Özlem SUVAK, Barış SAYLAM, Faruk COŞKUN, Mehtap OKTAY, Aynur ALBAYRAK, Burak SUVAK, Serkan TORUN, Yavuz BEYAZIT

“Tiroid nodülü tanısıyla takip edilen hastalarımızdaki tiroid kanser insidansı: Bir referans merkez çalışması”

Giriş: Bu retrospektif çalışmada hastanemize başvurarak tiroid nodülü saptanmış olan hastalarda tiroid kanseri insidansını saptamayı ve kanser tespit edilen hastaların tiroid ince iğne aspirasyon biyopsisi ile demografik özellikler, laboratuar ve görüntüleme tetkik sonuçlarının kanserle ilişkisini değerlendirmeyi amaçladık. Hastalar ve Yöntemler: Ocak 1999 ile Ekim 2007 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi 3. Genel Cerrahi Kliniği’nde tiroid nodülü nedeniyle takip ve tedavi edilen 473 hasta retrospektif olarak incelendi. Hastaların demografik özellikleri, labo ratuar sonuçları, tiroid ince iğne aspirasyon biyopsisi sonuçları ve patolojik tanıları çalışma için hazırlanmış formlara kaydedildi. Bulgular: Çalışmaya toplamda 233 multinodüler guatr, 150 toksik multinodüler guatr, 54 nodüler guatr, 20 toksik nodüler guatr ve 13 papiller tiroid kanseri dahil edildi. Tiroid nodülü olup tiroidektomi operasyonu uygulanan 428 hastanın 54 (%12.6)’ünde tiroid kanseri tespit edildi. Preoperatif tanı yöntemi olarak malignite için anlamlı tek parametrenin tiroid ince iğne aspirasyon biyopsisi (TİİAB) olduğu bulundu (p=0,0). Tartışma: Bu çalışmada tiroid kanseri saptanan hasta lardaki en sık histolojik tip papiller tiroid kanseri idi. Ayrıca eskiden beri bilinenin aksine tirotoksik hastalarda da hipoaktif (soğuk) nodülü olan hastalar kadar tiroid kanserinin sık olduğu gösterildi. Demografik özellikler ve klinik bulguların malign olguları ayrıştırmada belirgin etkisinin olmadığı, yine en değerli tanı yönteminin TİİAB olduğu da açıkça gözlemlenmiştir. Bu bulgular göz önün de bulundurularak tiroid nodülü saptanan hastalarda USG bulgularına göre TİİAB ile değerlendirme mutlaka yapılmalı, buna göre takip veya tedavi kararı alınmalıdır.

Anahtar Kelimeler:

Geriyedönük çalışma, Tiroid neoplazmları, Görülme sıklığı, Tiroid nodülü, Biyopsi, ince-iğne

Incidence of thyroid carcinoma in patients with thyroid nodules: experience of a tertiary referral center

Introduction: In this retrospective analysis we aimed to determine the incidence of thyroid carcinoma in patients with thyroid nodules who were admitted to our hospital. The relation between thyroid carcinoma and thyroid fine needle aspiration biopsy (TFNA), demographic factors, laboratory and imaging characteristics were also evaluated. Materials and Methods: Four hundred seventy three patients diagnosed with thyroid nodules who were admitted to 3rd general surgery clinic of Ankara Numune Education and Research Hospital during January 1999 and September 2007 were evaluated retrospectively. The demographic factors, laboratory results, TFNA and pathologic results, were noted and analyzed statistically Results: Two hundred and thirty three patients with the diagnosis of multinodular goiter, 150 toxic multinodular goiter, 54 nodular goiter, 20 toxic nodular goiter and 13 papillary thyroid cancer were included in the study. Of these 428 patients who underwent thyroid surgery due to the thyroid nodules, thyroid cancer was detected in 54 (12.6%) patients. TFNA was found to be the only significant parameter for detecting a thyroid malignancy as a preoperative diagnostic method. Discussion: Papillary thyroid cancer was the most detected histologic type of cancer in patients with thyroid malignancy. Moreover, contrary to previous studies, it was shown that thyrotoxic patients had an increased thyroid cancer rate as in patients who had hypoactive (cold) nodules. Although TFNA was found to be the gold standard for detecting malignancy, demographic and clinical profiles did not have a significant effect for detecting malignant outcome. Based on these results in patients with thyroid nodules TFNA must be performed according to the ultrasonographic examinations in order to decide follow-up and/or treatment.

Keywords:

Retrospective Studies, Thyroid Neoplasms, Incidence, Thyroid Nodule, Biopsy, Fine-Needle,

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