Ultrasonography Guided Fine Needle Aspiration Biopsies On Thyroid Nodules

Abstract

Objective: The objective for this study is to investigate the efficiency of ultrasonography guided fine-needle aspiration biopsies on thyroid nodules. Methods: The study population consisted of 929 ultrasonography guided thyroid nodule biopsies in 831 patients. The cytological results were classified as benign, suspicious for malignancy, malignant and inadequate material. The ultrasonography results are registered by designated criterias.Results: Cytological results were reported as 781 (% 84.1) benign nodules, 35 (%3.8) malignant suspicious nodules, 21 (% 2.3) malignant nodules and 92 (% 9.9) inadequate materials. Patients with malignant thyroid nodules were evaluated and there was no statistically significant difference found in age, gender, number and sonographic features of nodules (p>0.05).Conclusion: Fine needle aspiration biopsy is a functional and reliable diagnosing method. Complications of the procedure, such as hematoma or pain, are rare. The use of US guidance is necessary to define the correct side of semisolid thyroid lesions and helpful to obtain adequate sample from nodules. Fine needle aspiration biopsy has become the gold standard to diagnose thyroid nodules

Keywords

• Thyroid Gland, Nodule, Fine Needle Aspiration Biopsy, Ultrasonography

Tiroid Nodüllerinde Ultrason Rehberliğinde İnce İğne Aspirasyon Biyopsisi

Abstract

Amaç: Retrospektif çalışmamızda Ultrasonografi rehberliğinde tiroid ince iğne aspirasyon biyopsisi tekniğinin etkinliğini araştırmayı amaçladık.Gereç ve Yöntem: Kliniğimizde 831 olgunun toplam 929 tiroid nodülüne Ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi yapıldı. Sitolojik tanılar benign, şüpheli malignite, malignite pozitif ve yetersiz materyal olarak sınıflandırıldı. Olguların ultrasonografi bulguları daha önceden belirlenen kriterler dahilinde kaydedildi.Bulgular: Sitolojik değerlendirme sonucu 781 nodül (%84.1) benign, 35 nodül (%3.8) şüpheli malign, 21 nodül (%2.3) malign, 92’si (%9.9) ise yetersiz materyal olarak rapor edildi. Malignite pozitif olgularda hasta yaşı, cinsiyet, nodül sayısı ve sonografik özellikler açısından anlamlı fark saptanmadı (p>0.05). Sonuç: İnce iğne aspirasyon biyopsisi etkin ve güvenilir bir tanı yöntemidir. Hematom ve ağrı gibi komplikasyonları nadirdir. Doğru nodülden ve semisolid nodüllerde de doğru komponentten örnek alınmasında ultrasonografi önemli bir yardımcıdır. Utrasonografi eşlikli ince iğne aspirasyon biyopsisi tiroid nodüllerinin tanısında altın standart yöntemdir

Keywords

• Tiroid bezi,Nodül,İnce İğne Aspirasyon Biyopsisi,Ultrasonografi

References

1. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, Cronan JJ, Doubilet PM, Evans DB, Goellner JR, Hay ID, Hertzberg BS, Intenzo CM, Jeffrey RB, Langer JE, Larsen PR, Mandel SJ, Middleton WD, Reading CC, Sherman SI, Tessler FN; Society of Radiologists in Ultrasound: Management of thyroid nodules detected at US: Society of Radiologists
2. conference statement. Radiology. 237: 794- 800, 2005.
3. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentelomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 154:1838-1840, 1994.
4. Brander A, Viikinkovski P, Nickels J, Kivisaari L: Thyroid gland: US screening in a random adult population. Radiology. 181:683- 687, 1991.
5. Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T: Ultrasound- guided fine needle aspiration cytology in the diagnosis and managment of thyroid nodules. Cytopathology. 17:251-256, 2006.
6. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: Ann Intern Med. 118-282-289, 1993.
7. Rıfat S, Ruffin M: Management of thyroid nodules. Am Fam Physician. 1994;50:785-90.
8. Emral R, Bastemir M, Güllü S, Erdogan G. Thyroid consequences of the Chernobyl nuclear power station accident on the Turkish population. Eur J Endocrinol. 148:497-503, 2003.

