Tiroid Kanseri Tanısında ACR-TIRADS Skorlama Sistemi ile Bethesda Sınıflama Sisteminin Birlikte Kullanımının Önemi

Amaç: Tiroid kanseri (TK) olgularında Bethesda sistemi ile ACR-TIRADS skorlarının birlikte kullanımının önemini vurgulamayı amaçladık. Gereç ve Yöntem: Multinodüler guatr ve TK ön tanılarıyla total tiroidektomi yapılan hastalar retrospektif olarak incelendi. Hasta yaşı, cinsiyeti gibi demografik veriler ve nodül büyüklüğü kayıt altına alındı. Hastaların preoperatif Bethesda kategorilerine göre ACR-TIRADS skorları değerlendirildi. Bulgular: Çalışmaya toplam 241 hasta dahil edildi. Ortalama yaş 46,68±12,62 yıl ve kadın/erkek oranı 205/36 idi. Nodül boyutu ortalama 24,33±15,7 mm olarak tespit edildi. Bethesda 1 kategorisinde olan 6 hastanın 2’si (%33,3) TR4, 1 hasta (%16,7) TR5 olarak raporlandı. Bethesda 2 kategorisindeki 46 hastanın 13’ü (%28,3) TR4, 2 hasta (%4,3) TR5 olarak raporlandı. Bethesda 3-4 kategorisindeki 49 hastanın 17’si (%34,6) TR4, 1’i (%2,0) TR5 olarak raporlandı. Bethesda 5 kategorisinde olan 16 hastanın 11’i (%68,8) TR4, 1’i (%6,3) TR5 olarak raporlandı. Bethesda 6 kategorisindeki 124 hastanın 61’i (%49,2) TR4, 13’ü (%10,5) TR5 olarak raporlandı. Sonuç: ACR-TIRADS raporlama sistemini kullanmanın temel amacı tiroid nodüllerinin malign potansiyelini belirlemek ve benign biyopsi sonuçları gelen olgularda tedavi stratejisini belirlemeye yardımcı olmaktır. Bu çalışmanın sonuçları, tiroid nodüllerinin tanı ve tedavisinde yardımcı olacak iki yöntemin birlikte kullanımını desteklemektedir.

The Importance of Using ACR-TIRADS Scoring System and Bethesda Classification System Together in the Diagnosis of Thyroid Cancer

Objectives: We aimed to emphasize the importance of using the Bethesda system and ACR-TIRADS scores together in thyroid cancer (TC) cases. Materials and Methods: Patients who underwent total thyroidectomy with a pre-diagnosis of multinodular goiter and TC were retrospectively analyzed. Demographic data such as patient age and gender and nodule size were recorded. The ACR-TIRADS scores of the patients were evaluated according to the preoperative Bethesda categories. Results: A total of 241 patients were included. The mean age was 46.68±12.62 years and the female/male ratio was 205/36. The mean nodule size was 24.33±15.7 mm. Of the 6 patients in the Bethesda 1 category, 2 (33.3%) were reported as TR4 and 1 (16.7%) as TR5. Of the 46 patients in the Bethesda 2 category, 13 (28.3%) were reported as TR4, and 2 (4.3%) as TR5. Of the 49 patients in the Bethesda 3-4 category, 17 (34.6%) were reported as TR4, and 1 (2.0%) as TR5. Of the 16 patients in the Bethesda 5 category, 11 (68.8%) were reported as TR4 and 1 (6.3%) as TR5. Sixty-one (49.2%) of 124 patients in Bethesda 6 category were reported as TR4 and 13 (10.5%) as TR5. Conclusion: The main purpose of using the ACR-TIRADS reporting system is to determine the malignant potential of thyroid nodules and to help determine the treatment strategy in cases with benign biopsy results. The results of this study support the use of two methods to help in the diagnosis and treatment of thyroid nodules.

PDF

___

1. Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Invest. 2010;33:287-291.
2. Belfiore A, Giuffrida D, La Rosa GL, et al. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh). 1989;121:197-202.
3. Wei X, Li Y, Zhang S, et al. Meta-analysis of thyroid imaging reporting and data system in the ultrasonographic diagnosis of 10,437 thyroid nodules. Head Neck. 2016;38:309-315.
4. Thyroid cancer survival by type and stage. In: thyroid cancer. Accessed March 3, 2014.
5. Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892-899.
6. Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TIRADS Committee. J Am Col Radiol. JACR. 2017;14:587-595.
7. Hamberger B, Gharib H, Melton LJ 3rd, et al. Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care. Am J Med. 1982;73:381-384.
8. Mundasad B, Mcallister I, Carson J, et al. Accuracy of fine needle aspiration cytology in diagnosis of thyroid swellings. Internet J Endocrinol 2006.
9. Baloch ZW, LiVolsi VA, Asa SL, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008;36:425-437.
10. Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology. New York: Springer; 2010.
11. Pusztaszeri M, Rossi ED, Auger M, et al. The Bethesda System for Reporting Thyroid Cytopathology: Proposed Modifications and Updates for the Second Edition from an International Panel. Acta Cytol. 2016;60:399-405.
12. Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009;132:658-665.
13. Kwak JY, Kim EK, Kim HJ, et al. How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol. 2009;19:1923-1931.
14. Oyar O. Boyun Ultrasonografisi. İzmir: Güven-Nobel Tıp Kitabevleri.; 2000. s. 161-168.
15. Tollin SR, Mery GM, Jelveh N, et al. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid. 2000;10:235-241.
16. Leenhardt L, Hejblum G, Franc B, et al. Indications and limits of ultrasoundguided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab. 1999;84:24-28.
17. Durante C, Costante G, Lucisano G, et al. The natural history of benign thyroid nodules. JAMA. 2015;313:926-935.
18. Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14:587-595.
19. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94:1748-1751.
20. Yoon JH, Lee HS, Kim EK, et al. Thyroid Nodules: Nondiagnostic Cytologic Results according to Thyroid Imaging Reporting and Data System before and after Application of the Bethesda System. Radiology. 2015;276:579- 587.
21. Chng CL, Kurzawinski TR, Beale T. Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology. Clin Endocrinol (Oxf). 2015;83:711-716.
22. Chandramohan A, Khurana A, Pushpa BT, et al. Is TIRADS a practical and accurate system for use in daily clinical practice? Indian J Radiol Imaging. 2016;26:145-152.
23. Srinivas MN, Amogh VN, Gautam MS, et al. A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions. J Clin Imaging Sci. 2016;6:5.
24. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94:1748-1751.
25. Park JY, Lee HJ, Jang HW, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009;19:1257-1264.
26. Sarkis LM, Norlen O, Aniss A, et al. The Australian experience with the Bethesda classification system for thyroid fine needle aspiration biopsies. Pathology. 2014;46:592-595.
27. Melo-Uribe MA, Sanabria Á, Romero-Rojas A, et al. The Bethesda system for reporting thyroid cytopathology in Colombia: Correlation with histopathological diagnoses in oncology and non-oncology institutions. J Cytol. 2015;32:12-16.
28. Alshaikh S, Harb Z, Aljufairi E, et al. Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. Cytojournal. 2018;15:4.
29. Haugen BR, Alexander EK, Bible KC, 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. 2016;26:1-133.