NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI

Hakan Şarlar; Enver İlhan; Mehmet Akif Üstüner; Abdullah Şenlikci; Orhan Üreyen

NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI

Yıl 2013, Cilt: 17 Sayı: 1, 15 - 24, 01.03.2013

Hakan Şarlar Enver İlhan Mehmet Akif Üstüner Abdullah Şenlikci Orhan Üreyen

Öz

Bu çalışmada tiroid nodülü nedeniyle ameliyat edilen hastalarda demografik, laboratuar, görüntüleme ve sitoloji bulgularının histopatoloji sonuçlarıyla ilişkisi araştırıldı. Nodüler guatr tanısıyla ameliyat edilen olgular yaş, cinsiyet, nodül sayısı, nodül boyutu, fonksiyon durumu, hormon profili, ameliyat tipi, sitoloji ve histopatoloji sonuçlarına göre retrospektif olarak değerlendirildi. Toplam 179 olgunun 147 %82.1 ’si kadın, 32 %17.9 ’si erkek idi. Ortalama yaş 51.3 aralık 22- 81 idi. Olguların çoğunluğu %69.3 30-60 yaş grubundaydı. Multinodüler guatr 142 %79.3 , soliter nodül 37 %20.7 olguda mevcuttu. Toplam 41 hastaya İİAB yapıldı. Bunlardan 19 %46.3 ’u yetersiz materyal olarak değerlendirildi. Geri kalan 22 %53.7 olgunun 15’i benign, beşi şüpheli malign ve ikisi malign tanısı aldı. Histopatolojik olarak malignite saptanan 27 %15.09 olgunun; 15 %55.6 ‘inde papiller karsinom, 3 %11.1 ’ünde papiller mikrokarsinom, 6 22.2 ’sında folliküler karsinom, 3 %11.1 ’ünde Hurthle hücreli karsinom tesbit edildi. Bunların 21 %77.8 ’i multinodüler, 6 %22.2 ’sı soliter nodülü olan hastalardı. Histopatoloji sonuçları ile yaş p =0.601 , cinsiyet p =0.790 ,nodül sayısı p=0.829 , nodül boyutu p=0.845 , tiroid fonksiyon durumu 0.744 , hormon profili p=0.206 , sitoloji p=0.227 ve ameliyat tipi p=0.350 arasında istatistiksel olarak anlamlı ilişki tesbit edilmedi. Tiroid nodülü tesbit edilen hastalarda ameliyat gereksinimini azaltmak ve tiroidektominin istenmeyen etkilerinden kaçınmak için cerrah, radyolog ve patolog işbirliği ile sitolojik tetkik uygulama ve değerlendirmede başarı ve beceriyi geliştirmek için gerekli çaba sarfedilmelidir.

