Tiroid Kitlelerinde Ultrasonografik Bulgular İle İnce İğne Aspirasyon Biyopsi Sonuçlarının Değerlendirilmesi
Öz
Bu çalışmanın amacı tiroid nodüllerinin tanısında kullanılan USG ve İİAB sonuçlarımızı bildirmektir. Araştırma retrospektif 82 hasta çalışmaya dahil edildi. Çalışma için hastaların verileri geriye yönelik detaylıca değerlendirilerek yaş, cinsiyet, tiroid USG ve İİAB patoloji sonuçları kayıt altına alındı. Veriler 2017 Tiroid Görüntüleme Raporlama ve Veri Sistemini(TI-RADS) sınıflamasına göre sınıflandırıldı. İİAB sitoloji sonuçlarını bildirmek için 2023 Bethesda sınıflaması kullanıldı. Tanısal olmayan kategoriye sahip sonuçlar için tekrar İİAB önerildi. Benign lezyonlar klinik ve sonografik olarak takip edildi. Belirsiz veya foliküler lezyonları olan hasta grubunda, endokrinoloji bölümüne detaylı araştırma amacıyla yönlendirildi. Malignite şüpheli ve malign olarak raporlanan nodülü olan hastalara cerrahi önerildi. Olguların 61’i kadın(%75,3), 20’si erkek(%24,7) idi. Toplam 81 hastaya, 85 İİAB yapıldı. Sonografik sonuçlara göre 8 İİAB TI-RADS 1(%9,4), 21 İİAB TI-RADS 2(%24,7), 16 İİAB TI-RADS 3(%18,8), 33 İİAB TI-RADS 4(% 38,8), 7 İİAB TI-RADS 5(%8,2) olarak sonuçlandı. Sitoloji sonuçları ise bethesda kategorisine göre 12(%14,1) İİABde tanısal olmayan, 42(%49,4) İİABde benign, 15(%17,6) İİABde önemi belirsiz atipi, 5(%5,8) İİABde foliküler neoplazi şüphesi, 7(%8,2) İİABde malignite şüphesi, 4(%5,8) İİABde malign olarak raporlandı. TI-RADS 4 olan 33 İİABnin 3’ü(%9), TI-RADS 5 olan 7 İİABnin 1’i(%14,2) Bethesda sınıflamasına göre malign olarak raporlanmıştır. TI-RADS 1, TI-RADS 2 ve TI-RADS 3 olan İİAB lerin hiçbiri malign olarak raporlanmamıştır. Bethesda sınıflamasına göre malignite şüphesi ve malign olarak raporlanan 12 hastaya total tiroidektomi önerildi. 7 hasta cerrahiyi kabul etmedi, total tiroidektomi yapılan 4 hastanın 3’ünde sonuç papiller tiroid kanseri, 2 vakada ise fokal nodüler hastalık olarak raporlandı. 1 vaka ise dış merkezde opere olmayı tercih ettiğinden dolayı sonuçlara ulaşılamadı. Tiroid nodülleri değerlendirilirken yalnızca ultrasonografik bulgulara dayanarak değil klinik şüphe ve detaylı anamnez ile şüphemizi desteklemeli ve gerekirse İİAB tetkikine yönlenmeliyiz.
Etik Beyan
Bu araştırma Helsinki Deklarasyonu Prensipleri’ne uygun şekilde gerçekleştirilmiştir. Çalışmanın yürütülmesi için, girişimsel olmayan klinik araştırma etik komitesinden (onay tarihi: 26/04/2023, protokol kodu: SÜKAEK-2023 8/16), Samsun Üniversitesi hastanesinin başhekiminden izin alınmıştır.
Destekleyen Kurum
Samsun Üniversitesi Tıp Fakültesi
Kaynakça
- Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda system for reporting thyroid cytopathology. Thyroid, 33(9): 1039-1044.
- Barroeta JE, Wang H, Shiina N. 2006. Is fine-needle aspiration (FNA) of multiple thyroid nodules justi- fied?. Endocrine Pathol, 17: 61-65.
- Burguera B, Gharib H. 2000. Thyroid incidentalomas. Prevalence, diagnosis, sig- nificance, and management. Endocrinol Metab Clin North Am, 29: 187-203.
- Cooper DS, Doherty GM, Haugen BR. 2006. Management guidelines forpatients with thyroid nodules and differentiated thyroid cancer. Thyroid, 16: 109-142.
