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Tiroid Nodül Boyutu Ve Özelliklerinin İnce İğne Aspirasyon Biyopsisinin Doğruluğu Ve Malignite Riski Üzerine Etkisi

Yıl 2024, Cilt: 6 Sayı: 3, 321 - 330, 14.10.2024
https://doi.org/10.52827/hititmedj.1501055

Öz

Amaç: Ultrasonografi, tiroid nodüllerinin özelliklerinin incelenmesi ve ince iğne aspirasyon biyopsisinin (İİAB) alınması noktasında kolay, avantajlı ve güvenlik-maliyet etkin bir yöntemdir. Bununla beraber, büyük nodüllerde güvenilirliği tartışmalıdır. Bu çalışmada amacımız ultrasondaki tiroid nodül boyutu ve özelliklerinin malignite riski üzerine ve ince iğne aspirasyon biyopsisinin doğruluğu üzerine etkisini incelemektir.
Gereç ve Yöntem: Çalışmaya, retrospektif olarak 01.01.2020 ile 01.01.2024 tarihleri arasında tiroidektomi operasyonu geçiren 522 hasta dahil edilmiştir. Yaş, cinsiyet, preoperatif ultrason bulguları, preoperatif İİAB sonuçları, ameliyat notları ve postoperatif patoloji bulguları arşivden araştırılmıştır. İstatistiksel analizde Kruskal-Wallis Varyans Analizi, ROC (Receiver Operating Characteristics) eğrisi analizi, Bonferroni Düzeltmeli Mann-Whitney U Testi ve Ki-Kare Testleri kullanılmıştır.
Bulgular: Medyan yaş 49,45 olarak bulundu. Preoperatif İİAB ile postoperatif patoloji uyumu incelendiğinde; nodülün X düzlemdeki boyutu için eşik değer 27 mm olarak bulundu (p<0.001). X ≤ 27 mm olan nodüllerde İİAB nin Sensivite 0.842, Yanlış prediktif değer 0.636 ve Yanlış Negatif Oran (FNR) 0.157 daha anlamlı bulundu. X ≤ 27 mm boyutta; yaş ortalaması, nodül X boyutu ve iki boyutlu alan (X*Y) benign grupta (p<0.001); X ≤ 27 mm ve X tüm boyutta hipoekoik ve mikrokalsifikasyon özelliği malign grupta, İzoekoik görünüm benign grupta anlamlı yüksek bulundu.
Sonuç: Yaş, nodül boyutu ve iki boyutlu alan artışıyla malignite riskinin azaldığı; hipoekojenite ve mikrokalsifikasyon bulgusunun malignite riskini arttırdığı; >27 mm nodüllerde İİAB nin sensivitesinin azaldığı ve false negatif değerinin arttığı görüldü.

