ANALYSIS OF FINE NEEDLE ASPIRATIONS OF THE THYROID: CYTOLOGICAL-HISTOPATHOLOGICAL CORRELATION AND OUTCOMES OF THE BETHESDA SYSTEM

Abstract

Objective The Bethesda system is widely used to evaluate aspiration of thyroid nodules. The aim of the study is to evaluate the usability of the system by the correlation between cytology and final histopathology results and to review the literature. Materials and Methods Fine needle aspiration of thyroid nodules reported using Bethesda system were analyzed. Malignancy rates were calculated by the results of thyroidectomies. To analyze the power of the Bethesda system six distinct subgroups were designed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated separately in these subgroups. The data were analyzed using SPSS 20 for Windows. Results The distribution of thyroid nodules according to the Bethesda was 2212 (33.5%), 3163 (47.9%), 720 (10.9%), 67 (1%), 361 (5.5%) and 75 (1.1%), respectively. Of 873 nodules that underwent thyroidectomy, 254 (29.9%) were diagnosed as malignant. The diagnostic categories according to thyroidectomies were 233 (26.7 %), 277 (31.7%), 137 (15.7%), 23 (2.6%), 163 (18.7%) and 40 (4.6%), respectively. The malignancy rates of each Bethesda category were 14.5%, 6.8%, 32.8%, 52.1%, 66.8% and 97.5%. The sensitivity, spesifity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of fine needle aspiration was calculated and ranged from 61.8% to 89.3%, 79.6% to 99.6%, 70.4% to 97.5%, 84.5% to 93.1% and 79.5% to 93.6%, respectively. Conclusion The limitation of this study is that the B1 category is very high. However, since the data are evaluated by only one pathologist and it is one of the first three studies with the highest number of cases, it makes a significant contribution to the literature in terms of all categories except B1. The Bethesda system is a classification that provides the clinician with appropriate clinical follow-up and the accurate treatment approach, and a high interobserver agreement for pathologists.

Keywords

• thyroid
• fine-needle
• thyroidectomy
• Bethesda

TİROİD İNCE İĞNE ASPİRASYONLARININ ANALİZİ: SİTOLOJİK-HİSTOPATOLOJİK KORELASYON VE BETHESDA SİSTEMİNİN SONUÇLARI

Abstract

Amaç Bethesda sistemi, tiroid nodüllerinin aspirasyonunu değerlendirmek için yaygın olarak kullanılmaktadır. Çalışmanın amacı sitoloji ve histopatoloji sonuçları arasındaki korelasyonun ışığında sistemin kullanılabilirliğini değerlendirmek ve literatür eşliğinde gözden geçirmektir. Gereç ve Yöntem Bethesda sistemi kullanılarak raporlanan tiroid nodüllerinin ince iğne aspirasyon sonuçları analiz edildi. Tiroidektomi sonuçlarına göre malignite oranları hesaplandı. Bethesda sisteminin gücünü analiz etmek için altı farklı alt grup tasarlandı. Duyarlılık, özgüllük, pozitif prediktif değer, negatif prediktif değer ve tanısal doğruluk bu alt gruplarda ayrı ayrı hesaplandı. Veriler, Windows için SPSS 20 kullanılarak analiz edildi. Bulgular Tiroid nodüllerin Bethesda'ya göre dağılımı sırasıyla 2212 (%33,5), 3163 (%47,9), 720 (%10,9), 67 (%1), 361 (%5,5) ve 75 (%1,1) idi. Tiroidektomi yapılan 873 nodülün 254'ü (%29.9) malignite tanısı aldı. Tiroidektomilere göre tanı kategorileri sırasıyla 233 (%26,7), 277 (%31,7) 137 (%15,7), 23 (%2,6), 163 (%18,7) ve 40 (%4,6) idi. Her Bethesda kategorisinin malignite oranları %14,5, %6,8, %32,8, %52,1, %66,8 ve %97,5 idi. İnce iğne aspirasyonunun sensitivitesi, spesifisitesi, pozitif prediktif değeri (PPV), negatif prediktif değeri (NPV), doğruluğu hesaplandı ve sırasıyla %61,8 ile %89,3, %79,6 ile %99,6, %70,4 ile %97,5, %84,5 ile %93,1 ve %79,5 ila %93,6 arasında değişmekteydi. Sonuç Bu çalışmanın sınırlılığı B1 kategorisinin çok yüksek olmasıdır. Ancak verilerin sadece bir patolog tarafından değerlendirilmesi ve en fazla vaka sayısına sahip ilk üç çalışmadan biri olması nedeniyle B1 dışındaki diğer kategoriler açısından literatüre önemli bir katkı sağlamaktadır. Bethesda sistemi, klinisyene uygun klinik takip ve doğru tedavi yaklaşımı sağlayan ve patologlar için gözlemciler arası uyumun yüksek olduğu bir sınıflandırmadır.

Keywords

• tiroid
• ince iğne
• tiroidektomi
• Bethesda

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