Tiroid İnce İğne Aspirasyon Biyopsisinde Bethesda 3 Kategorisindeki Hastaların Klinikopatolojik ve Cerrahi Sonuçlarının Değerlendirilmesi: Üçüncü Basamak Hastane Deneyimi

Year 2024, , 66 - 70, 16.08.2024

Mehmet Baykan , Saliha Karagöz Eren , Mehmet Patmano , Tamer Ertan

https://doi.org/10.55694/jamer.1438765

Abstract

Amaç: Tiroid nodulleri dünya çapında oldukça yaygın bir patolojidir. Tiroid ince iğne aspirasyon biopsisi (TİİAB) tiroid malignitelerinin tanısında önemli bir tanı aracıdır. Ancak sonuçları sınıflandırmak için kullanılan Bethesda Sistemi hastalar önemi belirlenemeyen atipi/belirsiz öneme sahip folikuler lezyon (ÖBA/ÖBFL) nodulun benign veya malign olarak sınıflandıramamaktadır. Bu nedenle bu hastalarda en iyi tedavinin belirlenebilmesi için bazı risk faktörlerinin bilinmesi gerekmektedir. Bu çalışmamızda ÖBA/ÖBFL nedeniyle opere edilen hastalarımızı radyolojik görüntü,patolojik sonuç ve yapılan cerrahi yöntem açısından değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Eylül 2018-Aralık 2021 tarihleri arasında TİİAB yapılan 1298 hastadan sitolojisi ÖBA/ÖBFL gelen ve opere edilen 144 hastayı retrospektif olarak radyolojik görüntü, patolojik sonuç ve yapılan cerrahi yöntem açısından inceledik.

Bulgular: TİİAB yapılan sitolojisi ÖBA/ÖBFL gelen ve opere edilen 144 hastanın 58 (%40) inin histopatolojisi malign olarak geldi. Tiroid nodüllerinin ultrason görüntü özelliklerini malign histopatoloji sonuçları ile karşılaştırdığımız zaman hipoekojen, mikrokalsifikasyon, düzensiz sınır ve hipervaskularite görüntülerinin malignite açısından anlamlı olduğu tesbit edildi(p<0.005).

Sonuç: Cerrahi olarak doğrulanan nodüllerde malignite oranı bu çalışmada %40 olup bu oran Bethesda sınıflandırmasına göre yüksek olabilir. Hastalarda TİİAB histopatolojik sonucu ÖBA/ÖBFL ile birlikte hipoekoik yapıda, mikrokalsifikasyonlu, düzensiz kenarlı ve hipervasküler nodüller varsa cerrahi tedavi düşünülmelidir.

Keywords

Malignensi, önemi belirsiz atipi, önemi belirsiz foliküler lezyon, tiroid ince iğne aspirasyon biopsisi, tiroid nodülü

Evaluation of Clinicopathological Features and Surgical Outcomes in Thyroid Fine Needle Aspiration Biopsy of Bethesda 3 Category Patients: A Tertiary Hospital Experience

Abstract

Aim: Thyroid nodules are a very common pathology worldwide. Fine needle aspiration biopsy (FNAB) is a crucial diagnostic tool in identifying thyroid malignancies. However, the Bethesda System, used to categorize the results, cannot definitively classify patients with atypia/follicular lesion of undetermined significance (AUS/FLUS) nodules as benign or malignant. Therefore, it is essential to identify certain risk factors to determine the most appropriate treatment for these patients. This study aims to assess patients who underwent surgery for AUS/FLUS in terms of radiological appearance, pathological findings, and surgical approach.

Materials and Methods: We retrospectively examined 144 patients whose cytology showed AUS/FLUS and who underwent surgery, out of 1298 patients who had FNAB between September 2018 and December 2021. We analyzed their radiological appearance, pathological results, and surgical methods.