Anahtar Kelimeler

Tiroid nodülü, tiroid kanseri, ince iğne aspirasyon biopsisi

Kaynakça

) Burinicardi FC. Schwartz’s principels of surgery. In: Lal G, Clark HO. Thyroid, parathyroid, adrenal. McGraw Hill Company, Ninth Edition, Newyork 2010: p. 1343-1408. 2) Braverman EL, Utiger DR. The thyroid a fundemental and clinical text. In: Schneider BA, Ron E. Carcinoma of follicular epithelium. Lippincott Williams & Wilkins, Philadelphia 2005: p. 889-905.
) Hanks JB. Thyroid. Townsend CM, Beauchamp RD, Evers BM, Mattox KL (editors) In: Sabiston's Text Book of Surgery 17th ed. Philadelphia: Saunders; 2004; p. 961–2.
) Wu HS, Young MT, Ituarte PHG, D’Avanzo A, Duh QY, Greenspan FS, et al. Death from thyroid cancer of Follicular cell origin. J Am Coll Surg 2000; 191: 600–6.
) Townsend. Sabiston Textbook of Surgery. In:Hanks BJ. Thyroid. Saunders Elsevier, 17th edition, Philadelphia 2004: p. 947-99.
) Jameson JL, De Groot JL. Endocrinology adult and pediatric. In: Pacini F, Marchisotta S, De Groot JL. Thyroid neoplasia. Saunders Elsevier, 6th edition, Philadelphia 2010: p. 1668-1701.
) Mazafferi EL. Management of a solitary throid nodule. N Engl J Med. 1993; 328: 553- 6.
) Perros P. British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer. 2nd ed. London: Royal College of Physicians; 2007.
) Sampson, RJ, Woolner, LB, Bahn, RC, Kurland, LT. Occult thyroid carcinoma in Olmsted County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan. Cancer 1974; 34: 2072-76.
) Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22: 901-11.
) Thomas WEG. Neoplasm’s of thyroid gland (including the solitary nodule). Surg Int 2004; 64: 296–300.
) Qureshi JN, Muneer A, Memon AS, Memon S, Hammad A. Malignancy in nodular goiter. J Surg Pak 2006; 11: 71–2. 13) Khairy GA. Solitary thyroid nodule: the risk of cancer and the extent of surgical therapy. East Afr Med J 2004; 81: 459–462.
) Benzarti S, Miled I, Bassoumi T, Ben Mrad B, Akkari K, Bacha O, Chebbi MK. Thyroid surgery (356cases): risks and complications. Rev Laryngol Otol Rhinol (Board) 2002; 123: 33-7.
) Alagic-Smailbegovic J, Kapidzic A, Sutalo K, Resic M, Hadzic E. Surgical treatment of thyroid gland disease. Med Arh 2005; 59: 241–3.
) Prades JM, Dumollard JM, Timoshenko A, Chelikh L, MichelF, Estour B, et al. Multinodular goiter: surgical management and histopathological findings. Eur Arch Otolaryngol 2002; 259: 217–21.
) Senyurek G Y, Tunca F, Boztepe H, Kapran Y, Terzioglu T, Tezelman S. The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma. Surgery 2008; 144: 1028-36.
) Suvak O, Saylam B, Coşkun F, Oktay M, Albayrak A, Suvak B, ve ark. Tiroid Nodülü Tanısıyla Takip Edilen Hastalarda Tiroid Kanser İnsidansı: Bir Referans Merkezi Çalışması. Yeni Tıp Dergisi 2012; 29: 37-42. 19) Rios A, Rodriguez JM, Canteras M, Galindo PJ, Balsarobre MD, Parrilla P. Risk factors for malignancy in multinodüler goitres. Eur J Surg. Oncol 2004: 30: 58- 62.
) Abu Eshy SA ,Khan. AR, Khan GM, al Humanidi MA, al Shehri MY Malatani TS. Thyroid malignancy in multinodüler goitre and solitary nodüle. JR Coll Surg Edınb 1995; 40: 310- 312.
) Mumcuoğlu SA, Mecit M, İğdem A, Yücel O; Multinodüler Guatr Olgularında Kanser Görülme Sıklığı: Çağdaş Cerrahi Dergisi 2003; 17: 72.
) Gandolfi PP, Frisina A, Rafa M, Ronda F, Rocchetti O, Ruggeri C, et al. The incidence of thyroid carcinoma in multinoduler goiter: retrospective analysis, Acta Biomed Ateneo Parmense 2004;72: 114-7.
) Franco L, Lucıa V, Simonetta B, Alberto T, Pietro Z, Maria Cristiana M, et al. Usefull of 99m Tc-pertechnetate Scintigraphy and Fine-needle Aspiration Cytology in Patients with Solitary Thyroid Nodules and Thyroid Cancer. Anticancer Research 2004; 24: 2531- 4.
) Altun G, Altun B, Salihoğlu Y, Altaner Ş, Üstün F, Berkarda Ş. Non-Diagnostic Fine- Needle Aspiration of the Thyroid Gland. Turkısh Journal of Endocrinolgy and Metabolism 2004; 8: 15-7.
) Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer Risk in Patıents with cold thyroid nodules:relevance of iodine intake, sex, age and multınodularity. Am J Med. 1992; 93: 363-9.
) Mazzaferri EL. Thyroid Cancer in Thyroid Nodules: Finding a needle in the haystack. AM Journal Med. 1992; 93: 359-62. 27) Hamming JF, Vriens M R, Goslings B M, Songun I, Fleuren G J, van de Velde C J.Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy. World J Surg 1998; 22: 575-80.
) Bildik N, Altintaş M M, Aslan E, Çevik A, Ekinci H, Dalkiliç G, ve ark. Tiroid hastalıklarında postoperatif histopatolojik inceleme ile preoperatif testler arasındaki ilişki. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi 2009; 1: 29-36.
) Şengöz T, Çubuk R, Kaya H, Arıbal E. Tiroid nodüllerinde ultrason rehberliğinde ince iğne aspirasyon biyopsisi. Düzce Tıp Fakültesi Dergisi 2009; 11: 26-32.
) Ceresini G L, Corcione S, Morganti B, Milli L, Bertone R, Prampolini S et al.Ultrasound guided fine needle capillary biopsy of thyroid nodules, coupled with on site cytologic review, improves results. Thyroid 2004; 14: 385-89.
) Terzioğlu T, Tezelman S, Onaran Y, Tanakol R. Concurrent hyperthyroidism and thyroid carcinoma. Br J Surg 1993; 80: 1301-2.
) Rojeski TM, Gharrib H. Noduler thyroid disease: Medical progress. N Eng J Med 1984; 313: 428-34.
) Greenspan FS: The thyroid gland. In: Basic&Clinical Endocrinology. (Greenspan FS&Gradner DG, eds). New York, McGraw-Hill, 2002; pp 201-72.
) Ashcraft MW, Van Herle AJ. Management Of Thyroid Nodules. II. Scanning
Techniques, Thyroid Suppressive Therapy, And Fine Needle Aspiration. Head Neck Surg 1981; 3:297-322.
) Griffin JE. Management of thyroid nodules. Am J Med Sci 1988; 296: 336-47.
) Hawkins F, Bellido D, Bernal C, Rigopoulou D, Ruiz Valdepeñas MP, Lazaro E, et al. Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease. Cancer 1987; 59: 1206-9.
) Kronenberg MH et al. Williams textbook of endocrinology.In: Schlumberger JM, Filetti S, HayDL. Nontoxic diffuse and nodular goiter andthyroid neoplasia. Saunders Elsevier, 11th edition,Philadelphia 2008: 411-42.
) Malloy MK, Cunnane FM. Pathology and cytologic features of thyroid neoplasms. Surg Oncol Clin N Am 2008; 17: 57-70.