- Dean DS, Gharib H. 2008. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab, 22(6): 901-911.
- Deandrea M, Mormile A, Veglio M, Motta M, Pellerito R, Gallone G, Grassi A, Torchio B, Bradac R, Garberoglio R, Fonzo D. 2002 Jul-Aug. Fine-needle aspiration biopsy of the thyroid: comparison between thyroid palpation and ultrasonography. Endocr Pract, 8(4): 282-286.
- Gharib H, Goellner JR. 1995. Fine-needle aspiration biopsy of the thyroid nodules. Endocr Pract, 16: 410-417.
- Hegedus L. 2004. The thyroid nodule. N Engl J Med, 351: 1764 -1771.
- Malakzai HA, Khairy AL, Haidary AM, Hamidi H, Hussaini N, Ahmady SH, Abdul-Ghafar J. 2023. Relationship of age and gender with cytopathological findings of thyroid nodules diagnosed by FNAC: a retrospective study. Clin Exp Med. 23(6): 2201-2207.
- Mitchell J, Parangi S. 2005. The thyroid incidentaloma: An increasingly frequent consequence of radiologic imaging. Semin Ultrasound CT MR, 26: 37-46.
- Ogilvie JB, Piatigorsky EJ, Clark OH. 2006. Current status off in needle aspiration for thyroid nodules. Adv Surg, 40: 223-238.
- Refetoff S, Harrison J, Karanfilski BT. 1975. Continuing occurrence of thyroid carcinoma after irradiation to the neck in infancy and childhood. N Engl J Med, 292: 171-175.
- Singaporewalla RM, Hwee J, Lang TU, Desai V. 2017, Clinicopathological Correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications. World J Surg, 41(7): 1807-1811.
- Soyer Güldoğan E, Ergun O, Taşkın Türkmenoğlu T, Yılmaz KB, Akdağ T, Özbal Güneş S, Durmaz HA, Hekimoğlu B. 2021. The impact of TI-RADS in detecting thyroid malignancies: a prospective study. Radiol Med, 126(10): 1335-1344.
- Tessler FN, Middleton WD, Grant EG. 2017. ACR Thyroid ımaging, reporting and data system (TI-RADS): White paper of the ACR TI-RADS committee. J Am Coll Radiol, 14(5): 587-595.
- Wilhelm SM, Robinson AV, Krishnamurthi SS. 2007. Evaluation and management of incidental thyroid nodules in patients with another primary malignancy. Surgery, 142: 581-586.
- Yeung MJ, Serpell JW. 2008 Feb. Management of the solitary thyroid nodule. Oncologist, 13(2): 105-112.
Evaluation of Ultrasonographic Findings and Fine Needle Aspiration Biopsy Results in Thyroid Nodules
Öz
The aim of this study was to report the results of USG and FNAB used in the diagnosis of thyroid nodules. The study is retrospective and 82 patients were included in the study. For the study, the patients' data were evaluated retrospectively in detail and age, gender, thyroid USG and FNAB pathology results were recorded. Data were classified according to the 2017 Thyroid Imaging Reporting and Data System (TI-RADS) classification. The 2023 Bethesda classification was used to report FNAB cytology results. Repeat FNAB was recommended for results categorised as non-diagnostic. Benign lesions were followed clinically and sonographically. Surgery was recommended for patients with suspected malignancy and those reported as malignant. 61 of the patients were female (75.3%) and 20 were male (24.7%). A total of 86 FNABs were performed in 81 patients. According to sonographic results, 8 FNAB TI-RADS 1(9.4%), 21 FNAB TI-RADS 2(24.7%), 16 FNAB TI-RADS 3(18.8%), 33 FNAB TI-RADS 4(38.8%), 7 FNAB TI-RADS 5(8.2%). Cytology results were reported as 12(%14.2) FNAB non-diagnostic, 42(49.4%) FNAB benign, 15(17.6%) FNAB atypia of uncertain significance, 5(5.8%) FNAB suspected follicular neoplasia, 7(8.2%) FNAB suspected malignancy, 5(5.8%) FNAB malignant. Of the 33 fine-needle aspiration biopsies (FNABs) categorized as TI-RADS 4, three cases (9%) were classified as malignant based on the Bethesda System. Additionally, among the seven FNABs classified as TI-RADS 5, one case (14.2%) was reported as malignant. No malignancies were identified in FNABs classified as TI-RADS 1, TI-RADS 2, or TI-RADS 3. Total thyroidectomy was recommended for 12 patients with suspected malignancy and malignant according to Bethesda classification. 7 patients did not accept surgery, the result was reported as papillary thyroid cancer in 3 of 4 patients who underwent total thyroidectomy and focal nodular disease in 2 cases. In 1 case, the results could not be reached because the patient preferred to be operated in an external centre. When evaluating thyroid nodules, we should not rely solely on ultrasonographic findings but should support our suspicion with clinical suspicion and detailed anamnesis and if necessary, we should refer to FNAB examination.
