Kronik Lenfositik Tiroidit/Hashimoto Tiroiditli Hastalarının Sıvı Bazlı Preparatlarındaki Potansiyel Tuzaklar

Öz

Amaç: Kronik lenfositik tiroidit/Hashimoto tiroidit KLT/HT tanılı hastalarının, tiroid lezyonlarını değerlendirmek amacıyla ince iğne aspirasyon ile elde edilen sitoloji materyallerine uygulanan sıvı bazlı sitoloji yönteminin tanı güçlüğü yaratan sitomorfolojik özellikleri saptamak.Gereç ve Yöntemler: Retrospektif olarak bu çalışmaya 2014 ve Mayıs 2018 yılları arasında şüpheli nodül veya kozmetik amaçlı cerrahi operasyon geçiren 70 KLT/HT tanılı hastanın nodülüne ait tanısal ince iğne aspirasyon biyopsisi dahil edildi. Olguların histolojik ve sitolojik tanıları yeniden gözden geçirildi. Sıvı bazlı preparatlarındaki sitomorfolojik özellikler incelendi ve histolojik tanılarıyla karşılaştırıldı.Bulgular: Olgularımızın %52’si benign, %38’i ara sitolojik kategori önemi belirsiz atipi/önemi belirsiz foliküler lezyon, foliküler neoplazi/foliküler neoplazi şüphesi ve malignite şüpheli ve %10 malign sitoloji olarak raporlandı. Reaktif lenfoid hücre olguların %84’ünde az miktarda izlenirken kolloid ise olguların %50’inde saptandı. Papiller karsinom tanılı olguların %69’unda intranükleer psödoinklüzyon ve tamamında nükleer kontur düzensizliği mevcuttu.Sonuç: Sıvı bazlı sitoloji yöntemi uygulanan sitolojik materyallerde, kolloid ve inflamatuvar hücrelerinin azalması olguların ara sitolojik kategori olarak yorumlanmasına ve gereksiz cerrahiye neden olurken temiz zemin sayesinde nükleer detayı daha rahat değerlendirmemizi sağlayarak KLT/HT’li hastalarda malign lezyonların tanılabilirliğini artırdığını düşünmekteyiz

Anahtar Kelimeler

• Sure Path, Sıvı bazlı sitoloji, Tiroid ince iğne aspirasyon

Potential Pitfalls in Liquid-based Preparations of Patients with Chronic Lymphocytic Thyroiditis / Hashimoto Thyroiditis

Abstract

Objective: Our study aim to determine the cytomorphologic features that cause diagnostic difficulties with the liquid-based cytology method applied to cytological materials obtained by fine needle aspiration to evaluate thyroid lesions of chronic lymphocytic thyroiditis / Hashimoto thyroiditis CLT/HT patients.Material and Methods: This study retrospectively included diagnostic fine needle aspiration biopsies from the nodules of 70 CLT/HT patients who had undergone surgery for a suspicious nodule or cosmetic surgery between 2014 and May 2018. Histological and cytological diagnoses of the cases were reviewed. Cytomorphological features of liquid-based preparations were evaluated and compared with the histological diagnoses.Results: Fifty-two percent of our cases were reported as benign, 38% were in the indeterminate cytological category atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy and 10% had malignant cytology. Reactive lymphoid cells were observed in 84% of the cases and colloid in 50% of the cases. Intranuclear pseudoinclusion was present in 69% of the cases. Nuclear contour irregularity was detected in all papillary carcinoma cases.Conclusion: We think that cleaner background in cytological material prepared with the liquidbased cytology method allows us to evaluate the nuclear detail more easily, thereby increasing the diagnostic accuracy of malignant lesions, in patients with CLT/HT while the decrease of colloid and inflammatory cells causes interpretation of cases as belonging to the intermediate cytological category and results in unnecessary surgery

Keywords

• Sure Path, Liquid based cytology, Thyroid fine needle aspiration

Kaynakça

1. Baser H, Ozdemir D, Cuhaci N, Aydin C, Ersoy R, Kilicarslan A, Cakir B. Hashimoto’s thyroiditis does not affect ultrasonographical, cytological, and histopathological features in patients with papillary thyroid carcinoma. Endocrine Pathology 2015;26:356- 64.
2. Guarino V, Castellone MD, Avilla E, Melillo RM. Thyroid cancer and inflammation. Molecular and Cellular Endocrinology 2010;321:94-102.
3. Chui MH, Cassol CA, Asa SL, Mete O. Follicular epithelial dysplasia of the thyroid: Morphological and immunohistochemical characterization of a putative preneoplastic lesion to papillary thyroid carcinoma in chronic lymphocytic thyroiditis. Virchows Archiv 2013;462:557-63.
4. Hasan G. Tümöral olmayan tiroid patolojileri. İçinde: Dizbay Pak S, Sökmensüer C, ed. Endokrin organ patolojisi. 1. basım. İzmir: O’Tıp Kitabevi, 2017:33-56.
5. Harvey AM, Truong LD, Mody DR. Diagnostic pitfalls of Hashimoto’s/lymphocytic thyroiditis on fine-needle aspirations and strategies to avoid overdiagnosis. Acta Cytol 2012;56(4):352-60.
6. Elsheikh TM, Cochand-Priolllet B, Won Hong S, Sidawy MK. Benign. In: Ali SZ, Cibas ES, eds. The bethesda system for reporting thyroid cytopathology. 2nd ed. Cham: Springer Press, 2018:19-48.
7. Duncan LD, Forrest L, Law WM, Hubbard E, Stewart LE. Evaluation of thyroid fine‐needle aspirations: Can ThinPrep be used exclusively to appropriately triage patients having a thyroid nodule? Diagnostic Cytopathology 2011;39(5):341-8.
8. Cochand‐Priollet B, Prat JJ, Polivka M, Thienpont L, Dahan H, Wassef M, Guillausseau PJ. Thyroid fine needle aspiration: The morphological features on ThinPrep® slide preparations. Eighty cases with histological control. Cytopathology 2003;14:343-9.

