THE PREDICTIVE VALUE OF ULTRASONOGRAPHY FOR POTENTIALLY MALIGNANT THYROID NODULES

Öz

Objective: In this study, we aimed to predict the malignancy potential of a thyroid nodule based on ultrasonography (US) features. Material and Method: The data of 726 nodules in 619 patients who underwent thyroidectomy between 2005 and 2012 at Istanbul University, Istanbul Medical Faculty were retrospectively analyzed. US features of nodules were recorded and matched with pathology reports and each US feature was evaluated for diagnostic value. Results: The study group consisted of mainly female patients (86.9%) and the mean age was 46,3 years. Thyroid cancer was detected in 374 (51.7%) nodules and the most common type was papillary thyroid cancer 97% (n=341). Microcalcifications (p=0.0001), irregular margin (p=0.001) and hypoechogenicity (p=0.038) were correlated with malignancy. The absence of any of these suspicious US features significantly predicted benign disease (p=0.0001). An increasing number of suspicious features predicted malign disease with increasing specificity, positive predictive value, and likelihood ratio. Microcalcifications and irregular borders had high specificity (>80%) to predict thyroid cancer. Conclusion: The presence of microcalcifications, irregular margin, and hypoechogenicity in a thyroid nodule significantly correlates with malignant disease. Microcalcifications and irregular borders had high specificity to predict thyroid cancer. The probability of thyroid cancer increases with an increasing number of suspicious US features.

Anahtar Kelimeler

• Thyroid nodules
• ultrasonography
• thyroid cancer

POTANSİYEL MALİGN TİROİD NODÜLLERİ İÇİN ULTRASONOGRAFİNİN TAHMİN DEĞERİ

Öz

Amaç: Bu çalışmada tiroid nodüllerindeki malignite olasılığını ultrasonografi (US) özelliklerinin öngörme seviyesini araştırmayı amaçladık. Gereç ve Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi’nde, 2005 ila 2012 yılları arasında total tiroidektomi ameliyatı olan 619 hastada 726 nodül geriye dönük olarak incelendi. Tiroid nodüllerinin US özellikleri kaydedildi, patoloji raporları ile karşılaştırılarak eşleştirildi ve US özelliklerin tanısal değeri hesaplandı. Bulgular: Çalışmaya alınan hastalarda kadın oranı (%86,9) olup, ortalama yaş 46,3 olarak hesaplandı. Tiroid kanseri 374 (%51,7) nodülde tespit edilirken, en sık kanser türü %97 (n=341) oranla papiller tiroid kanseriydi. Tiroid nodülünde mikrokalsifikasyon (p=0,0001), düzensiz sınır (p=0,001) ve hipoekojenite (p=0,038) varlığı malignite ile korelasyon gösterdi. Mikrokalsifikasyon ve düzensiz sınır özelliklerinin kanser öngörüsü bakımından özgüllüğü yüksek (>%80) bulundu. Nodülde bu şüpheli US özelliklerinden hiçbirinin olmaması selim hastalığı (p=0,0001) tahmin etti. Artan US şüpheli özelliklerin sayısı, artan özgüllük, pozitif prediktif değer ve olasılık oranı ile malign hastalığı öngördü. Mikro kalsifikasyonlar ve düzensiz sınır tiroid kanserini öngörmek için yüksek özgüllüğe (>%80) sahipti. Sonuç: Bir tiroid nodülünde mikrokalsifikasyon, düzensiz sınır ve hipoekojenite varlığında tiroid kanseri olasılığı anlamlı şekilde yüksektir. Malignite öngörüsü açısından özgüllüğü en yüksek bulgular mikrokalsifikasyon ve düzensiz sınırdır. Bir nodüldeki şüpheli US özelliklerinin sayısı arttıkça malignite olasılığı da paralel olarak anlamlı şekilde artar.

Anahtar Kelimeler

• Tiroid nodülleri
• ultrasonografi
• tiroid kanseri

Kaynakça

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