The Role of Fine Needle Aspiration Biopsy with Bethesda System in the Evaluation of Thyroid Nodules

Öz

Aim: In this study, the role of fine needle aspiration biopsy (FNAB) evaluated with the Bethesda System in the diagnosis of thyroid nodules was investigated.

Materials and Methods: Total 2284 FNAB materials of 1846 patients were performed in the Pathology Department of Kutahya Health Sciences University, Evliya Celebi Traning and Research Hospital between 2016 and 2019 and reported according to the Bethesda category. Among these cases, diagnostic sensitivity, specificity, accuracy, positive and negative predictive values of FNAB were calculated by making cytohistopathologica comparison in 328 cases who underwent total thyroidectomy.

Results: In the study, 1538 of the 1846 patients included were female (83.31%) and 308 (16.68%) were male. The average age was 49.92 years (Age range 19-87). The final cytological diagnoses of 2284 FNABs were as follows: 287 (12.57%) nondiagnostic or unsatisfactory, 1517 (66.42%) benign cytology, 316 (13.83%) atypia of undetermined significance/follicular lesion of undetermined significance, 63 (2.75%) follicular neoplasm or suspicious for a follicular neoplasm, 59 (2.59%) suspicious for malignancy and 42 (1.84%) malignant cytology. Histologically, 245 (74.70%) of the 328 cases were benign, while 83 (25.30%) were malignant. The number of true negative cases was 216 (65.85%), the number of true positive cases was 62 (19.90%), the number of false positive cases was 29 (8.84%) and the number of false negative cases was 21 (6.40%). In this case, diagnostic sensitivity, specificity, accuracy rates, positive and negative predictive values were 74.7%, 88.16%, 84.76%, 68.13% and 91.14%, respectively.

Conclusion: In our study, it was observed that the sensitivity, specificity, accuracy rates, positive and negative predictive values of thyroid FNABs were compatible with the literature. We think that as the experience of the clinician and cytopathologist increases, false negative and positive results will decrease and at the same time, the confidence in thyroid FNABs will increase even more with the participation of some recent molecular methods (BRAF and RET/PTC, AX8/PPARG and RAS) applied to FNABs.

Anahtar Kelimeler

• Bethesda system
• fine needle aspiration biopsy
• thyroid nodule
• cytology

Tiroid Nodüllerinin Değerlendirilmesinde Bethesda Sistemi ve İnce İğne Aspirasyon Biopsisinin Yeri

Öz

Amaç: Bu çalışmada tiroid nodüllerinin tanısında Bethesda Sistemi ile değerlendirilen ince iğne aspirasyon biyopsisinin (İİAB) rolü araştırıldı.

Gereç ve Yöntemler: Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi Patoloji Bölümü’nde 2016-2019 yılları arasında Bethesda kategorisine göre raporlanan 1846 hastaya ait 2284 İİAB materyali incelendi. Bu olgular içerisinden tiroidektomisi yapılan 328 olguda sito-histopatolojik karşılaştırma yapılarak İİAB'nin tanısal duyarlılık, özgüllük, doğruluk, pozitif ve negatif prediktif değerleri araştırıldı.

Bulgular: Çalışmaya alınan 1846 hastanın 1538'i kadın (%83,31), 308'i (%16,68) erkekti. Yaş ortalaması 49,92 idi (Yaş aralığı 19-87). 2284 İİAB'nin son sitolojik tanıları şöyleydi: 287 (%12,57) yetersiz materyal, 1517 (%66,42) benign sitoloji, 316 (%13,83) önemi belirsiz atipi/önemi belirsiz folliküler lezyon, 63 (%2,75) folliküler neoplazi veya folliküler neoplazi kuşkusu, 59 (%2,59) malignite kuşkulu sitoloji ve 42 (%1,84) malign sitoloji. Eksizyonu da yapılan toplam 328 olgunun 245'i (%74,70) benign iken, 83'ü (%25,30) maligndi. Gerçek negatif olgu sayısı 216 (%65,85), gerçek pozitif olgu sayısı 62 (%19,90), yalancı pozitif olgu sayısı 29 (%8,84), yalancı negatif olgu sayısı 21 (%6,40) bulundu. Bu durumda tanısal duyarlılık, özgüllük, doğruluk oranları, pozitif ve negatif prediktif değerleri sırasıyla %74,7, %88,16, %84,76, %68,13 ve %91,14 olarak saptandı.

Sonuç: Çalışmamızda tiroid İİAB’lerindeki duyarlılık, özgüllük, doğruluk oranları ile pozitif ve negatif prediktif değerlerinin literatürle uyumlu olduğu görüldü. Klinisyen ve sitopatoloğun deneyimi arttıkça, yalancı negatif ve pozitif sonuçların azalacağı ve aynı zamanda İİAB’lere uygulanan bazı yeni moleküler yöntemlerin de (BRAF ve RET/PTC, eğer mümkünse PAX8 / PPARG ve RAS) katılımıyla, tiroid İİAB’lerine olan güvenin daha da artacağını düşünmekteyiz.

Anahtar Kelimeler

• Bethesda sistemi
• ince iğne aspirasyon biyopsisi
• tiroid nodülleri
• sitoloji

Kaynakça

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