Belirsiz sitolojili tiroid nodüllerinde ince iğne aspirasyon biyopsisi yanlış negatifliğine etkili faktörler

Amaç: İnce iğne aspirasyon biyopsilerinin (İİAB) yanlış negatif sonuçları tiroid nodüllerine yaklaşımda en önemli sorunlardan biri olmaya devam etmektedir. Bu çalışmanın amacı, özellikle belirsiz sitolojili tiroid nodüllerinde İİAB'nin yanlış negatif sonuçlarını etkileyen faktörleri değerlendirmektir. Gereç ve Yöntem: Ocak 2017 ile Ocak 2020 arasında İİAB yapılan ve ardından tiroidektomi kararı alınan tiroid nodüllü hastalar çalışmaya dahil edildi. TIRADS sınıflamasına uygun olarak şüpheli nodüllerden İİAB yapıldı. İİAB'ye göre "atipi/önemi belirsiz foliküler lezyon (AUS/FLUS)", "Non-diagnostik sitoloji (ND)" veya "Folliküler neoplazm/foliküler neoplazm için şüpheli (FN/SFN)" olan nodüller "Belirsiz sitoloji (IC)" olarak tanımlandı. Nodüller İİAB ve final patoloji uyumlarına göre iki gruba ayrıldı. Yalancı negatif İİAB saptanan nodüller Grup-1'e alınırken, doğru pozitif ve doğru negatif İİAB sonuçları Grup 2'ye alındı. Hastaların demografik ve klinik verileri, patolojik sonuçları ve genetik profilleri tüm hastalar ve IC grubu için ayrı ayrı istatistiksel olarak karşılaştırıldı. Bulgular: 94 hastanın İİAB sonuçları ile final patoloji sonucları uyumsuz (Grup-1), 233 hastanın ise uyumlu bulundu (Grup-2). IC alt grubunda 95 hastanın 56'sı IC/Grup-1'de, 39'u ise IC/Grup-2'de yer aldı. Ekstratiroidal yayılım (%71.4 vs. %30.8), perinöral/lenfovasküler invazyon (%60.0 vs. %29.6), klasik varyant varlığında (%68.5 vs. 50.7%), non-enkapsüle tümörlerde (%67.9 vs. %50.0) ve multisentrik tümörlerde (%47.2 vs. %24.1) İİAB doğruluğu istatistiksel olarak anlamlı derecede yüksek saptandı. IC grubunda tiroidit varlığında (%75.0 vs. %49.2) ve yüksek serum Anti-TPO düzeylerinde (%60.0 vs. %30.7) İİAB yanlış negatifliği artmaktadır. Yüksek serum Nötrofil/Lenfosit Oranı (NLR) ve küçük tümör boyutu varlığı da özellikle IC grubu hastalarda İİAB'nin yanlış negatifliğini arttırmaktadır. Sonuç: Ekstratiroidal yayılım, perinöral/lenfovasküler invazyon, non-enkapsüle tümör ve multisentrik tümörler gibi agresif seyir göstermesi beklenen tümörlerde ve klasik varyant tümörlerde İİAB'nin tanısal doğruluğu artmaktadır. Bununla beraber tiroidit varlığında, yüksek serum Anti-TPO düzeyleri ve yüksek NLR varlığında İİAB'nin yanlış negatif sonuçlarının arttığı akılda tutulmalıdır.

Anahtar Kelimeler:

Tiroid nodülü, İİAB, Indeterminate sitoloji, tiroid malignitesi

Factors affecting the false negativity of fine-needle aspiration biopsy in thyroid nodules with indeterminate cytology

Purpose: False negative results of fine needle aspiration biopsies (FNAB) remain one of the most important problems in the management of thyroid nodules. The aim of this study was to evaluate the factors affecting the false negative results of FNAB, especially in thyroid nodules with indeterminate cytology. Materials and Methods: Patients with thyroid nodules who underwent FNAB and subsequent thyroidectomy between January 2017 and January 2020 were included in the study. FNAB was performed on suspicious nodules according to the TIRADS classification. Nodules with "atypia/follicular lesion of undetermined significance (AUS/FLUS)", "non-diagnostic (ND)" cytology or "follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)" according to FNAB were defined as "indeterminate cytology (IC)". Nodules were analyzed in two groups. Nodules with false negative FNAB were included in Group-1, while nodules with true positive and true negative FNAB were included in Group-2. Demographic and clinical data, pathologic results and genetic profiles of the patients were statistically compared for all patients and IC group separately. Results: The results of FNAB and final pathology were discordant in 94 patients (Group-1) and concordant in 233 patients (Group-2). In the IC subgroup, 56 of 95 patients were in IC/Group-1 and 39 patients were in IC/Group-2. The accuracy of FNAB was statistically significantly higher in the presence of extrathyroidal extension (71.4% vs. 30.8%), perineural/lymphovascular invasion (60.0% vs. 29.6%), classical variants (68.5% vs. 50.7%), non-encapsulated tumors (67.9% vs. 50.0%) and multicentricity (47.2% vs. 24.1%). In the IC group, the presence of thyroiditis (75.0% vs. 49.2%) and high serum Anti-TPO levels (60.0% vs. 30.7%) increased the rate of false negativity on FNAB. High serum Neutrophil to Lymphocyte Ratio (NLR) and small tumor size also increase the false negativity of FNAB, especially in IC group patients. Conclusion: The diagnostic accuracy of FNAB is increased in classical variant tumors and in tumors expected to be aggressive due to presence of extra-thyroidal extension, perineural/lymphovascular invasion, non-encapsulated tumors and multicentricity. It should be kept in mind that the false negative results of FNAB increase in the presence of thyroiditis, high level of serum anti-TPO and high level of NLR.

Keywords:

Thyroid nodule, FNAB, Indeterminate cytology, thyroid malignancy,

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