Tiroid Nodüllerinde Sitopatolojik Ve Histopatolojik Uyum Değerlendirmesi: 425 Olgu İçeren Tek Merkez Çalışması

Abstract

Amaç: Tiroid nodülleri, toplumda sık görülen ve görüntüleme yöntemleri arttıkça insidantal saptanma oranları da gittikçe artan bir sağlık problemidir. Bu nedenle ki tiroid nodüllerine klinik yaklaşımda takip edilecek ve operasyona yönlendirilecek olguların ayrımı için, sitopatolojik Bethesda sınıflaması çok önemli bir yer tutmaktadır. Bu sınıflama sistemi 6 kategoriden oluşmaktadır ve tiroid nodüllerinin hepsini bir sınıflamaya koymak mümkündür. Biz çalışmamıza tiroid ince iğne aspirasyon sitoloji (İİAS) yapılan ve sonrasında cerrahi opere edilen olguları retrospektif olarak inceleyerek, kendi merkezimizdeki uyumu değerledirmeyi amaçladık. Materyal ve Metot: Çalışmamıza, S.B.Ü Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesinde, 2014-2019 yılları arasında opera edilen ve öncesinde tiroid İİAB uygulanan 425 olgu dâhil ettik. Tiroid Bethesda sınıf 4 (Foliküler neoplazi/Foliküler neoplazi kuşkusu) olgularının histopatolojik tanıları ile papiller mikrokarsinom ve Hashimoto/lenfositik tiroidit tanısı alan vakaların sitopatolojik tanıları ayrıca belirtilmiştir. Bulgular: Bethesda tiroid sitopatoloji sınıflamasına göre, olguların 53’ü yetersiz, 193’ü benign, 85’i önemi belirsi atipi/önemi belirsiz foliküler lezyon, 22’si foliküler neoplazi açısından kuşkulu, 61’i malignite açısından kuşkulu ve 11’i malign sitoloji olarak raporlanmıştır. Histopatolojik olarak tiroid papiller mikrokarsinom tanısı alan toplam 33 olgunun çoğunluğu 10 (%31) önemi belirsiz atipi tanısı almış olup sırasıyla; yetersiz 7 (%21), benign 7 (%21), malignite açısından kuşkulu 7 1(%21), foliküler neoplazi kuşkusu 1 (%3) ve malign sitoloji 1 (%3) tanıları almıştır. Hashimoto tiroiditi ya da lenfositik tiroidit tanısı alan toplam 51 vakanın sitoloji preparatında aldığı tanılar sırasıyla; benign 17 (%33), önemi belirsiz atipi 16 (%51), malignite kuşkulu 11 (%21), yetersiz 4 (%8), foliküler neoplazi kuşkusu 2 (%4) ve malign sitoloji 1 (%2)’dir. Sonuç: Çalışmamızda, vaka oranlarımız genel olarak literatür ile uyumludur. Ancak papiller mikrokarsinomların yanlış negatif tanı oranını arttırabileceğini, Hashimoto tiroiditi/lenfositik tiroidit olgularının ise önemli belirsiz atipi ve malignite kuşkulu sitoloji tanılarını arttırabileceği gözlemlenmiştir. Tek merkezle yaptığımı çalışmamızda sitolojik tanı veririken olgunun bu yönlerden klinik, sonografik ve laboratuar bulgularıyla birlikte değerlendirilmesi gerektiğini böylece bu durumu aşabileceğimizi düşünmekteyiz.

Keywords

• Tiroid nodül
• Sitopatoloji
• İnce iğne aspirasyon

Evaluation Of Cytopathological And Histopathological Compatibility In Thyroid Nodules: Single Center Study With 425 Cases

Abstract

Aim: Thyroid nodules are a common health problem, which is common in the community, and its rates of detection are increasing in proportion to the increasing use of imaging methods. For this reason, cytopathological classification of Bethesda has a very important place for the differentiation of the cases that will be followed in the clinical approach to the thyroid nodules and directed to the operation. This classification system consists of 6 categories and it is possible to put all thyroid nodules into one classification. We aimed to evaluate the compliance in our center by retrospectively examining the patients who underwent thyroid fine needle aspiration cytology (FNAC) and subsequently operated surgically. Material and Method: In our study, we included 425 patients who were operated between 2014-2019 and who had undergone thyroid FNAC in the Diyarbakır Gazi Yaşargil Training and Research Hospital. Histopathological diagnoses of thyroid Bethesda class 4 (Follicular neoplasia / Follicular neoplasia suspicion) cases and cytopathological diagnoses of cases diagnosed with papillary microcarcinoma and Hashimoto / lymphocytic thyroiditis were also evaluated. Results: According to the Bethesda thyroid cytopathology classification, 53 of the cases were reported as nondiagnostic, 193 as benign, 85 as Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS / FLUS), 22 as suspicious in terms of follicular neoplasia, 61 as suspicious in terms of malignancy, and 11 as malignant cytology. 33 cases diagnosed with thyroid papillary microcarcinoma, cytopathologically; 10 (31%) were reported as AUS / FLUS, 7 (%21) were non-diagnostic, 7 (%21) were benign, 7 (%21) were Suspicious for Malignancy, 1 (%3) were Follicular Neoplasm or Suspicious for a Follicular Neoplasm, and 1 (%3) was reported as malignant cytology. The diagnoses of 51 cases diagnosed with Hashimoto thyroiditis or lymphocytic thyroiditis in the cytology preparation are; benign 17 (33%), AUS/FLUS 16 (51%), suspicious of malignancy 11 (21%), nondiagnostic 4 (8%), Follicular Neoplasm or Suspicious for a Follicular Neoplasm 2 (4%) and malignant cytology 1 (2%). Conclusion: In our study, our case rates are generally compatible with the literature. However, we observed that papillary microcarcinomas may increase the false negative diagnosis rate, while Hashimoto's thyroiditis /Lymphocytic thyroiditis cases may increase cases of AUS/FLUS and suspicious of malignancy cytology. In our study with a single center, we think that the case should be evaluated together with clinical, sonographic and laboratory findings in these aspects, and that we can overcome this situation.