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Destekleyen Kurum

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Kaynakça

  • Haugen BR, Alexander EK, Bible KC 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. 2016;26:1-133.
  • Kiernan CM, Solórzano CC. Bethesda category III, IV, and V thyroid nodules: can nodule size help predict malignancy? Journal of the American College of Surgeons. 2017;225(1):77-82.
  • Liu T, Tilak M, Awad S, Lakoff J. A literature review of factors associated with pain from fine needle aspiration biopsy of thyroid nodules. Endocrine Practice. 2022;28(6):628-636.
  • Hambleton C, Kandil E. Appropriate and accurate diagnosis of thyroid nodules: a review of thyroid fine-needle aspiration. International Journal of Clinical and Experimental Medicine. 2013;6(6):413.
  • Aydoğan Bİ, Şahin M, Ceyhan K et al. The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound-guided fine-needle aspiration cytology. Diagnostic Cytopathology. 2019;47(7):682-687.
  • Zufry H, Nazarrudin N, Zulfa PO et al. Comparative analysis of accuracy between fine-needle aspiration biopsy and postoperative histopathology for detecting large thyroid nodules: A retrospective observational study. Narra J. 2023;3(2).
  • Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. Journal of Surgical Research. 2013;181(1):6-10.
  • Wharry LI, McCoy KL, Stang MT et al. Thyroid nodules (≥ 4 cm): can ultrasound and cytology reliably exclude cancer? World Journal of Surgery. 2014;38:614-621.
  • Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head & Neck. 2009;31(7):856-866.
  • Megwalu UC. Risk of malignancy in thyroid nodules 4 cm or larger. Endocrinology and Metabolism. 2017;32(1):77.
  • Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341-1346.
  • Agrafiotis AC, Sokolow Y, Ruiz-Patino M et al. Treatment of solitary thyroid nodules according to size, preoperative fine-needle aspiration cytology and frozen section: A retrospective single-centre study. Acta Chirurgica Belgica. 2019;119(5):294–302. https://doi.org/10.1080/00015458.2018.1527566
  • Karadeniz E, Yur M, Temiz A, Akçay MN. Malignancy risk for thyroid nodules larger than 4 cm and diagnostic reliability of ultrasound-guided FNAB results. Turkish Journal of Surgery. 2019;35(1):13.
  • Rosario PW, Salles DS, Bessa B, Purisch S. Low false-negative rate of cytology in thyroid nodules ≥ 4 cm. Arq Bras Endocrinol Metab. 2009;53:1143–1145.
  • Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules. Langenbeck’s Archives of Surgery. 2010;395:127–132.
  • Kulstad R. Do all thyroid nodules > 4 cm need to be removed? An evaluation of thyroid fine-needle aspiration biopsy in large thyroid nodules. Endocrine Practice. 2016;22(7):791-798.
  • Kim JH, Kim NK, Oh YL et al. The validity of ultrasonography-guided fine needle aspiration biopsy in thyroid nodules 4 cm or larger depends on ultrasonography characteristics. Endocrinology and Metabolism. 2014;29(4):545.
  • Koo DH, Song K, Kwon H et al. Does tumor size influence the diagnostic accuracy of ultrasound-guided fine-needle aspiration cytology for thyroid nodules? International Journal of Endocrinology. 2016;1:3803647.
  • Godazandeh G, Kashi Z, Zargarnataj S, Fazli M, Ebadi R, Kerdabadi EH. Evaluation of the relationship between thyroid nodule size with malignancy and accuracy of fine needle aspiration biopsy (FNAB). Acta Informatica Medica. 2016;24(5):347.
  • Mehanna R, Murphy M, McCarthy J et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013;123(5):1305-1309.
  • Giles WH, Maclellan RA, Gawande AA et al. False negative cytology in large thyroid nodules. Annals of Surgical Oncology. 2015;22:152–157.
  • Cavallo A, Johnson DN, White MG et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid. 2017;27:641–650.
  • Magister MJ, Chaikhoutdinov I, Schaefer E et al. Association of thyroid nodule size and Bethesda class with rate of malignant disease. JAMA Otolaryngology-Head & Neck Surgery. 2016;141:1089–1095.
  • Ucler R, Usluogulları CA, Tam AA et al. The diagnostic accuracy of aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagnostic Cytopathology. 2015;43:622–628.
  • Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E. A meta-analysis examining the independent association between thyroid nodule size and malignancy. Gland Surgery. 2016;5(3):312-317.
  • Kişioğlu SV, Atacan H, Çakır E et al. Efficacy of multidisciplinary approach in thyroid nodules: analysis of factors used for predicting malignancy. Turkish Journal of Endocrinology and Metabolism. 2022;26:125–130.
  • Mandel SJ. Diagnostic use of ultrasonography in patients with nodular thyroid disease. Endocrine Practice. 2004;10:246–252.
  • Santos JEC, Kalk WJ, Freitas M, Marques Carreira I, Castelo Branco M. Iodine deficiency and thyroid nodular pathology-epidemiological and cancer characteristics in different populations: Portugal and South Africa. BMC Research Notes. 2015;8:1-7.
  • Harding KB, Peña-Rosas JP, Webster AC et al. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database of Systematic Reviews. 2017;3.
  • Kahmke R, Lee WT, Puscas L et al. Utility of intraoperative frozen sections during thyroid surgery. International Journal of Otolaryngology. 2013;1:496138.

