Bethesda III (ÖBA) sitolojisi olan nodüllerin yönetiminde ACR-EU-K TIRADS skorlarına göre tekrarlanan ince iğne aspirasyon biyopsisinin değerlendirilmesi

Abstract

Amaç: Bethesda III (önemi belirsiz atipi [ÖBA]) sitolojisi olan nodüllerin yönetimi konusunda bir fikir birliği yoktur. Bu çalışmada, ÖBA tanılı nodüllerde tekrarlanan ince iğne aspirasyon biyopsisinin (İİAB) tanısal katkısını değerlendirmek ve ultrasonografi temelli risk sınıflama sistemleri ile birlikte yorumlandığında ek bir değer sağlayıp sağlamadığını araştırmak amaçlanmıştır. Gereç ve Yöntemler: İlk İİAB sonuçları ÖBA olan ve tiroidektomi uygulanan hastalar çalışmaya dahil edildi. Nodüller, histopatolojik özellikleri temel alınarak benign ve malign olarak iki ayrı sınıfa ayrıldı. Tek ve tekrarlanan İİAB grupları karşılaştırıldı ve ACR, EU ve K-TIRADS skorlarına göre dağılımları incelendi. Ayrıca, tekrarlanan İİAB sitolojisinin malignite oranları Bethesda kategorileri ve TIRADS 4–5 (orta-yüksek risk) sınıfları temelinde analiz edildi. Bulgular: Tiroidektomi uygulanan nodüllerin 87'sine (%28,2) cerrahi öncesi tek İİAB yapılırken, 222'sine (%71,8) mükerrer İİAB yapılmıştı. Tek İİAB yapılan nodüllerin 35'i (%40,2) ve mükerrer İİAB yapılan nodüllerin 106'sı (%47,7) nihai histopatoloji sonuçlarına göre malign olarak raporlandı (p = 0,233). ACR, EU ve K-TIRADS sınıflamalarına göre tek ve tekrarlanan İİAB grupları arasında dağılımlar genellikle benzerdi. Tekrarlanan İİAB sitolojisi en sık ÖBA idi (%50,9) ve bu nodüllerde malignite oranı %40,7 bulundu. Benign (%30,0) ve nondiagnostik (%31,2) tekrar İİAB sonuçlarında da yüksek malignite oranları saptandı. Bu alt grupların önemli bir kısmı TIRADS 4–5 kategorisinde yer almakta olup, bu nodüllerde malignite oranları ACR, EU ve K-TIRADS sistemlerinde %60–70 düzeyine ulaştı. Sonuç: ÖBA tanılı nodüllerde tekrarlanan İİAB sınırlı tanısal fayda sağlamaktadır; çünkü sitoloji sonuçlarından bağımsız olarak, özellikle TIRADS 4–5 kategorisinde yer alan nodüllerde malignite oranları yüksek seyretmektedir. Bulgularımız, klinik karar verme sürecinde ultrasonografi temelli risk sınıflamasının, tekrar İİAB’ye kıyasla daha güvenilir olabileceğini göstermektedir. Ancak bu sonuçların doğrulanması için ileriye dönük ve çok merkezli çalışmalara ihtiyaç vardır.

Keywords

• Önemi belirsiz atipi (ÖBA)
• İİAB tekrarı
• ACR-TIRADS
• EU-TIRADS
• K-TIRADS

Evaluation of repeat fine-needle aspiration biopsy according to ACR-EU-K TIRADS scores in the management of nodules with Bethesda III (AUS) cytology

Abstract

Aim: There is no consensus on the management of nodules with Bethesda III (atypia of undetermined significance [AUS]) cytology. This study aimed to evaluate the diagnostic contribution of repeat fine-needle aspiration biopsy (FNAB) in nodules with AUS and to investigate whether it provides additional value when interpreted together with ultrasound- based risk stratification systems. Material and Methods: Patients whose initial FNAB results were AUS and who underwent thyroidectomy were included. The nodules were classified into two distinct categories, benign and malignant, based on their histopathological features. Single and repeat FNAB groups were compared, and their distributions according to ACR, EU, and K-TIRADS scores were analyzed. In addition, malignancy rates of repeat FNAB cytology were assessed based on Bethesda categories and TIRADS 4–5 (intermediate-to-high risk) classifications. Results: While 87 (28.2%) of the nodules that underwent thyroidectomy had undergone a single FNAB before surgery, 222 (71.8%) had undergone repeat FNAB. 35 (40.2%) of the nodules that underwent single FNAB and 106 (47.7%) of the nodules that underwent repeat FNAB were reported as malignant on final histopathology results (p = 0.233). The distributions of ACR, EU, and K-TIRADS scores were generally similar between the groups. The most frequent repeat FNAB result was AUS (50.9%) with a malignancy rate of 40.7%. High malignancy rates were also observed in benign (30.0%) and nondiagnostic (31.2%) repeat FNAB results. A substantial proportion of these subgroups were classified as TIRADS 4–5, where malignancy rates reached 60–70% across the ACR, EU, and K-TIRADS systems. Conclusion: Repeat FNAB in AUS nodules showed limited diagnostic utility, as malignancy rates remained high regardless of cytological results, particularly in nodules classified as TIRADS 4–5. Our findings suggest that ultrasound-based risk stratification may be more reliable than repeat FNAB alone in guiding clinical decision-making. However, further prospective multicenter studies are needed to validate these results.

Keywords

• Atypia of undetermined significance (AUS)
• repeat FNAB
• ACR-TIRADS
• EU-TIRADS
• K-TIRADS

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