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

Year 2022, Volume: 29 Issue: 2, 213 - 222, 30.06.2022

Ayca Tan

https://doi.org/10.17343/sdutfd.1100450

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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