Predictive Factors Increasing the Risk of Malignancy in Thyroid Follicular Neoplasia

Year 2025, Volume: 8 Issue: 1, 85 - 95

Fatma Özarslan , Hüseyin Özgür Aytaç , İlker Murat Arer , M. Eda Ertörer , Emrah Koçer , Murathan Erkent , Hakan Yabanoğlu

Abstract

Introduction: 22-42% of patients with thyroid nodules are diagnosed as Bethesda category IV “Follicular Neoplasia (FN)”. The aim of this study is to evaluate our clinical results in patients with FN who underwent surgery and determine predictive risk factors in patients with malignant pathology results.
Materials and Methods: 364 patients were included in the study. Fine needle aspirastion biopsy (FNAB) with a FN result was defined as a “target nodule”. Demographic, radiological and clinical characteristics of the two groups were determined. Two different types of surgical procedures were applied to the patients: HT or TT.
Results: The number of patients was 199 (54.7%) in Group 1 and 165 (45.3%) in Group 2. Malignancy was incidentally detected in 138 patients (37.9%) outside the target nodule. The risk of malignancy was higher in those under 45 compared to those aged 45 and older. Malignancy was observed in 123 (42.7%) of female patients and 42 (55.3%) of male patients. Additionally, the risk of malignancy increased in patients with nodules measuring 2 cm or larger.
Conclusion: In FN cases, the risk of malignancy increases in males, in nodules 2 cm and above, and in younger age groups. According to our data, the risk of malignancy in FN is 45.3%. Additionally, the rate of incidental thyroid cancer is 37.9%. We attribute the higher rates of these findings compared to literature to the increased frequency of thyroid cancer in our region.

Keywords

follicular neoplasia, nodule size, thyroid nodule

TİROİD FOLİKÜLER NEOPLAZİSİNDE MALİGNİTE RİSKİNİ ARTTIRAN PREDİKTİF FAKTÖRLER

Abstract

Giriş: Tiroid nodülü tespit edilen hastaların %22-42’si Bethesda kategori IV “Foliküler Neoplazi (FN)” tanısı almaktadır. Foliküler neoplazide önerilen tedavi yöntemi hemitiroidektomi (HT) olsa da hasta veya hastalığa ait bazı özellikler bu tedavi seçimin total tiroidektomi (TT) yönünde olmasına neden olmaktadır. Bu çalışmanın amacı FN tespit edilen ve cerrahi uygulanan hastalardaki klinik sonuçlarımızı değerlendirmek, patoloji sonucu malign gelen hastalarda prediktif risk faktörlerini belirlemektir.
Gereç ve Yöntemler: Çalışmaya 364 hasta dahil edildi. İnce iğne aspirasyon biyopsi (İİAB) sonucu FN olan nodül “hedef nodül” olarak tanımlandı. Hastalar, hedef nodülde cerrahi sonrası malignite saptanmayan (Grup 1) ve saptanan (Grup 2) olarak iki gruba ayrıldı. İki grubun demografik, radyolojik ve klinik özellikleri belirlendi. Hastalara HT veya TT olarak iki ayrı tür cerrahi işlem uygulandı.
Sonuç: Hasta sayısı, Grup 1’de 199 (%54,7), Grup 2’de 165 (%45,3) idi. Hastaların 138 (%37,9)’inde hedef nodül dışında insidental olarak malignite saptandı. Malignite riskini etkileyen faktörleri belirlemek amacı ile yapılan tek değişkenli lojistik regresyon analizi sonucunda 45 yaşın malignite için belirleyici bir kestirim değeri olabileceği gözlendi. 45 yaş altında malignite riski; 45 ve üzerindekilere göre daha fazla bulundu. Kadın hastaların 123’ünde (%42,7), erkek hastaların ise 42’isinde (%55,3) malignite görüldü. Ayrıca nodül boyutu 2 cm ve üzerinde olan hastalarda malignite riski artmaktaydı.
Tartışma: FN olgularında erkek cinsiyette, 2 cm ve üzerinde olan nodüllerde, genç yaşlarda malignite riski artmaktadır. Bizim verilerimize göre FN’de malignite riski %45,3’tür. Ayrıca insidental tiroid kanseri oranı %37,9’dur. Bu oranların literatürdeki verilerden fazla olmasını bölgemizde tiroid kanser sıklığının fazla olmasına bağlamaktayız.

Keywords

Foliküler Neoplazi, Nodül Boyutu, Yaş, Cinsiyet

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