The Effect of Thyroid Nodule Size and Characteristics on the Accuracy of Fine-Needle Aspiration Biopsy and the Risk of Malignancy

Yıl 2024, Cilt: 6 Sayı: 3, 321 - 330, 14.10.2024
https://doi.org/10.52827/hititmedj.1501055

Öz

Objective: Ultrasound evaluation of nodule characteristics and FNAB is a simple, cost-effective method. However, its reliability in large nodules is controversial. This study aims to examine the impact of thyroid nodule size and characteristics on malignancy risk and FNAB accuracy as evaluated by ultrasound.
Material and Method: This retrospective study included 522 patients who underwent thyroidectomy between January 1, 2020, and January 1, 2024. The data included the patients’ age, gender, preoperative thyroid ultrasound findings, preoperative FNAB pathology findings, operation notes, and postoperative pathology results colleected from hospital archives. Kruskal-Wallis Variance Analysis, ROC (Receiver Operating Characteristics) curve analysis, Bonferroni Corrected Mann-Whitney U Test, Chi-Square Tests, were used at statistical analysis.
Results: The median age was 49.45 years. The threshold value for nodule size in the X plane was 27 mm (p<0.001) when comparing preoperative FNAB with postoperative pathology. For nodules with X ≤ 27 mm, FNAB sensitivity was 0.842, the false predictive value was 0.636, and the false negative rate was 0.157. In this group, the mean age, nodule size, and two-dimensional area (X*Y) were significantly higher nodules, while isoechoic features were more common in benign nodules.
Conclusion: It was found that the risk of malignancy decreases with increasing age, nodule size, and two-dimensional area; the risk of malignancy increases with hypoechoic and microcalcification findings; and FNAB sensitivity decreases and the false negative value increases in nodules >27 mm.