9. Akarsu E, Akcay G, Capoglu I, Unuvar N. Iodine deficiency and goiter prevalence of the adult population in Erzurum. Acta Medica. 48:39-42, 2005.
10. Nabriski D, Ness-Abramof R, Brosh TO, Konen O, Shapiro MS, Shenkman L: Clinical relevance of non-palpabl thyroid nodules as assessed by ultrasound-guided fine needle aspiration biopsy. J Endocrinol Invest. 26:3-4, 2003.
11. Rojeski MT, Gharib H. Noduler thyroid disease: evaluation and management. N Engl J Med. 313:428-436, 1985.
12. Van Herle AJ, Rich P, Ljung B-ME, Ashcraft MW, Solomon DH, Keeler EB 1982 The thyroid nodule. Ann Intern Med 96: 221– 232, 1982.
13. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, Orcutt J, Moore FD Jr, Larsen PR, Marqusee E, Alexander EK: Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 91:3411-3417, 2006.
14. Welker MJ. Orlov D. Thyroid nodules. Am Fam Physician 67:559-6, 2003.
15. Silver RJ, Parangi S. Management of thyroid incidentalomas. Surg Clin N Am. 84:907-19, 2004.
16. Kang KW, Kim SK, Kang HS, Lee ES, Sim JS, Lee IG, Jeong SY, Kim SW: Prevalence and risk of cancer of focal thyroid incidentaloma fluorodeoxyglucose
17. tomography for metastasis evaluation and cancer screening in healthy subjects. J Clin Endocrinol Metab. 88:4100-4104, 2003. 18F- positron
18. emission 16. Roman SA: Endocrine tumors: evaluation of the thyroid nodule. Curr Opin Oncol. 15:66- 70, 2003.
19. Hegedus L: The thyroid nodule. N Eng J Med 351:1764-1771, 2004.
20. Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, Kawamoto H, Yamashita H: Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg. 136: 334-337, 2001.
21. Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB Jr. Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound Med 22:1083- 1090, 2003.
22. Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med 23:1455-1464, 2004. 21. Rumack CM, Wilson SR, Charboneau JW. Diagnostic Ultrasound Third edition. Mosby, volume 1. pp: 736-43, 2005.
23. The American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 6:1-33, 2006.
24. Tollin SR, Mery GM, Jelveh N, Fallon EF, Mikhail M, Blumenfeld W, Perlmutter S: The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. Thyroid. 10:235-41, 2000.
25. Rojeski TM, Gharrib H: Noduler thyroid disease: Medical progress. N Eng J Med. 313: 428-434, 1984.
26. Chen H, Zeiger NA, Clark DP, Westra WH, Udelsman R: Papiller carcinoma of thyroid: Can operative management be based safely on fine needle aspiration? J Am Coll Surg. 184: 605, 1997.
27. Silverman JC, West LR, Larkin EW, Park KH. Role of fine needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer. 57: 1164-70, 1986.
28. Singer PA. Evaluation and management of the solitary thyroid nodule. Otolarygology Clinics of North America. 29: 577-79, 1996.
29. Ross DS. Diagnostic approach to and treatment of thyroid nodules. Up To Date. 18/04/2007.
30. http//www.utdol.com/utd/content/topic.do?topi cKey=thyroid/8983&view=print adresinden 08/08/2007 tarihinde erişilmiştir.
31. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM: Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color Doppler features. J Clin Endocrinol Metab 87:1941-6, 2002.
32. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM: Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color Doppler features. J Clin Endocrinol Metab. 87:1941-6, 2002.
33. Kuma K, Matsuzuka F, Yokozawa T, Miyauchi A, Sugawara M: Fate of untreated benign thyroid nodules: results of long-term follow-up. World J Surg. 18:495-8, 1994.
34. Burguera B, Gharib H. Thyroid incidentalomas. significance and management. Endocrinol Metab Clin North Am. 29:187-203, 2000.
35. Alexander EK, Hurwitz S, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, Larsen PR, Marqusee E: Natural history of benign solid and cystic thyroid nodules. Ann Intern Med. 138:315-8, 2003.
36. Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A
37. accuracy of conventional versus sonography guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 8:15-21, 1998.
38. Jeh SK, Jung SL, Kim BS, Lee YS: Evaluating the Degree of Conformity of Papillary Carcinoma and Follicular Carcinoma to the Reported Ultrasonographic Findings of Malignant Thyroid Tumor. Korean J Radiol. 8:192-197, 2007.
39. Fukunari N, Nagahama M, Sugino K, Mimura T, Ito K, Ito K: Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. World J Surg. 28:1261- 1265, 2004.