Maligniteyi Öngörmede Tiroid Nodüllerinin Ultrasonografik Özellikleri ve Sitopatoloğun Rolü
Amaç: Tiroid ince iğne aspirasyon biyopsisi ile değerlendirilmesi gereken doğru nodülleri belirlemek ve gereksiz işlemlerden kaçınmak çok önemlidir. Bu çalışmada tiroid ince iğne aspirasyon biyopsi sonuçları ile ultrasonografik özellikler arasındaki ilişkiyi ve patoloğun rolünü incelemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya tiroid ince iğne aspirasyon biyopsisi yapılan 458 hasta dahil edildi. Ultrasonografik özellikler (ekojenite, şekil, vaskularizasyon, sınır ve kalsifikasyon) ve biyopsi sonuçları ile patolog faktörü arasındaki ilişki retrospektif olarak değerlendirildi. Bethesda VI (malign) sonucu olmadığı için 5 alt grup arasında analizler yapıldı. İİAB işlemleri patoloji sonuçları açısından yetersiz, benign, önemi belirsiz atipi/önemi belirsiz folliküler lezyon, foliküler neoplazi ve malignite şüphesi olarak değerlendirilmiştir. Bulgular: Düzensiz sınır, hipoekojenite, mikrokalsifikasyon varlığı, ön-arka çapın transvers çapından büyük olması (AP> T) Bethesda alt grupları arasında istatistiksel olarak farklı bulundu. (ekojenite için p
Ultrasonographic Characteristics of Thyroid Nodules in Predicting the Malignancy and the Role of the Cytopathologist
Aim: It is very important to determine the correct nodules which should be evaluated with thyroid fine- needle aspiration biopsy (FNAB) and avoid unnecessary operations. In this study, we aimed to analyze the relationship and the compatibility between thyroid FNAB results with ultrasonographic features and the role of the pathologist who examines the specimens. Material and Methods: 458 patients with nodules who underwent FNAB were included in the study. The relationships between the ultrasonographic features (echogenicity, shape, margin, vascularization and calcification) and biopsy results and, the factor of the pathologist were evaluated retrospectively. Since there was no Bethesda VI (malignant) result, analyzes were made among 5 subgroups. FNAB procedures were considered as, inadequate or nondiagnostic, benign, atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), follicular neoplasia and suspicion of malignancy. Results: Solid internal structure, irregular margin, hypoechogenicity, presence of microcalcification, nodules with taller than wide (AP> T) were found significantly different between the subgroups of Bethesda classification system (p
___
- 1. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM. Risk of malignancy in nonpalpable thyroid nodules: Predictive value of US and color- Doppler features. J Clin Endocrinol Metab 2002;87:1941-1946.
- 2. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A. Diagnostic accuracy of conventional versus sonography- guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 1998;8:15-21.
- 3. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS. Eur Thyroid J 2017;6:225-237.
- 4. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017;27:1341-1346.
- 5. Frates MC, Benson CB. Society of Radiologists in Ultrasound. Management of thyroid nodules detected at US: Society of Radiologists in US consensus conference statement. Radiology 2005;237:794-800.
- 6. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, Kim J, Kim HS, Byun JS, Lee DH, Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology. Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology. Benign and malignant thyroid nodules: US differentiation: Multicenter retrospective study. Radiology 2008;247:762-770.
- 7. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178: 687-691.
- 8. Takashima S, Fakuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: Re-evaluation with ultrasound. J Clin Ultrasound 1995;23:179-184.
- 9. Clary KM, Condel JL, Liu Y, Johnson DR, Grzybick DMi, Raab SS. Variability in the fine needle aspiration biopsy diagnosis of follicular lesions of the thyroid gland. Acta Cytol 2005;49:378- 382.
- 10. Seok JY, An J, Cho HY. Improvement of diagnostic performance of pathologists by reducing the number of pathologists responsible for thyroid fine needle aspiration cytology: An institutional experience. Diagn Cytopathol 2018;46:561-567.
- 11. Jing X, Knoepp SM, Roh MH, Hookim K, Placido J, Davenport R, Rasche R, Michael CW. Group consensus review minimizes the diagnosis of “follicular lesion of undetermined significance” and improves cytohistologic concordance. Diagn Cytopathol 2012;40:1037-1042.
- 12. Gerhard R, Boerner SL. The value of second opinion in thyroid cytology: A review. Cancer Cytopathology 2014;122:611-619.