The Effects of The Fine Needle Aspiration Biopsy Method To The Surgical Treatment Decision of The Thyroid Nodules

Yıl 2015, Cilt: 16 Sayı: 3, 185 - 191, 27.08.2015

Volkan Öter Ozan Barış Namdaroğlu Serdar Öter Abdullah Eroğlu Mete Dolapçı Ömer Cengiz

https://doi.org/10.18229/ktd.11309

Cited By: 1

Öz

Background: We aimed to investigate the sensitivity of
the frequently used preoperative diagnostic test FNAC
(fine needle aspiration cytology) in thyroid diseases by
analysing the correlation between this test and histopathological examination in the light of our clinical experience.
Materal and Methods: The medical records of 355 thyroid patients who underwent bilateral total thyroidectomy
operation in the 2nd General Surgery Clinic of Ankara
Numune Training and Research Hospital between 2006
January- October 2010 were reviewed. The detection rate
of malignancy by fine-needle aspiration biopsy prior to
thyroidectomy in terms of specificity and sensitivity were
retrospectively analyzed. The diagnostic tests performed
in the preoperative period of the patients, including thyroid function tests, US, scintigraphy and thyroid FNAC
results were correlated with postoperative histopathological examination results.
Findings: The results of FNAC in 167 cases were as follows; benign in 97 (58%), suspicious in 50 (29.9%), insufficient material in 11 (6.6%) and malignant in 9 cases
(5.4%). The sensitivity and specificity of FNAC in our study
were 83% and 100% respectively.
Results: According to the data presented in this study,
determination of the need for operation and verification
of malignancy supports the use of FNAC. But a negative
FNAC result should not impede the indication of thyroidectomy which is planned by the results of other diagnostic tests. The extension of resection should be decided by analyzing of risk factors and by findings of the
neck eksploration.

Anahtar Kelimeler

Fine Needle Aspiration Biopsy, Surgical Treatment, Thyroid

İnce İğne Aspirasyon Biyopsisi Yönteminin Tiroid Nodüllerinde Cerrahi Kararındaki Etkileri

Öz

Giriş: Tiroid hastalıklarında sık kullanılan ameliyat öncesi tanı yöntemi olan İİAB’ nin histopatolojik inceleme ile korelasyonunu yaparak kendi klinik deneyimimiz eşliğinde bu yöntemin duyarlılığını ortaya koymayı amaçladık.

Gereç ve yöntem: Ankara Numune Eğitim ve Araştırma Hastanesi 2. Cerrahi Kliniği’nde Ocak 2006- Aralık 2010 tarihleri arasında total tiroidektomi ameliyatı uygulanan 355 hasta malignite oranı ve ince iğne aspirasyon biyopsinin tiroidektomi öncesi maligniteyi saptamadaki özgüllüğü ve duyarlılığı yönünden geriye dönük olarak incelendi. Hastaların preoperatif dönemde yapılan laboratuar incelemeleri, tiroidin fonksiyonel durumu, ultrasonografi, sintigrafi ve tiroid İİAB gibi tanı yöntemleri ile postoperatif histopatolojik inceleme sonuçları korele edildi.

Bulgular: İİAB uygulanan 167 hastanın patolojik inceleme sonucunda, benign sonuç % 58 (n=97), şüpheli sonuç % 29,9 (n=50), yetersiz materyal oranı % 6,6 (n=11) ve malign sonuç % 5,4 (n=9)’unda raporlandı. Çalışmamızdaki İİAB nin duyarlılığı %83, özgüllüğü %100 olarak saptandı.

Sonuç: Bu çalışmada sunulan veriler, operasyon gereklili- ğinin belirlenmesi ve malignitenin doğrulanmasında İİAB nin kullanımını desteklemektedir. Negatif İİAB sonucu diğer klinik faktörlerle gerekliliği gösterilen operasyonu engellememelidir. Rezeksiyonun büyüklüğüne, oluşmuş risk faktörlerinin ve boyun eksplorasyonundaki bulgularına bakılarak karar verilmelidir.