Keywords

• Thyroid nodule
• Cytopathology
• Fine needle aspiration

References

1. 1. Hegedüs, L. The thyroid nodule. New England Journal of Medicine 2004; 351(17): 1764-71.
2. 2. Seib, C.D. and J.A. Sosa. Evolving understanding of the epidemiology of thyroid cancer. Endocrinology and Metabolism Clinics 2019; 48(1): 23-35.
3. 3. Toyran, T , Fındık Güvendi, G , Adalı, Y , Üstün, H. Effects of bedside adequacy assessment in thyroid cytology on cytological sufficiency and the final histopathological diagnosis. Cukurova Medical Journal 2020; 45: 1173-81
4. 4. Rothberger GD, Cohen M, Sahay P, Szczepanczyk PT, Islam S. Method of detection of thyroid nodules: correlation with frequency of fine‐needle aspiration and malignancy rate. Head & Neck 2020; 42(2):210-6.
5. 5. Liebeskind A, Sikora AG, Komisar A, Slavit D, Fried K. Rates of malignancy in incidentally discovered thyroid nodules evaluated with sonography and fine‐needle aspiration. Journal of ultrasound in medicine 2005; 24(5):629-34
6. 6. Wong, C., X. Liu, and B. Lang. Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules. Journal of Endocrinological Investigation 2020; 1-10.
7. 7. Cibas, E.S. and S.Z. Ali. The Bethesda system for reporting thyroid cytopathology. Thyroid 2009; 19(11): 1159-65.
8. 8. Bongiovanni M, Spitale A, Faquin W, C, Mazzucchelli L, Baloch Z, W. Overview of diagnostic terminology and reporting in The Bethesda System for Reporting Thyroid Cytopathology. Springer 2018; 1-6.

9. 9. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta cytologica 2012; 56(4): 333-9.
10. 10. Cibas, E.S. and S.Z. Ali, The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017; 27(11): 1341-6.
11. 11. Park JH, Yoon SO, Son EJ, Kim HM, Nahm JH, Hong S. Incidence and malignancy rates of diagnoses in the bethesda system for reporting thyroid aspiration cytology: an institutional experience. Korean Journal of Pathology 2014; 48(2): 133-9.
12. 12. Zarif HA, Ghandurah SE, Al-Garni MA, Binmahfooz SK, Alsaywid BS, Satti MB. Thyroid nodules cytopathology applying the Bethesda system with histopathological correlation. Saudi journal of medicine & medical sciences 2018; 6(3): p. 143-8.
13. 13. Elbiastanlı, M.S. Tiroid nodüllerinde ince iğne aspirasyon biyopsisi sonuçlarının ameliyat sonrası patoloji sonuçları ile karşılaştırılması. KBB Uygulamaları 2019; 7(2):59-3
14. 14. Heller KS. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS): Is there a correct answer?. Thyroid 2014; 24(5):787-8.
15. 15. Lee, Kyungji, Jung, Chan Kwon, Lee, Kyo Young, Bae, Ja Seong, Lim, Dong Jun, Jung, So Lyung. Application of Bethesda System for Reporting Thyroid Aspiration Cytology. The Korean Journal of Pathology 2010; 44(5): p. 521-7.
16. 16. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine‐needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer Cytopathology,2007; 111(5): 306-5.
17. 17. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long‐term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer Cytopathology: Interdisciplinary International Journal of the American Cancer Society 2007; 111(6): 508-6.
18. 18. Krane JF, Alexander EK, Cibas ES, Barletta JA. Coming to terms with NIFTP: a provisional approach for cytologists. Cancer cytopathology 2016; 124(11): 767-2.
19. 19. Strickland KC, Howitt BE, Marqusee E, Alexander EK, Cibas ES, Krane JF, Barletta JA. The impact of noninvasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid 2015; 25(9): 987-2.
20. 20. Faquin WC, Wong LQ, Afrogheh AH, Ali SZ, Bishop JA, Bongiovanni M. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology. Cancer cytopathology 2016; 124(3): 181-7.
21. 21. Kim SJ, Roh J, Baek JH, Hong SJ, Shong YK, Kim WB, Song DE. Risk of malignancy according to sub‐classification of the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category in the Bethesda system for reporting thyroid cytopathology. Cytopathology 2017; 28(1): 65-3.