirasyon biyopsisi sonuçlarına ne zaman kuşkuyla yaklaşılması gerektiğinin veya ne zaman güvenilebileceğinin anlaşılmasıdır.
Materyal ve Metot: Çalışmaya 127 hastaya ait toplam 152 tiroid nodülüne ait veriler dahil edilmiştir. İnce iğne aspirasyon biyopsisinin histopatoloji ile uyumlu ve uyumsuz olduğu gruplar bazı demografik ve klinik özelliklere göre karşılaştırılmıştır. İnce iğne aspirasyon biyopsisinin hem genel hem de farklı durumlar için duyarlılık, özgüllük, negatif prediktif değeri, pozitif prediktif değeri, yalancı negatiflik oranı ve doğruluk oranı ayrı ayrı hesaplanmıştır. Tüm testler için p<0,05 değeri istatistiksel olarak anlamlı kabul edilmiştir.
Bulgular: İnce iğne aspirasyon biyopsisinin nodüllerin 40.8%’ inde histopatolojiyle uyumlu, 59.2%’ sinde ise uyumsuz olduğu görülmüştür. İnce iğne aspirasyon biyopsisinin histopatoloji ile uyumlu olduğu grubun çoğu (51.6%) çapı 3 cm’ den küçük nodüller idi (p=0.047).
Sonuç: Bu çalışma nodül çapı 3 cm’ nin altındaysa ince iğne aspirasyon biyopsisi sonucunun histopatoloji sonuçlarıyla daha fazla uyumlu olduğunu göstermiştir. Yine bu çalışmada çapı 4 cm altında olan; çapı 3 cm’nin altında olup hashimato hastalığı olmayan; ultrasonografik k-tirads kategorisi 4 veya 5 olan nodüllerde ince iğne aspirasyon biyopsisinin duyarlılığı 100% ve yalancı negatiflik oranı 0% olarak bulunmuştur. Dolayısıyla bu nodüllerden yapılan ince iğne aspirasyon biyopsilerinin benign olarak raporlanan sonuçlarına diğer nodüllere kıyasla daha çok güvenilebileceği saptanmıştır.
References
- Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M ve ark. (2013). Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. International Journal of Endocrinology, https://doi.org/10.1155/2013/126084.
- Alexander EK, Marqusee E, Orcutt J, Benson CB, Frates MC, Doubilet PM ve ark. (2004). Thyroid nodule shape and prediction of malignancy. Thyroid, 14(11), 953-958.
- Bozbıyık O, Öztürk Ş, Ünver M, Erol V, Bayol Ü, Aydın C. (2017). Reliability of fine needle aspiration biopsy in large thyroid nodules. Turkish Journal of Surgery, 33(1), 10-13.
- Cibas ES, Ali SZ (2017). The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid, 27(11), 1341-1346.
- Çahalov M, Makay Ö, İçöz G, Akyıldız M, Yılmaz M. (2013). What should be done in thyroid nodules less than two centimeters, ultrasonographically suspicious and cytologically benign? Turkish Journal of Surgery/Ulusal cerrahi dergisi, 29(4), 167-170.
- Davies L, Welch HG. (2014). Current thyroid cancer trends in the United States. JAMA Otolaryngology–Head & Neck Surgery, 140(4), 317-322.
- Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A ve ark. (2015). The natural history of benign thyroid nodules. Jama, 313(9), 926-935.
- Gharib H, Goellner JR. (1993). Fine-needle aspiration biopsy of the thyroid: an appraisal. Annals of Internal Medicine, 118(4), 282-289.
- Gharib H, Goellner JR, Johnson DA. (1993). Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies. Clinics In Laboratory Medicine, 13(3), 699-709.
- Hegedüs L. (2004). Clinical practice: The thyroid nodule. N Engl J Med, 351, 1764-1771.
- Hershman JM, Cheng S, Gianoukakis AG. (2011). Update in thyroidology 2010. The Journal of Clinical Endocrinology & Metabolism, 96(1), 9-14.
- Karadeniz E, Yur M, Temiz A, Akçay MN. (2019). Malignancy risk for thyroid nodules larger than 4 cm and diagnostic reliability of ultrasound-guided FNAB results. Turkish Journal of Surgery, 35(1), 13-18.
- McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. (2007). The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery, 142(6), 837-844.
- Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard BA ve ark. (2014). Guidelines for the management of thyroid cancer. Clinical Endocrinology, 81, 1-122.
- Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. (2009). Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Archives of Surgery, 144(7), 649-655.
- Ravetto C, Colombo L, Dottorini ME. (2000). Usefulness of fine‐needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer Cytopathology, 90(6), 357-363.
- Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Maso LD. (2016). Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med, 375(7), 614-617.
- Wharry LI, McCoy KL, Stang MT, Armstrong MJ, LeBeau SO, Tublin ME ve ark. (2014). Thyroid nodules (≥ 4 cm): can ultrasound and cytology reliably exclude cancer? World Journal of Surgery, 38, 614-621.
- Yang J, Schnadig V, Logrono R, Wasserman PG. (2007). Fine‐needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer Cytopathology, 111(5), 306-315.
