Kronik Lenfositik Tiroidit/Hashimoto Tiroiditli Hastalarının Sıvı Bazlı Preparatlarındaki Potansiyel Tuzaklar

Öz

Amaç: Kronik lenfositik tiroidit/Hashimoto tiroidit KLT/HT tanılı hastalarının, tiroid lezyonlarını değerlendirmek amacıyla ince iğne aspirasyon ile elde edilen sitoloji materyallerine uygulanan sıvı bazlı sitoloji yönteminin tanı güçlüğü yaratan sitomorfolojik özellikleri saptamak.Gereç ve Yöntemler: Retrospektif olarak bu çalışmaya 2014 ve Mayıs 2018 yılları arasında şüpheli nodül veya kozmetik amaçlı cerrahi operasyon geçiren 70 KLT/HT tanılı hastanın nodülüne ait tanısal ince iğne aspirasyon biyopsisi dahil edildi. Olguların histolojik ve sitolojik tanıları yeniden gözden geçirildi. Sıvı bazlı preparatlarındaki sitomorfolojik özellikler incelendi ve histolojik tanılarıyla karşılaştırıldı.Bulgular: Olgularımızın %52’si benign, %38’i ara sitolojik kategori önemi belirsiz atipi/önemi belirsiz foliküler lezyon, foliküler neoplazi/foliküler neoplazi şüphesi ve malignite şüpheli ve %10 malign sitoloji olarak raporlandı. Reaktif lenfoid hücre olguların %84’ünde az miktarda izlenirken kolloid ise olguların %50’inde saptandı. Papiller karsinom tanılı olguların %69’unda intranükleer psödoinklüzyon ve tamamında nükleer kontur düzensizliği mevcuttu.Sonuç: Sıvı bazlı sitoloji yöntemi uygulanan sitolojik materyallerde, kolloid ve inflamatuvar hücrelerinin azalması olguların ara sitolojik kategori olarak yorumlanmasına ve gereksiz cerrahiye neden olurken temiz zemin sayesinde nükleer detayı daha rahat değerlendirmemizi sağlayarak KLT/HT’li hastalarda malign lezyonların tanılabilirliğini artırdığını düşünmekteyiz

Anahtar Kelimeler

• Sure Path, Sıvı bazlı sitoloji, Tiroid ince iğne aspirasyon

Potential Pitfalls in Liquid-based Preparations of Patients with Chronic Lymphocytic Thyroiditis / Hashimoto Thyroiditis

Abstract

Objective: Our study aim to determine the cytomorphologic features that cause diagnostic difficulties with the liquid-based cytology method applied to cytological materials obtained by fine needle aspiration to evaluate thyroid lesions of chronic lymphocytic thyroiditis / Hashimoto thyroiditis CLT/HT patients.Material and Methods: This study retrospectively included diagnostic fine needle aspiration biopsies from the nodules of 70 CLT/HT patients who had undergone surgery for a suspicious nodule or cosmetic surgery between 2014 and May 2018. Histological and cytological diagnoses of the cases were reviewed. Cytomorphological features of liquid-based preparations were evaluated and compared with the histological diagnoses.Results: Fifty-two percent of our cases were reported as benign, 38% were in the indeterminate cytological category atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy and 10% had malignant cytology. Reactive lymphoid cells were observed in 84% of the cases and colloid in 50% of the cases. Intranuclear pseudoinclusion was present in 69% of the cases. Nuclear contour irregularity was detected in all papillary carcinoma cases.Conclusion: We think that cleaner background in cytological material prepared with the liquidbased cytology method allows us to evaluate the nuclear detail more easily, thereby increasing the diagnostic accuracy of malignant lesions, in patients with CLT/HT while the decrease of colloid and inflammatory cells causes interpretation of cases as belonging to the intermediate cytological category and results in unnecessary surgery

Keywords

• Sure Path, Liquid based cytology, Thyroid fine needle aspiration

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