Results: The histopathology of 58 (40%) of the 144 patients who underwent FNAB, and had cytology results of AUS/FLUS and subsequently underwent surgery, was malignant. A comparison of ultrasound images of thyroid nodules with malignant histopathology revealed that hypoechoic, microcalcification, irregular border, and hypervascularity were significantly associated with malignancy (p < 0.005).

Conclusion: The malignancy rate in surgically confirmed nodules was 40% in this study, which was deemed high according to the Bethesda classification. If patients have hypoechoic, microcalcified, irregular-edged, and hypervascular nodules along with AUS/AUFL histopathological results on FNAB, surgical treatment should be considered.

Keywords

Atypia of undetermined significance, follicular lesion of undetermined significance, fine needle aspiration biopsy, malignancy, thyroid nodule

References

• 1. Cibas ES, Ali SZ. NCI Thyroid FNA state of the cience conference. the bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658-665.
• 2. Çakır B, Bilginer MC, Ozdemir D, Topaloglu O, Aydin C, Dumlu G, et al. Hemithyroidectomy seems to be a reasonable initial surgical approach in patients with cytological Bethesda category III thyroid nodules: An institutional experience. Turkish Journal of Endocrinology & Metabolism 2018: 22(2):57-63.
• 3. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated Thyroid cancer: The american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133.
• 4. Erdem E, Gülçelik MA, Kuru B, Alagöl H. Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma. Eur J Surg Oncol. 2003;29:747-749.
• 5. Bernstein JM, Shah M, MacMillan C, Freeman JL. Institutionspecific risk of papillary thyroid carcinoma in atypia/follicular lesion of undetermined significance. Head Neck 2016;38:1210-1215.
• 6. Kholova I, Ludvikova M. Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable bethesda 2010 diagnostic category or waste garbage? Acta Cytol. 2014;58:319-329.
• 7. Carr R, Ustun B, Chhieng D. Radiologic and clinical predictors of malignancy in the follicular lesion of undetermined significance of the thyroid. Endocr Pathol. 2013;24:62-68.
• 8. Çelebi B, Taşdelen HA, Kurnaz E. Should encountering atypia of undetermined significance / follicular lesion of undetermined significance after thyroid biopsy lead to the operation?. The European Research Journal 2023;9(4):708-716.
• 9. Sahin M, Gursoy A, Tutuncu NB, Guvener DN. Prevalence and prediction of malignancy in cytologically indeterminate thyroid nodules. Clin Endocrinol. 2006;65:514-518.
• 10. Renshaw AA. Should “atypical follicular cells” in thyroid fine needle aspirates be subclassified? Cancer Cytopathol. 2010;118:186-189.
• 11. Gweon HM, Son EJ, Youk JH, Kim JA. Thyroid nodules with Bethesda system III cytology: can ultrasonography guide the next step? Ann Surg Oncol. 2013; 20:3083–3088.
• 12. Sippel RS, Elaraj DM, Khanafshar E, Kebebew E, Duh QY, Clark OH. Does the presence of additional thyroid nodules on ultrasound alter the risk of malignancy in patients with a follicular neoplasm of the thyroid? Surgery 2007;142:851-857.
• 13. Ryu YJ, Jung YS, Yoon HC, Hwang MJ, Shin SH, Cho JS, et al Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res. 2014;86:109–114.
• 14. Hong SH, Lee H, Cho MS, Lee JE, Sung YA, Hong YS. Malignancy risk and related factors of atypia of undetermined significance/ follicular lesion of undetermined significance in thyroid fine needle aspiration. Int J Endocrinol. 2018 Jul 30;2018:4521984.
• 15. Kuru B, Atmaca A, Tarim IA, Kefeli M, Topgul K, Yoruker S, et al. Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as bethesda category III (AUS/FLUS). Eur J Surg Onc 2016;42(1):87-93.
• 16. Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Cytologyultrasonography risk-stratification scoring system based on fine needle aspiration cytology and the korean-thyroid imaging reporting and data system. Thyroid 2017;27(7):953-959.