- Yeh MW, Demircan O, Ituarte P, Clark OH. (2004). False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. Thyroid, 14(3), 207-215
Abstract
Objective: The most crucial point in managing thyroid nodules is avoiding unnecessary thyroidectomies and not missing thyroid cancer. This study aims to understand when fine needle aspiration biopsy results should be approached with suspicion and when they can be trusted to manage thyroid nodules.
Material and Method: This study analysed data from a total of 152 thyroid nodules belonging to 127 patients retrospectively. The groups in which fine needle aspiration biopsy was compatible and incompatible with histopathology were compared according to some demographic and clinical characteristics. Sensitivity, specificity, negative/positive predictive value, false negative rate and accuracy of fine needle aspiration biopsy were calculated separately for different conditions. A p-value of <0.05 was considered statistically significant for all tests.
Results: Fine needle aspiration biopsy was consistent with histopathology in 40.8% of the nodules and 59.2% of them were incosistent. Most (51.6%) of the group in which fine needle aspiration biopsy was compatible with histopathology were nodules smaller than 3 cm in diameter (p=0.047).
Conclusion: This study showed that if the nodule diameter is less than 3 cm, the fine needle aspiration biopsy result is more consistent with the histopathology results. The sensitivity of fine-needle aspiration biopsy was 100%, and the false-negative rate was 0% in nodules with a diameter of less than 4 cm, a diameter of less than 3 cm without Hashimoto's disease, and ultrasonographic k-tirads category 4 or 5. Therefore, the benign results of fine-needle aspiration biopsies obtained from these nodules can be more reliable than others.
References
- Agcaoglu O, Aksakal N, Ozcinar B, Sarici IS, Ercan G, Kucukyilmaz M ve ark. (2013). Factors that affect the false-negative outcomes of fine-needle aspiration biopsy in thyroid nodules. International Journal of Endocrinology, https://doi.org/10.1155/2013/126084.
- Alexander EK, Marqusee E, Orcutt J, Benson CB, Frates MC, Doubilet PM ve ark. (2004). Thyroid nodule shape and prediction of malignancy. Thyroid, 14(11), 953-958.
- Bozbıyık O, Öztürk Ş, Ünver M, Erol V, Bayol Ü, Aydın C. (2017). Reliability of fine needle aspiration biopsy in large thyroid nodules. Turkish Journal of Surgery, 33(1), 10-13.
- Cibas ES, Ali SZ (2017). The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid, 27(11), 1341-1346.
- Çahalov M, Makay Ö, İçöz G, Akyıldız M, Yılmaz M. (2013). What should be done in thyroid nodules less than two centimeters, ultrasonographically suspicious and cytologically benign? Turkish Journal of Surgery/Ulusal cerrahi dergisi, 29(4), 167-170.
- Davies L, Welch HG. (2014). Current thyroid cancer trends in the United States. JAMA Otolaryngology–Head & Neck Surgery, 140(4), 317-322.
- Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A ve ark. (2015). The natural history of benign thyroid nodules. Jama, 313(9), 926-935.
- Gharib H, Goellner JR. (1993). Fine-needle aspiration biopsy of the thyroid: an appraisal. Annals of Internal Medicine, 118(4), 282-289.
- Gharib H, Goellner JR, Johnson DA. (1993). Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies. Clinics In Laboratory Medicine, 13(3), 699-709.
- Hegedüs L. (2004). Clinical practice: The thyroid nodule. N Engl J Med, 351, 1764-1771.
- Hershman JM, Cheng S, Gianoukakis AG. (2011). Update in thyroidology 2010. The Journal of Clinical Endocrinology & Metabolism, 96(1), 9-14.
- Karadeniz E, Yur M, Temiz A, Akçay MN. (2019). Malignancy risk for thyroid nodules larger than 4 cm and diagnostic reliability of ultrasound-guided FNAB results. Turkish Journal of Surgery, 35(1), 13-18.
- McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. (2007). The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery, 142(6), 837-844.
- Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard BA ve ark. (2014). Guidelines for the management of thyroid cancer. Clinical Endocrinology, 81, 1-122.
- Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. (2009). Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Archives of Surgery, 144(7), 649-655.
- Ravetto C, Colombo L, Dottorini ME. (2000). Usefulness of fine‐needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer Cytopathology, 90(6), 357-363.
- Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Maso LD. (2016). Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med, 375(7), 614-617.
- Wharry LI, McCoy KL, Stang MT, Armstrong MJ, LeBeau SO, Tublin ME ve ark. (2014). Thyroid nodules (≥ 4 cm): can ultrasound and cytology reliably exclude cancer? World Journal of Surgery, 38, 614-621.
- Yang J, Schnadig V, Logrono R, Wasserman PG. (2007). Fine‐needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer Cytopathology, 111(5), 306-315.
- Yeh MW, Demircan O, Ituarte P, Clark OH. (2004). False-negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. Thyroid, 14(3), 207-215
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Research Articles |
| Authors | |
| Publication Date | August 30, 2023 |
| Submission Date | March 24, 2023 |
| Published in Issue | Year 2023 Volume: 16 Issue: 2 |
Van Health Sciences Journal (Van Sağlık Bilimleri Dergisi) başlıklı eser bu Creative Commons Atıf-Gayri Ticari 4.0 Uluslararası Lisansı ile lisanslanmıştır.
