Bethesda IV-V tiroid nodüllerinin değerlendirilmesi: klinik deneyim

Year 2022, , 152 - 157, 26.09.2022

Salih Celepli , İrem Bigat , Baki Türkoğlu , Mustafa Tanrıseven , Pınar Celepli , Levent Donmez

https://doi.org/10.47582/jompac.1132934

Abstract

Amaç: Tiroidde nodül nedeniyle opere edilen olgularda malignite oranı yaklaşık %5-10 olup, bu oran Bethesda kategorilerine göre önemli farklılıklar göstermekle birlikte diğer kategorilere göre kategori IV ve V’te yüksek malignite riski mevcuttur. Biz çalışmamızda Bethesda IV-V tanısı alan nodüllerde sitolojik tanı başarısını etkileyen klinikopatolojik etkenleri inceledik.
Gereç ve Yöntem: Çalışmaya merkezimizde 2016-2021 yılları arasında tiroid nodülü tanısı alan ve opere edilen 780 hasta dahil edildi. Hastaların preoperatif sitolojik tanıları Bethesda Sistemi kullanılarak sınıflandırıldı. Hastaların demografik verileri, nodüllerin Bethesda sınıflandırması ve postoperatif histopatolojik inceleme sonuçları alt gruplar halinde değerlendirilerek anlamlı sonuçlar raporlandı.
Bulgular: Olguların en yoğun olarak bulunduğu yaş grubu 45-59 olup, K/E oranın 3:1 olduğu görülmektedir. Malign tanı grubundaki nodüllerin %41,8’inin; benign tanı grubundakilerin %58,2’sinin palpabl olduğu görülmektedir. 20 mm Sonuç: Çalışmamız mikrokarsinom ve büyük çaplı nodüllerde İİAB tanı başarısının düştüğünü, sitolojik başarı açısından en uygun nodül boyutunun 10-20 mm nodüller olduğunu göstermektedir. Malignite riski 20 mm’den küçük nodüllerde 20 mm’den büyük nodüllere göre daha yüksektir. DC-IV tanılarda bening patolojiler ön planda düşünülürken; DC-V sitolojik tanılı nodüllerin çapı 20 mm’den büyük ise ön planda DTK, 20mm’den küçük ise PTK düşünülmelidir.

Keywords

Tiroid neoplazmaları, tiroid nodülü, ince iğne biyopsisi

Evaluation of Bethesda IV-V thyroid nodules: clinical experience

Abstract

Introduction: The malignancy rate in cases operated for thyroid nodule is approximately 5-10%, and although this rate shows significant differences according to Bethesda categories, there is a high risk of malignancy in categories IV and V compared to other categories. In our study, we examined the clinicopathological factors affecting the success of cytological diagnosis in nodules diagnosed with Bethesda IV-V.
Material and Method: A total of 780 patients who were diagnosed with thyroid nodules and underwent surgery at our center between 2011 and 2021 were included in the study. The preoperative cytological diagnoses of the patients were categorized using the Bethesda classification system. The demographic data of the patients, Bethesda classification of the nodules, and postoperative histopathological examination results were evaluated in subgroups, and their significance was determined.
Results: The age group with the highest number of cases was 45-59 years, and the female/male ratio of the whole cohort was 3:1. The rate of palpable nodules was 41.8% for the malignant diagnosis group and 58.2% for the benign diagnosis group. In both malignant and benign groups, <20 mm nodules were found at statistically significantly higher rates compared to nodule groups of other diameters (p<0.001 for both). While 50% of those diagnosed with DC-IV have a diameter greater than 20 mm; It was observed that 43.5% of those diagnosed with DC-V were more intense in the 10-20 mm diameter range. When the FNAB cytological diagnoses of the cases are compared with the postoperative histopathological diagnoses, it is seen that 32.5% of the cases diagnosed with DC-IV and 78.3% of those diagnosed with DC-V were diagnosed as malignant. While 69.2% of the cases with a cytological diagnosis of DC-IV were PTC and 30.8% were OTC; 100% of the cases with DC-V diagnosis are PTC histopathologically.
Conclusion: Our study showed that the diagnostic success of FNAB was decreased in microcarcinoma and large-sized nodules, with 10-20-mm nodules being the most suitable size for the success of cytological diagnosis. The risk of malignancy was higher in the nodules smaller than 20 mm compared to those larger than 20 mm. OTC should be primarily considered in >20-mm nodules with a DC-V diagnosis and PTC in smaller nodules. While benign pathologies are considered in DC-IV diagnoses; If the diameter of DC-V cytologically diagnosed nodules is larger than 20 mm, OTC should be considered primarily, and if less than 20 mm, PTC should be considered.

Keywords

Thyroid neoplasms, thyroid nodule, fine-needle biopsy

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