Kaynakça
- Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda system for reporting thyroid cytopathology. Thyroid, 33(9): 1039-1044.
- Barroeta JE, Wang H, Shiina N. 2006. Is fine-needle aspiration (FNA) of multiple thyroid nodules justi- fied?. Endocrine Pathol, 17: 61-65.
- Burguera B, Gharib H. 2000. Thyroid incidentalomas. Prevalence, diagnosis, sig- nificance, and management. Endocrinol Metab Clin North Am, 29: 187-203.
- Cooper DS, Doherty GM, Haugen BR. 2006. Management guidelines forpatients with thyroid nodules and differentiated thyroid cancer. Thyroid, 16: 109-142.
- Dean DS, Gharib H. 2008. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab, 22(6): 901-911.
- Deandrea M, Mormile A, Veglio M, Motta M, Pellerito R, Gallone G, Grassi A, Torchio B, Bradac R, Garberoglio R, Fonzo D. 2002 Jul-Aug. Fine-needle aspiration biopsy of the thyroid: comparison between thyroid palpation and ultrasonography. Endocr Pract, 8(4): 282-286.
- Gharib H, Goellner JR. 1995. Fine-needle aspiration biopsy of the thyroid nodules. Endocr Pract, 16: 410-417.
- Hegedus L. 2004. The thyroid nodule. N Engl J Med, 351: 1764 -1771.
- Malakzai HA, Khairy AL, Haidary AM, Hamidi H, Hussaini N, Ahmady SH, Abdul-Ghafar J. 2023. Relationship of age and gender with cytopathological findings of thyroid nodules diagnosed by FNAC: a retrospective study. Clin Exp Med. 23(6): 2201-2207.
- Mitchell J, Parangi S. 2005. The thyroid incidentaloma: An increasingly frequent consequence of radiologic imaging. Semin Ultrasound CT MR, 26: 37-46.
- Ogilvie JB, Piatigorsky EJ, Clark OH. 2006. Current status off in needle aspiration for thyroid nodules. Adv Surg, 40: 223-238.
- Refetoff S, Harrison J, Karanfilski BT. 1975. Continuing occurrence of thyroid carcinoma after irradiation to the neck in infancy and childhood. N Engl J Med, 292: 171-175.
- Singaporewalla RM, Hwee J, Lang TU, Desai V. 2017, Clinicopathological Correlation of thyroid nodule ultrasound and cytology using the TIRADS and Bethesda classifications. World J Surg, 41(7): 1807-1811.
- Soyer Güldoğan E, Ergun O, Taşkın Türkmenoğlu T, Yılmaz KB, Akdağ T, Özbal Güneş S, Durmaz HA, Hekimoğlu B. 2021. The impact of TI-RADS in detecting thyroid malignancies: a prospective study. Radiol Med, 126(10): 1335-1344.
- Tessler FN, Middleton WD, Grant EG. 2017. ACR Thyroid ımaging, reporting and data system (TI-RADS): White paper of the ACR TI-RADS committee. J Am Coll Radiol, 14(5): 587-595.
- Wilhelm SM, Robinson AV, Krishnamurthi SS. 2007. Evaluation and management of incidental thyroid nodules in patients with another primary malignancy. Surgery, 142: 581-586.
- Yeung MJ, Serpell JW. 2008 Feb. Management of the solitary thyroid nodule. Oncologist, 13(2): 105-112.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi (Diğer) |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mayıs 2025 |
| Gönderilme Tarihi | 10 Kasım 2024 |
| Kabul Tarihi | 13 Şubat 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 8 Sayı: 3 |
