THE RELATIONSHIP BETWEEN THE NUMBER OF SLIDES AND THE DIAGNOSIS IN THYROID FINE NEEDLE ASPIRATIONS

Abstract

Objective The first method used in the diagnosis of thyroid nodules is the Bethesda system, which is the most widely used system to evaluate aspiration. The adequacy of aspiration applied to symptomatic and asymptomatic nodules is important for appropriate follow-up and treatment of the patient. The aim of the study is to evaluate the relationship between the number of slides prepared from thyroid nodules and nodules sampled at the same time, and diagnostic efficiency. Material and Method 5092 aspirations from 3747 cases were included in the study. The age and gender of the cases, the diameter of the nodules, the number of preparations, the number of nodules and the diagnosis of all nodules were noted. The number of preparations and the number of sampled nodules were categorized and their relationship with the diagnosis was examined. All data were analyzed using SPSS 20. Results Of the aspirations, 3929 (77.2%) were female and 1163 (22.8%) were male patients, and the mean age was 52.3 (11-93 years). The diagnostic rate of aspirations examined with a single preparation was lower than multiple preparations (p=0.001). Suspicious group and malignant diagnoses were higher in those who were examined with multiple preparations, and the rate of benign diagnosis was higher in those who were examined with a single preparation (p=0.013). Considering the diagnostic categories, while benign diagnoses were more common in aspirations from multiple nodules, suspicious and malignant diagnoses were more common in single nodule aspirations. Conclusion Ultrasonographic features of the nodule and the accuracy of the procedure directly affect the diagnosis. It has been concluded that aspiration from several areas of the nodule and the preparation of aspirations with two or more preparations compared to a single preparation are important both to increase the diagnosis and to increase the probability of suspicious and malignant diagnosis.

Keywords

• thyroid
• fine needle
• Bethesda
• aspiration

TİROİD İNCE İĞNE ASPİRASYONLARINDA İNCELENEN PREPARAT SAYISI İLE TANI ARASINDAKİ İLİŞKİ

Abstract

Amaç Tiroid nodüllerinin tanısında kullanılan tek yöntem olan ince iğne aspirasyonunu değerlendirmede en yaygın kullanılan sistem Bethesda sistemidir. Semptomatik ve asemptomatik nodüllere uygulanan ince iğne aspirasyonunun yeterliliği hastanın uygun takip ve tedavisi için önemlidir. Çalışmanın amacı tiroid nodüllerinden yapılan aspirasyonlarda hazırlanan preparat sayısı ve aynı anda örneklenen nodül sayısı ile tanısal yeterlilik arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem 3747 olguya ait 5092 ince iğne aspirasyonu çalışmaya alındı. Olguların yaş ve cinsiyeti, nodül çapı, nodül başına örneklenen preparat sayısı, aynı seansta örneklenen nodül sayısı ve tüm nodüllerin tanıları not edildi. Preparat sayısı ve örneklenen nodül sayısı parametreleri kategorize edilerek tanı ile arasındaki ilişkiye bakıldı. Tüm veriler SPSS 20 programı kullanılarak analiz edildi. Bulgular İnce iğne aspirasyonlarının 3929’u (%77,2) kadın, 1163’ü (%22,8) erkek hastalardan yapılmıştı ve yaş ortalaması 52,3 (11-93 yaş) idi. Tek preparat ile incelenmiş aspirasyonlarda tanısallık oranı multipl preparat ile incelenenlere göre daha düşük idi (p=0,001). Multipl preparat ile incelenenlerde kuşkulu grup ve malign tanıları daha fazlaydı, tek preparat incelenenlerde ise benign tanı oranı daha yüksek idi (p=0,013). Tanı kategorilerine bakıldığında ise multipl nodülden yapılan aspirasyonlarda benign tanılar daha fazlayken, tek nodül aspirasyonlarında kuşkulu ve malign tanı daha fazla idi. Sonuç Aspirasyon yapılan nodülün ultrasonografik özellikleri ve yapılan işlemin doğruluğu tanıyı doğrudan etkilemektedir. Nodülden yapılan aspirasyonlarda nodülün birkaç alanından aspirasyon yapılması ve aspirasyonların tek preparata kıyasla iki ya da daha fazla preparat ile hazırlanmasının hem tanısallığı artırmak hem de kuşkulu ve malign tanı olasılığını artırmak için önemli olduğu sonucuna varıldı.