Kaynakça

  • Haugen BR, Alexander EK, Bible KC 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. 2016;26:1-133.
  • Kiernan CM, Solórzano CC. Bethesda category III, IV, and V thyroid nodules: can nodule size help predict malignancy? Journal of the American College of Surgeons. 2017;225(1):77-82.
  • Liu T, Tilak M, Awad S, Lakoff J. A literature review of factors associated with pain from fine needle aspiration biopsy of thyroid nodules. Endocrine Practice. 2022;28(6):628-636.
  • Hambleton C, Kandil E. Appropriate and accurate diagnosis of thyroid nodules: a review of thyroid fine-needle aspiration. International Journal of Clinical and Experimental Medicine. 2013;6(6):413.
  • Aydoğan Bİ, Şahin M, Ceyhan K et al. The influence of thyroid nodule size on the diagnostic efficacy and accuracy of ultrasound-guided fine-needle aspiration cytology. Diagnostic Cytopathology. 2019;47(7):682-687.
  • Zufry H, Nazarrudin N, Zulfa PO et al. Comparative analysis of accuracy between fine-needle aspiration biopsy and postoperative histopathology for detecting large thyroid nodules: A retrospective observational study. Narra J. 2023;3(2).
  • Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. Journal of Surgical Research. 2013;181(1):6-10.
  • Wharry LI, McCoy KL, Stang MT et al. Thyroid nodules (≥ 4 cm): can ultrasound and cytology reliably exclude cancer? World Journal of Surgery. 2014;38:614-621.
  • Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head & Neck. 2009;31(7):856-866.
  • Megwalu UC. Risk of malignancy in thyroid nodules 4 cm or larger. Endocrinology and Metabolism. 2017;32(1):77.
  • Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341-1346.
  • Agrafiotis AC, Sokolow Y, Ruiz-Patino M et al. Treatment of solitary thyroid nodules according to size, preoperative fine-needle aspiration cytology and frozen section: A retrospective single-centre study. Acta Chirurgica Belgica. 2019;119(5):294–302. https://doi.org/10.1080/00015458.2018.1527566
  • Karadeniz E, Yur M, Temiz A, Akçay MN. Malignancy risk for thyroid nodules larger than 4 cm and diagnostic reliability of ultrasound-guided FNAB results. Turkish Journal of Surgery. 2019;35(1):13.
  • Rosario PW, Salles DS, Bessa B, Purisch S. Low false-negative rate of cytology in thyroid nodules ≥ 4 cm. Arq Bras Endocrinol Metab. 2009;53:1143–1145.
  • Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. The false-negative rate of fine-needle aspiration cytology for diagnosing thyroid carcinoma in thyroid nodules. Langenbeck’s Archives of Surgery. 2010;395:127–132.
  • Kulstad R. Do all thyroid nodules > 4 cm need to be removed? An evaluation of thyroid fine-needle aspiration biopsy in large thyroid nodules. Endocrine Practice. 2016;22(7):791-798.
  • Kim JH, Kim NK, Oh YL et al. The validity of ultrasonography-guided fine needle aspiration biopsy in thyroid nodules 4 cm or larger depends on ultrasonography characteristics. Endocrinology and Metabolism. 2014;29(4):545.
  • Koo DH, Song K, Kwon H et al. Does tumor size influence the diagnostic accuracy of ultrasound-guided fine-needle aspiration cytology for thyroid nodules? International Journal of Endocrinology. 2016;1:3803647.
  • Godazandeh G, Kashi Z, Zargarnataj S, Fazli M, Ebadi R, Kerdabadi EH. Evaluation of the relationship between thyroid nodule size with malignancy and accuracy of fine needle aspiration biopsy (FNAB). Acta Informatica Medica. 2016;24(5):347.
  • Mehanna R, Murphy M, McCarthy J et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. The Laryngoscope. 2013;123(5):1305-1309.
  • Giles WH, Maclellan RA, Gawande AA et al. False negative cytology in large thyroid nodules. Annals of Surgical Oncology. 2015;22:152–157.
  • Cavallo A, Johnson DN, White MG et al. Thyroid nodule size at ultrasound as a predictor of malignancy and final pathologic size. Thyroid. 2017;27:641–650.
  • Magister MJ, Chaikhoutdinov I, Schaefer E et al. Association of thyroid nodule size and Bethesda class with rate of malignant disease. JAMA Otolaryngology-Head & Neck Surgery. 2016;141:1089–1095.
  • Ucler R, Usluogulları CA, Tam AA et al. The diagnostic accuracy of aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagnostic Cytopathology. 2015;43:622–628.
  • Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E. A meta-analysis examining the independent association between thyroid nodule size and malignancy. Gland Surgery. 2016;5(3):312-317.
  • Kişioğlu SV, Atacan H, Çakır E et al. Efficacy of multidisciplinary approach in thyroid nodules: analysis of factors used for predicting malignancy. Turkish Journal of Endocrinology and Metabolism. 2022;26:125–130.
  • Mandel SJ. Diagnostic use of ultrasonography in patients with nodular thyroid disease. Endocrine Practice. 2004;10:246–252.
  • Santos JEC, Kalk WJ, Freitas M, Marques Carreira I, Castelo Branco M. Iodine deficiency and thyroid nodular pathology-epidemiological and cancer characteristics in different populations: Portugal and South Africa. BMC Research Notes. 2015;8:1-7.
  • Harding KB, Peña-Rosas JP, Webster AC et al. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database of Systematic Reviews. 2017;3.
  • Kahmke R, Lee WT, Puscas L et al. Utility of intraoperative frozen sections during thyroid surgery. International Journal of Otolaryngology. 2013;1:496138.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi Onkoloji, Genel Cerrahi
Bölüm Araştırma Makaleleri
Yazarlar

Mehmet Alperen Avcı 0000-0003-3911-2686

Can Akgün 0000-0002-8367-0768

Mustafa Gün 0000-0002-2343-0316

Selim Tamam 0000-0002-2924-1874

Meltem Türk 0000-0003-3975-331X

Yayımlanma Tarihi 14 Ekim 2024
Gönderilme Tarihi 13 Haziran 2024
Kabul Tarihi 18 Eylül 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 6 Sayı: 3

Kaynak Göster

AMA Avcı MA, Akgün C, Gün M, Tamam S, Türk M. The Effect of Thyroid Nodule Size and Characteristics on the Accuracy of Fine-Needle Aspiration Biopsy and the Risk of Malignancy. Hitit Medical Journal. Ekim 2024;6(3):321-330. doi:10.52827/hititmedj.1501055