Anahtar Kelimeler

İnce İğne Aspirasyon Biyopsi, Tiroid, Cerrahi Tedavi

Kaynakça

• Bender Ö, Yüney E, Çapar H ve ark. Total ti- roidektomi deneyimlerimiz. Endokrin Diyalog subtotal thyroidectomy in benign nodular di- 2004; 1: 15- 18. sease: personal series and review of published
• Reed AF. The relations of the inferior laryn- geal nerve to the inferior tiroid artery. Anat Rec 1943; 85: 17.
• Swain BT. The Heritage of the Thyroid. In: The thyroid. 7th Ed: Brawerman LE, Utiger RD, New York Lippincott-Raven. 1996: 2- 5.
• Urgancıoğlu İ, Hatemi H, Uslu İ. Endemik Gu- atr Taramalarının 2. değerlendirilmesi. Klinik gery 1998; 123: 2-7. Gelişim 1987; 36- 38.
• Friguglietti CU, Lin CS, Kulcsar MA. Total th- İşgör A. Anatomi. In: Tiroid hastalıkları ve cer- rahisi. 1st Ed: İşgör A, İstanbul, Avrupa Tıp. 2000; 8: 367-381.
• Müller PE, Kabus S, Robens E, Spelsberg F. In- dications, risks and acceptance of total thyroi- dectomy for multinodular benign goiter. Surg Today 2001; 31: 958-962.
• Gough IR, Wilkinson D. Total ;thyroidectomy for management of thyroid disease World J extent of thyroidectomy for the treatment of Surg 2000; 24: 962-965. hyperthyroidism. Surg Clin N Am 2004; 84: 849
• Clark OH, Levin KE, Zeng QH, Greenspan FS, Siperstein A. Thyroid cancer: the case for total thyroidectomy. Eur J Cancer Clin Oncol 1998; group Definition in Differentiated Thyroid Car- 24: 30 cinoma. Surgery 1988; 104: 947-53.
• Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998; 228: 320-330.
• Bhattacharyya N, Fried MP. Assessment of morbidity and complications of total thyroidec- Skandalakis JE, Droulias C, Harlaftis N, Tzinas S, Gray SW, Akin JT Jr. Recurrent laryngeal ner- ves. Am Surg 1976; 42: 629.
• Pappalarado G, Guadalaxara A, Frattalori FM, Illomei G, Falaschi P. Total compared with reports. Eur J Surg 1998; 164:501-506.
• Acun Z, Comert M, Cihan A, Ulukent SC, Ucan B, Cakmak GK. Near- otalthyroidectomy could be the best treatment for thyroid disease in endemic regions. Arch Surg 2004; 139: 444- 4
• Liu Q, Djuricin G, Prinz RA. Total thyroidec- tomy for management of thyroid disease. Sur- yroidectomy for benign thyroid disease. Laryn- goscope 2003; 113: 1820-1826.
• Delbridge L, Guinea AI, Reeve TS. Total th- yroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 1999; 134: 1389-1393.
• Boger MS, Perrier ND. Advantages ans di- sadvantages of surgical therapy and optimal 8 Cady B, Rossi R. An Expanded View of Risk- Glinoer D, Andry G, Chantrain G, Samil N. 30. Goeliner JR, Gharib H, Grant CS, Jhonson Clinical aspects of early and late hypocalcemia DA. Fine needle aspiration cytology of thyroid, after thyroid surgery. Eur J Surg Oncol 2000; 26: 571-5
• Ramacciotti CE, Pretorius HT, Chu ÞW, et. Kim YJ. Insufficient Experience in Thyroid Fi- al. Diagnostic accuracy and use of aspiration ne-Needle Aspiration Leads to Misdiagnosis of biopsy in the management of thyroid nodules. Arch Intern Med 1984; 144: 1169-1173.
• Hegedus L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001; 30: 339-343.
• Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thy- roid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 109-142.
• Levine RA. Endocr Pract. Current guidelines for the management of thyroid nodules. 2012; 18: 596-599.
• Gharib H, Goellner JR. Fine-needle aspirati- on biopsy of the thyroid: an appraisal. Ann In- tern Med 1993; 118: 282-289.
• La Rosa GL, Belfiore A, Giuffrida D, et al. Eva- luation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid no- dules. Cancer 1991; 67: 2137- 2141.
• Muratli A, Erdogan N, Sevim S, Unal I, Ak- yuz S. Diagnostic efficacy and importance of log 2009; 6: 25-28 fine-needle aspiration cytology of thyroid no- dules. J Cytol. 2014; 31: 73-78.
• Gürel FS. Nodüler tiroid hastalıklarında ince iğne aspirasyon biyopsisinin yeri. ADÜ Tıp Fa- kültesi Dergisi. 2001; 1: 21-26.
• Silverman JF, West RL, LarkinEW, Finley JL. The role of fine- needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer 1986; 57: 1164-1170.
• Kılıçturgay S, Özgüç H, Ergil C, Sadıkoğlu Y, Yerci Ö, Bilgel H. Tiroid nodüllerinde ince iğne aspirasyon biyopsisi ve cerrahi karara etkisi. Ulusal Cerrahi Dergisi 1993; 9: 260-267. 980 to 1986. Acta Cytologica 1987; 31: 587-590.
• Son JI, Rhee SY, Woo J, Park WS, Byun JK, Thyroid Cancer. Endocrinol Metab 2014; 9: 293- 2
• Gardiner GW, de Souza FM, Carydis B, Se- emann C. Fine needle aspiration biopsy of the thyroid gland:results of a five year experience and discussion of its clinical limitations. J Oto- laryngol 1986; 15: 161-165.
• Hawkins F, Bellido D, Bernal C, Rigopoulou D, Ruiz Valdepenas MP, Lazaro E. Fine needle as- piration biopsy in the thyroid cancer and thyro- id disease. Cancer 1987; 59: 1206-9.
• Caplan RH, Strutt PJ, Kisken WA, Wester SM. Fine needle aspiration biopsy of thyroid nodu- les. Wis Med J 1991; 90: 285-288.
• Burch HB, Burman D, Reed L. Fine needle as- piration of thyroid nodules. Acta Cyto 1996; 40: 1176-1183.
• Ünal B, Işık B, Bozkurt B ve ark. Tiroid has- talıklarında sık kullanılan preoperatif patolojik inceleme ile korelasyonu. Endokrinolojide Diya