Keywords

• tiroid
• ince iğne
• Bethesda
• aspirasyon

References

1. 1. Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. Journal of cytology. 2013;30(2):94-9.
2. 2. Rago T, Chiovato L, Aghini-Lombardi F, Grasso L, Pinchera A, Vitti P. Non-palpable thyroid nodules in a borderline iodine-sufficient area: detection by ultrasonography and follow-up. Journal of endocrinological investigation. 2001;24(10):770-6.
3. 3. Udul P. , Barut F. , Özdamar Ş. O. Tiroid Karsinomu Olgularında İnce İğne Aspirasyonu Bulguları. SDÜ Tıp Fakültesi Dergisi. 2018; 25(3): 265-274
4. 4. Burman KD, Wartofsky L. CLINICAL PRACTICE. Thyroid Nodules. The New England journal of medicine. 2015;373(24):2347-56.
5. 5. Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003;9(2):128-36.
6. 6. Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. The Journal of clinical endocrinology and metabolism. 2006;91(9):3411-7.
7. 7. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2006;12(1):63-102.
8. 8. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association. 2016;26(1):1-133.

9. 9. Levenson JN, Santaella I, Wachtel MS, Levenson DI. Discordance between cytologic results in multiple thyroid nodules within the same patient. Acta cytologica. 2010;54(5):673-8.
10. 10. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. The Journal of clinical endocrinology and metabolism. 2002;87(5):1941-6.
11. 11. Burch HB, Burman KD, Cooper DS, Hennessey JV, Vietor NO. A 2015 Survey of Clinical Practice Patterns in the Management of Thyroid Nodules. The Journal of clinical endocrinology and metabolism. 2016;101(7):2853-62.
12. 12. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid : official journal of the American Thyroid Association. 2009;19(11):1159-65.
13. 13. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. American journal of clinical pathology. 2010;134(3):450-6.
14. 14. Sahin D, Yilmazbayhan D, Firat P, Hacisalihoglu UP, Kirimlioglu SH, Celenk E, et al. Comparison of conventional cytology and SurePath in split thyroid fine needle aspiration materials. Cytopathology : official journal of the British Society for Clinical Cytology. 2017;28(4):291-8.
15. 15. Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid : official journal of the American Thyroid Association. 2012;22(12):1251-6.
16. 16. Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R, et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. European journal of endocrinology. 2010;162(4):763-70.
17. 17. Nagarajan N, Schneider EB, Ali SZ, Zeiger MA, Olson MT. How do liquid-based preparations of thyroid fine-needle aspiration compare with conventional smears? An analysis of 5475 specimens. Thyroid : official journal of the American Thyroid Association. 2015;25(3):308-13.
18. 18. Rossi ED, Morassi F, Santeusanio G, Zannoni GF, Fadda G. Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results. Cytopathology : official journal of the British Society for Clinical Cytology. 2010;21(2):97-102.
19. 19. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clinic proceedings. 1994;69(1):44-9.
20. 20. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142(6):837-44; discussion 44.e1-3.
21. 21. Mehanna R, Murphy M, McCarthy J, O'Leary G, Tuthill A, Murphy MS, et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013;123(5):1305-9.
22. 22. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009;117(3):195-202.
23. 23. 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. 2007;111(5):306-15.
24. 24. 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. 2007;111(6):508-16.
25. 25. Kim DW. How to do it: ultrasound-guided fine-needle aspiration of thyroid nodules that commonly result in inappropriate cytology. Clinical imaging. 2013;37(1):1-7.
26. 26. Tulecke MA, Wang HH. ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings. Diagnostic cytopathology. 2004;30(1):7-13.
27. 27. Hasteh F, Pang Y, Pu R, Michael CW. Do we need more than one ThinPrep to obtain adequate cellularity in fine needle aspiration? Diagnostic cytopathology. 2007;35(11):740-3.
28. 28. Mihailescu DV, Schneider AB. Size, number, and distribution of thyroid nodules and the risk of malignancy in radiation-exposed patients who underwent surgery. The Journal of clinical endocrinology and metabolism. 2008;93(6):2188-93.
29. 29. Sippel RS, Elaraj DM, Khanafshar E, Kebebew E, Duh QY, Clark OH. Does the presence of additional thyroid nodules on ultrasound alter the risk of malignancy in patients with a follicular neoplasm of the thyroid? Surgery. 2007;142(6):851-7; discussion 7.e1-2.
30. 30. Barroeta JE, Wang H, Shiina N, Gupta PK, Livolsi VA, Baloch ZW. Is fine-needle aspiration (FNA) of multiple thyroid nodules justified? Endocrine pathology. 2006;17(1):61-5.
31. 31. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. The American journal of medicine. 1992;93(4):363-9.
32. 32. Lansford CD, Teknos TN. Evaluation of the thyroid nodule. Cancer control : journal of the Moffitt Cancer Center. 2006;13(2):89-98.
33. 33. Bouhabel S, Payne RJ, Mlynarek A, Hier M, Caglar D, Tamilia M. Are solitary thyroid nodules more likely to be malignant? Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2012;41(2):119-23.