Selçuk GÜNEŞ, Nuri Alper ŞAHBAZ, Cevher AKARSU, MUSTAFA ÇELİK, Murat OLGUN, Ahmet Cem DURAL, İbrahim SAYIN

An analysis of preoperative sonographic findings and fine-needle aspiration biopsy results of thyroidectomy cases

Objectives: This study aims to compare the preoperative sonographic findings, fine-needle aspiration biopsy FNAB and postoperative histopathological results in patients who underwent total thyroidectomy. Patients and Methods: A total of 884 patients 199 males, 685 females; mean age 46.8±12.7 years; range, 16 to 82 years who underwent total thyroidectomy were included. Thyroid ultrasonography was performed in all patients with an initial diagnosis of thyroid nodules. Sonographic findings of thyroid nodules were evaluated. The sonographic characteristics were the number of nodules and sizes, having microcalcifications, having irregular margins and echogenicity. Sonographic malignancy scores were calculated due to sonographic findings. All thyroidectomy specimens were sent for pathological evaluation. The specimens were divided into two groups as benign and malignant groups, due to pathological evaluation. Groups were compared in terms of preoperative sonographic findings, FNAB and postoperative histopathological results. Results: The sonographic malignancy scores were statistically higher in malignant group than in benign group p=0.001 . Nodule size was smaller in malignant group than in benign group p=0.001 . Capsule irregularity rate was statistically higher in malignant group than in benign group p=0.001 . Hypoechogenicity rate was statistically higher in malignant group than in benign group p=0.001 . There was a statistically significant consistency between pathology and FNAB results kappa=0.478, p=0.001 . The sensitivity, specificity, positive predictive and negative predictive values of FNAB were 55.7%, 92.4%, 72.5% and 82.9%, respectively. Conclusion: Although the thyroid FNAB has acceptable sensitivity and specificity, it is not effective alone in establishing a decision of operation. Risk factors of thyroid malignancy should also be considered when assessing FNAB results.

Keywords:

Biopsy, consistency, malignancy, nodule, thyroid, ultrasonography,

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Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid 2013;23:885-91.
Udelsman R, Zhang Y. The epidemic of thyroid cancer in the United States: the role of endocrinologists and ultrasounds. Thyroid 2014;24:472-9.
Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed? Cancer 2017;123:372-81.
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 2016;26:1-133.
Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99:1253-63.
Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009;39:699-706.
Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126:226-31.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.
Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140:317-22.
Leenhardt L, Bernier MO, Boin-Pineau MH, Conte Devolx B, Maréchaud R, Niccoli-Sire P, et al. Advances in diagnostic practices affect thyroid cancer incidence in France. Eur J Endocrinol 2004;150:133-9.
Brito JP, Al Nofal A, Montori VM, Hay ID, Morris JC. The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012. Thyroid 2015;25:999-1007.
Mohammadi A, Hajizadeh T. Evaluation of diagnostic efficacy of ultrasound scoring system to select thyroid nodules requiring fine needle aspiration biopsy. Int J Clin Exp Med 2013;6:641-8.
Kim KM, Park JB, Kang SJ, Bae KS. Ultrasonographic guideline for thyroid nodules cytology: single institute experience. J Korean Surg Soc 2013;84:73-9.
Cheng PW, Chou HW, Wang CT, Lo WC, Liao LJ. Evaluation and development of a real-time predictive model for ultrasound investigation of malignant thyroid nodules. Eur Arch Otorhinolaryngol 2014;271:1199-206.
Herek B, Özcan Ö, Arıkan S, Ersöz F, Sarı S, Dönmez M. Tiroid ince iğne aspirasyon biyopsisi sonuçları ile cerrahi patoloji sonuçlarının karşılaştırılması. Endokrinolojide Diyalog 2011;8:105-10.
İnan G, Sert S, Bircan S, Karahan N, Çiriş İM, Başpınar Ş, et al. Tiroid lezyonlarında tiroid ince iğne aspirasyon biyopsisi ve histopatoloji sonuçlarının karşılaştırılması. SDÜ Tıp Fak Derg 2006:13:27-31.
Akhavan A, Jafari SM, Khosravi MH, Khajehpour H, Karimi-Sari H. Reliability of fine-needle aspiration and ultrasound-based characteristics of thyroid nodules for diagnosing malignancy in Iranian patients. Diagn Cytopathol 2016;44:269-73.
Yerci Ö, Filiz G, Özuysal S, Ertürk E. Tiroid ince iğne aspirasyon biyopsilerinin değerlendirilmesi (1676 olgu). Türkiye Ekopatoloji Dergisi 1997;3:14-8.
Erdem H, Yıldırım Ü, Özaydın İ, Doğan S, Aydın Y, Uzunlar AK, et al. Tiroid ince İğne Aspirasyon Biyopsilerinin Retrospektif Olarak Karşılaştırılması. Konuralp Tıp Dergisi 2012;4:26-30. Sonuçlarının
Cibas ES, Ali SZ. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 2009;132:658-65.
Yeh MW, Demircan O, Ituarte P, Clark OH. False- negative fine-needle aspiration cytology results delay treatment and adversely affect outcome in patients with thyroid carcinoma. Thyroid 2004;14:207-15.
Ucler R, Usluogulları CA, Tam AA, Ozdemir D, Balkan F, Yalcın S, et al. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015;43:622-8.
Samulski TD, Shutty C, LiVolsi VA, Montone K, Baloch Z. The reliability of thyroid nodule ultrasound features and size to predict malignancy in fine needle aspiration specimens: Practical utility for the evaluating pathologist. Diagn Cytopathol 2015;43:471-7.
Tutuncu Y, Berker D, Isik S, Akbaba G, Ozuguz U, Kucukler FK, et al. The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology. Endocrine 2014;45:37-45.
Shin DY, Lee YK, Kim KJ, Park KH, Hwang S, Park SH, et al. Thyroid cancers with benign-looking sonographic features have different lymph node metastatic risk and histologic subtypes according to nodule size. Endocr Pathol 2014;25:378-84.
Na DG, Kim DS, Kim SJ, Ryoo JW, Jung SL. Thyroid nodules with isolated macrocalcification: malignancy risk and diagnostic efficacy of fine-needle aspiration and core needle biopsy. Ultrasonography 2016;35:212-9.
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. Endocr Pract 2006;12:63-102.