Hashimoto Tiroditine Eşlik Eden Nodüllerin Ultrasonografik Özellikleri ve Sitolojik Bulguları

Year 2018, Volume: 18 Issue: 3, 438 - 446, 28.09.2018

Didem Özdemir , Fatma Dilek Dellal Hüsniye Başer Aylin Kılıç Yazgan Şeyda Türkölmez Reyhan Ersoy Bekir Çakır

https://doi.org/10.17098/amj.461660

Abstract

Amaç: Hashimoto tiroiditi (HT) olan
hastalarda tiroid nodüllerin ultrasonografik özellikleri ve ince iğne
aspirasyon biyopsisi (İİAB) sonuçlarının tiroidit varlığından etkilenip
etkilenmediği net olarak bilinmemektedir. Bu çalışmada HT’ye eşlik eden
nodüllerin ultrasonografik özelliklerinin ve sitolojik bulgularının HT olmayan
nodüler guatrlı hastalarla karşılaştırılması amaçlanmıştır.

Materyal ve Metot: Kliniğimizde 4 ay süresince ultrason (US)
eşliğinde tiroid İİAB yapılan hastalar prospektif olarak incelendi. Tüm
hastalardan bilgilendirilmiş olur formu alındı ve İİAB yapılacak olan
nodüllerin ultrasonografik özellikleri belirlendi. Sitolojik olarak nodüller
Bethesda sınıflamasına göre yetersiz, benign, önemi belirsiz atipi/önemi
belirsiz foliküler lezyon (ÖBA/ÖBFL), foliküler neoplazi/foliküler neoplazi
şüphesi (FN/FNŞ), malinite şüphesi ve malign olmak üzere 6 gruba ayrıldı.

Bulgular: Çalışmaya 181 (%35,49) HT olan (166
kadın, 15 erkek) ve 329 (%64,51) HT olmayan (277 kadın, 52 erkek) 510 hasta
alındı. HT olanların yaş ortalaması, olmayanlara oranla daha fazlaydı
(sırasıyla 50,62±12,28 ve 46,73±12,04, p=0,001). HT’li hastalarda antikor
pozitifliği ve hipotiroidi, HT olmayanlardan anlamlı derecede yüksekti
(p<0,001). HT grubunda 288 (%36,00), HT olmayan grupta 512 (%64,00) olmak
üzere toplam 800 nodül vardı. Ultrasonografik olarak hipoekoik halo varlığı ve
kenar düzensizliği her iki grupta benzerdi (sırasıyla p=0,176 ve p=0,187). HT
zemininde gelişen nodüllerde mikrokalsifikasyon oranı %11,81, HT olmayanlarda
%20,31 saptandı (p=0,002). Makrokalsifikasyon oranı, HT olanlarda %19,45 HT
olmayanlarda %23,83 idi (p=0,012). HT olanlarda nodüllerin %30,77’si hipoekoik,
%66,43’ü izoekoik ve %2,80’i hiperekoikti; HT olmayanlarda nodüllerin %38,93’ü
hipoekoik, %59,63’ü izoekoik ve %1,44’ü hiperekoikti (p=0,010). HT olanlarda
nodüllerin %78,47’si solid yapıda iken HT olmayanlardaki nodüllerin %61,72’si
solid yapıdaydı (p<0,001). HT olanlarda sitolojik olarak %80,21 benign, %3,81
ÖBA/ÖBFL, %0,35 malinite şüphesi, %1,74 malign ve %13,89 yetersiz sonuç elde
edildi. HT olmayanlarda %80,86 benign, %3,32 ÖBA/ÖBFL, %0,98 FN/FNŞ, %1,17
malinite şüphesi, %1,37 malign ve %12,30 yetersiz sonuç saptandı (p=0,427).