9. Chong Y, Ji S-J, Kang CS, Lee EJ. Can liquid-based preparation substitute for conventional smear in thyroid fine-needle aspiration? A systematic review based on meta-analysis. Endocrine Connections 2017;6:817-29.
10. Sahin D, Yilmazbayhan D, Firat P, Hacisalihoglu U, Kirimlioglu S, Celenk E, Arslan E. Comparison of conventional cytology and SurePath in split thyroid fine needle aspiration materials. Cytopathology 2017;28:291- 8.
11. Fadda G, Rossi ED. Liquid-based cytology in fine-needle aspiration biopsies of the thyroid gland. Acta cytologica 2011;55:389-400.
12. Lee JS, Choi H-S, Park IA, Ryu HS. Liquid-based fine needle aspiration biopsy of papillary thyroid carcinoma: logistic regression analysis with conventional and new cytomorphologic features. Acta Cytologica 2013;57:233- 40.
13. Chong Y, Baek KH, Kim JY, Kim TJ, Lee EJ, Kang CS. Comparison of EASYPREP® and SurePath® in thyroid fine‐needle aspiration. Diagnostic Cytopathology 2016;44:283-90.
14. 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 2015;25:308-13.
15. Saleh HA, Hammoud J, Zakaria R, Khan AZ. Comparison of Thin-Prep and cell block preparation for the evaluation of Thyroid epithelial lesions on fine needle aspiration biopsy. Cytojournal 2008;5:3.
16. Singh N, Kumar S, Negi VS, Siddaraju N. Cytomorphologic study of Hashimoto’s thyroiditis and its serologic correlation. Acta Cytologica 2009;53:507-16.
17. Nguyen GK, Ginsberg J, Crockford PM, Villanueva RR. Hashimoto’s thyroiditis: cytodiagnostic accuracy and pitfalls. Diagnostic Cytopathology 1997;16:531-6.
18. Ravinsky E, Safneck JR. Differentiation of Hashimoto’s thyroiditis from thyroid neoplasms in fine needle aspirates. Acta Cytologica 1988;32:854-61.
19. Kapan M, Onder A, Girgin S, Ulger BV, Firat U, Uslukaya O, Oguz A. The reliability of fine-needle aspiration biopsy in terms of malignancy in patients with Hashimoto thyroiditis. International Surgery 2015;100:249-53.
20. Galera-Davidson H, Gonzalez-Campora R. Thyroid. In: Bibbo M, Wilbur DC, eds. Comprehensive Cytopathology. 4th ed. London: Elsevıer Press, 2015:511-44.
21. Bakhos R, Selvaggi SM, DeJong S, Gordon DL, Pitale SU, Herrmann M, Wojcik EM. Fine‐needle aspiration of the thyroid: Rate and causes of cytohistopathologic discordance. Diagnostic Cytopathology 2000;23:233-7.
22. Sclabas GM, Staerkel GA, Shapiro SE, Fornage BD, Sherman SI, Vassillopoulou-Sellin R, Evans DB. Fine- needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients. American Journal of Surgery 2003;186:702-10.
23. Ruben Harach H, Zusman SB, Saravia Day E. Nodular goiter: A histo‐cytological study with some emphasis on pitfalls of fine‐needle aspiration cytology. Diagnostic Cytopathology 1992;8:409-19.
24. Afify AM, Liu J, Al‐Khafaji BM. Cytologic artifacts and pitfalls of thyroid fine‐needle aspiration using ThinPrep®. Cancer Cytopathology 2001;93:179-86.
25. Mesonero C, Sickel J. Thyroid fine needle aspiration: a comparison of thin-layer slide preparation with conventional smears. Acta Cytol 1993;37:795.
26. Faquin WC, Michael CW, Renshaw AA, Vielh P. Follicular neoplasm, hürthle cell (Oncocytic) type/supicious for a follicular neoplasm, hürthle cell (Oncocytic) type. In: Ali SZ, Cibas ES, eds. The bethesda system for reporting thyroid cytopathology. 2nd ed. Cham: Springer Press, 2018:81-100.
27. Kwon H, Kim WG, Eszlinger M, Paschke R, Song DE, Kim M, Shong YK. Molecular diagnosis using residual liquid-based cytology materials for patients with nondiagnostic or indeterminate thyroid nodules. Endocrinology and Metabolism 2016;31:586-91.
28. Kasper KA, Stewart J 3rd, Das K. Fine-needle aspiration cytology of thyroid nodules with Hürthle cells: Cytomorphologic predictors for neoplasms, improving diagnostic accuracy and overcoming pitfalls. Acta Cytologica 2014;58:145-52.
29. DeMay R. The Art and Science of Cythopathology, 2th ed. Chicago: ASP, 2012:830-942.