Malignancy Rate and Reliability of Cytology in Operated Giant Thyroid Nodules

Abstract

Objectives: The main determinants of surgery decision for thyroid nodules are cytology and ultrasonography. It is still debated in the literature if the giant nodules should be routinely operated despite benign cytology reports. This study aimed to determine the malignancy rate in operated giant nodules and calculate the false negativity of cytology in that group.
Materials and Methods We enrolled 675 patients with giant nodules who were followed in our clinics between the dates of June 2015 and April 2019. We evaluated the malignancy rates and other hormonal and demographic parameters of 226 patients who underwent an operation and had histopathology result, retrospectively
Results: According to the histopathology results; 37 (14.40%) of the giant nodules were malignant whereas 220 (85.60%) were benign. There was no statistically significant difference between malign and benign groups regarding preoperative ultrasonographic features, nodule size and demographic properties. TSH was higher in the malignant group. False negativity of the cytology was calculated as 11.65%.
Conclusion: Decision of surgery should be based on ultrasonography findings and FNAC in giant thyroid nodules. Routine surgery is not recommended. Repeated biopsies and sampling the different parts of the nodule during a biopsy can decrease the false negative results.

Keywords

• Giant nodüle,cytology,malignancy rate

Opere Dev Tiroid Nodüllerinde Malignite Oranı ve Sitolojinin Güvenilirliği

Öz

Amaç: Tiroid nodüllerinde operasyon kararının en önemli belirleyicisi ultrason özellikleri ile birlikte altın standart olarak kabul edilen sitolojidir. Dev nodüller sitoloji benignse takip mi edilmeli yoksa sitoloji sonucundan bağımsız olarak opere mi edilmeli henüz netleştirilmemiştir. Bu çalışmanın amacı opere olmuş dev nodüllerde malignite ve İİAB'ın yanlış negatiflik oranlarını belirlemektir.
Materyal ve Metot: Bu çalışmaya Haziran 2015- Nisan 2019 tarihleri arasında ≥ 4 cm çaplı nodülü olan 675 hasta dahil edilmiştir. Bu hastaların 226 'sı opere edilmiş ve verileri retrospektif olarak incelenmiştir.
Bulgular: Histopatolojik incelemede bu nodüllerin 37'si (14.40%) malign, 220’si (85.60%) benigndi. Benign ve malign nodüllerin ultrasonografik özellikleri ve nodül çapları arasında anlamlı farklılık saptanmadı. İki grup demografik özellikler açısından benzer bulunurken, TSH düzeyi malign nodüllerde daha yüksekti. Sitolojinin yanlış negatiflik oranı dev nodüller için %11.65’di.
Sonuç: Sonuç olarak dev nodüllerde cerrahi kararı verirken sitoloji ve ultrason özellikleri ve bası semptomu varlığı veya kozmetik problem varlığı göz önünde bulundurulmalıdır. Sitolojide yanlış negatiflik oranı küçük nodüllerden yüksek olabilir bu nedenle takipte ultrason ve gerektiğinde tekrarlayan biyopsi yapmak gerekir. Bu bulgular rutin cerrahi önermek için yeterli değildir.

Anahtar Kelimeler

• Dev nodül,sitoloji,malignite oranı

Kaynakça

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