Sonuç: HT zemininde gelişen nodüllerde malignite
lehine kabul edilen mikrokalsifikasyon ve makrokalsifikasyon varlığı ve
hipoekoik görünüm daha düşük oranda saptanmıştır. Bu nodüllerde, tiroid İİAB
ile elde edilen sitolojik sonuçlar, kronik tiroidit zemininde olmayan
nodüllerle benzer bulunmuştur.

Keywords

Hashimoto tiroiditi, nodül, ultrasonografi, tiroid ince iğne aspirasyon biyopsisi

The Ultrasonographical Features and Cytological Findings of Thyroid Nodules in Patients with Hashimoto Thyroiditis

Abstract

Objectives: It is unclear whether ultrasonography (US) features and fine-needle aspiration biopsy (FNAB) results of nodules accompanying with Hashimoto’s thyroiditis (HT) are affected by the presence of thyroiditis or not. In this study, we aimed to compare US features and cytological results of nodules in patients with and without HT.

Materials and Methods: Patients who underwent thyroid FNAB in our clinic during a 4 months’ period were evaluated prospectively. Informed consent was obtained from all patients and US features of nodules were determined. Cytological results were classified as nondiagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasia/suspicious for follicular neoplasia (FN/SFN), suspicious for malignancy and malignant.
Results: 181 (35.49%) patients with HT (166 female, 15 male) and 329 (64.51%) patients (277 female and 52 male) without HT were included. The mean age of patients with HT was significantly higher than patients without HT (50.62±12.28 vs 46.73±12.04, p=0.001). Antibody positivity and hypothyroidism were higher in patients wtih HT (p<0.001 for each). There were totally 800 nodules, of which 288 (36.00%) were in patients with HT, 512 (64.00%) in patients without HT. Ultrasonographically, presence of hypoechoic halo and marginal irregularity were similar in two groups (p=0.176 and p=0.187, respectively). Microcalcification was present in 11.81% of nodules with HT and 20.31% of nodules without HT (p=0.002). Macrocalcification was detected in 19.45% and 23.83% of nodules in patients with and without HT, respectively (p=0.012). Among nodules with HT, 30.77% were hypoechoic, 66.43% were isoechoic, and 2.80% were hyperechoic; while among nodules without HT, 38.93% were hypoechoic, 59.63% were isoechoic and 1.44% were hyperechoic (p=0.010). Solid texture was observed in 78.47% of nodules with HT and 61.72% of nodules without HT (p<0.001). Cytologically, 80.21% of nodules with HT were benign, 3.81% were AUS/FLUS, 0.35% were suspicious for malignancy, 1.74% were malignant and 13.89% were nondiagnostic. In nodules without HT, cytological results were benign in 80.86%, AUS/FLUS in 3.32%, FN/SFN in 0.98%, suspicious for malignancy in 1.17%, malignant in 1.37% and nondiagnostic in 12.30% (p=0.427).

Conclusion: Suspicious US features such as microcalcification, macrocalcification and hypoechoic appearance were found with a lower prevalence in nodules accompanying HT. Cytological results of nodules that arise on chronic thyroiditis were similar with nodules that arise on a normal parenchyma.

Keywords

Hashimoto thyroiditis, nodule, ultrasonography, thyroid fine needle aspiration biopsy

