Tiroid Nodüllerinin Yönetiminde İnce İğne Aspirasyon Biyopsisine Ne Zaman ve Ne Kadar Güvenmeliyiz?

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.

Anahtar Kelimeler:

ince iğne aspirasyon biyopsisi, tiroid nodülü, yalancı negatiflik

When and How Much Should We Rely on Fine Needle Aspiration Biopsy to Manage Thyroid Nodules?

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.

Keywords:

Fine needle aspiration biopsy, thyroid nodule, false negativity,

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