References

• 1. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev 2014;13(4-5):391-7.
• 2. Langer JE, Khan A, Nisenbaum HL, et al. Sonographic appearance of focal thyroiditis. AJR Am J Roentgenol 2001;176(3):751-4.
• 3. Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM 2007;100(1):29-35.
• 4. Moon WJ, Jung SL, Lee JH, et al; and Thyroid Study Group, Korean Society of Neuro- and Head and Neck Radiology. Benign and malignant thyroid nodules: US differentiation–multicenter retrospective study. Radiology 2008;247(3):762–70.
• 5. Takashima S, Matsuzuka F, Nagareda T, Tomiyama N, Kozuka T. Thyroid nodules associated with Hashimoto thyroiditis: assessment with US. Radiology 1992;185(1):125-30.
• 6. Isik S, Gokay F, Ozuguz U, et al. Comparison of the prevalence and sonographic features of thyroid nodules accompanying autoimmune thyroid diseases. Endokrynol Pol 2010;61(6):658-64.
• 7. Mukasa K, Noh JY, Kunii Y, et al. Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid diseases. Thyroid 2011;21(1):37-41.
• 8. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid 2008;19:1159-1165.
• 9. Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. The Bethesda thyroid fine needle aspiration classification system: year 1 at an academic institution. Thyroid 2009;19:1215-23.
• 10. Luu MH, Fischer AH, Pisharodi L, Owens CL. Improved preoperative definitive diagnosis of papillary thyroid carcinoma in FNAs prepared with both ThinPrep and conventional smears compared with FNAs prepared with ThinPrep alone. Cancer Cytopathol 2011;119:68-73.
• 11. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol 2012;56:333-9.
• 12. Cunha LL, Ferreira RC, Marcello MA, Vassallo J, Ward LS. Clinical and pathological implications of concurrent autoimmune thyroid disorders and papillary thyroid cancer. J Thyroid Res 2011;2011:387062.
• 13. Azizi G, Malchoff CD. Autoimmune thyroid disease: a risk factor for thyroid cancer. Endocr Pract. 2011;17(2):201-9.
• 14. Kim KW, Park YJ, Kim EH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis. Head Neck 2011;33(5):691-5.
• 15. Zhang L, Li H, Ji QH, et al. The clinical features of papillary thyroid cancer in Hashimoto's thyroiditis patients from an area with a high prevalence of Hashimoto's disease. BMC Cancer 2012;12:610.
• 16. Gul K, Dirikoc A, Kiyak G, et al. The association between thyroid carcinoma and Hashimoto's thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules. Thyroid 2010;20(8):873-8.
• 17. Anil C, Goksel S, Gursoy A. Hashimoto's thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study. Thyroid 2010;20(6):601-6.
• 18. Erdogan M, Erdem N, Cetinkalp S, et al. Demographic, clinical, laboratory, ultrasonographic, and cytological features of patients with Hashimoto's thyroiditis: results of a university hospital of 769 patients in Turkey. Endocrine 2009;36(3):486-90.
• 19. Anderson L, Middleton WD, Teefey SA, et al. Hashimoto thyroiditis: Part 2, sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis. AJR Am J Roentgenol 2010;195(1):216-22.
• 20. Zhou H, Yue WW, Du LY, et al. A Modified Thyroid Imaging Reporting and Data System (mTI-RADS) For Thyroid Nodules in Coexisting Hashimoto's Thyroiditis. Sci Rep 2016;6:26410.
• 21. Oppenheimer DC, Giampoli E, Montoya S, Patel S, Dogra V. Sonographic Features of Nodular Hashimoto Thyroiditis. Ultrasound Q 2016;32(3):271-6.
• 22. Ohmori N, Miyakawa M, Ohmori K, Takano K. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis. Intern Med 2007;46(9):547-50.
• 23. Baser H, Ozdemir D, Cuhaci N, et al. Hashimoto's Thyroiditis Does Not Affect Ultrasonographical, Cytological, and Histopathological Features in Patients with Papillary Thyroid Carcinoma. Endocr Pathol 2015;26(4):356-64.
• 24. Zosin I, Balaş M. Clinical, ultrasonographical and histopathological aspects in Hashimoto's thyroiditis associated with malignant and benign thyroid nodules. Endokrynol Pol. 2013;64(4):255-62.
• 25. Gayathri B, Kalyani R, Harendra KM, Krishna PK. Fine needle aspiration cytology of Hashimoto's thyroiditis-A diagnostic pitfall with review of literature. J Cytol. 2011;28(4):210-3.
• 26. Lai X, Xia Y, Zhang B, Li J, Jiang Y. A meta-analysis of Hashimoto thyroiditis and papillary thyroid carcinoma risk. Oncotarget 2017;8(37):62414-24.
• 27. Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP. Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome. Surgery 1999;126(6):1070-7.