THE INCIDENCE OF MALIGNANCY IN CASES WHO OPERATED WITH DIAGNOSIS OF NODULAR GOITER

Yıl 2013, Cilt: 17 Sayı: 1, 15 - 24, 01.03.2013

Hakan Şarlar Enver İlhan Mehmet Akif Üstüner Abdullah Şenlikci Orhan Üreyen

Öz

In this study, we examined the relationship between demographic, laboratory, imaging and cytology results with histopathology results in patients who underwent surgery for thyroid nodules. Patients who underwent surgery for nodular goiter were evaluated retrospectively according to age, gender, number of nodules, nodule size, functional status, hormones, surgery type, cytology and the results of histopathology. A total of 179 patients, 147 82.1% were female and 32 17.9% were male. Mean age was 51.3 range 22-81 years. The majority of patients 69.3% were between 30-60 years of age. There was multinodular goiter in 142 79.3% cases and solitary nodules in 37 20.7% cases. FNAB was performed in 41 patients. 19 46.3% of these patients were evaluated as non diagnostic material. The remaining 22 53.7% were diagnosed 15 cases were benign, five cases were suspected malignant and two caes were malignant. Histopathological examination of 27 patients with diagnosed malignancy, papillary carcinoma, papillary microcarcinoma, follicular carcinoma and Hurthle cell carcinoma were detected in 15 55.6% , 3 11.1% , 6 22.2 and 3 11.1% cases respectively. 21 77.8% of the patients had multinodular goitre and 6 22.2% patients had solitary nodules. There was not found to be statistically significant relationship between the results of histopathology with age p = 0.601 , gender p = 0.790 , number of nodules p = 0829 , nodule size p = 0845 , thyroid function status 0744 , hormonal profile p = 0.206 , cytology p = 0227 and type of surgery p = 0.350 . Surgeons, radiologists, and pathologists should be made to develop the skill in collaboration with cytological examination and evaluation of implementation success and efforts for reducing the need for surgery in patients with thyroid nodules identified and avoiding undesirable effects of thyroidectomy.

Anahtar Kelimeler

Thyroid nodule, thyroid carcinoma, fine needle aspiration biopsy

Kaynakça

) Burinicardi FC. Schwartz’s principels of surgery. In: Lal G, Clark HO. Thyroid, parathyroid, adrenal. McGraw Hill Company, Ninth Edition, Newyork 2010: p. 1343-1408. 2) Braverman EL, Utiger DR. The thyroid a fundemental and clinical text. In: Schneider BA, Ron E. Carcinoma of follicular epithelium. Lippincott Williams & Wilkins, Philadelphia 2005: p. 889-905.
) Hanks JB. Thyroid. Townsend CM, Beauchamp RD, Evers BM, Mattox KL (editors) In: Sabiston's Text Book of Surgery 17th ed. Philadelphia: Saunders; 2004; p. 961–2.
) Wu HS, Young MT, Ituarte PHG, D’Avanzo A, Duh QY, Greenspan FS, et al. Death from thyroid cancer of Follicular cell origin. J Am Coll Surg 2000; 191: 600–6.
) Townsend. Sabiston Textbook of Surgery. In:Hanks BJ. Thyroid. Saunders Elsevier, 17th edition, Philadelphia 2004: p. 947-99.
) Jameson JL, De Groot JL. Endocrinology adult and pediatric. In: Pacini F, Marchisotta S, De Groot JL. Thyroid neoplasia. Saunders Elsevier, 6th edition, Philadelphia 2010: p. 1668-1701.
) Mazafferi EL. Management of a solitary throid nodule. N Engl J Med. 1993; 328: 553- 6.
) Perros P. British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer. 2nd ed. London: Royal College of Physicians; 2007.
) Sampson, RJ, Woolner, LB, Bahn, RC, Kurland, LT. Occult thyroid carcinoma in Olmsted County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan. Cancer 1974; 34: 2072-76.
) Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22: 901-11.
) Thomas WEG. Neoplasm’s of thyroid gland (including the solitary nodule). Surg Int 2004; 64: 296–300.
) Qureshi JN, Muneer A, Memon AS, Memon S, Hammad A. Malignancy in nodular goiter. J Surg Pak 2006; 11: 71–2. 13) Khairy GA. Solitary thyroid nodule: the risk of cancer and the extent of surgical therapy. East Afr Med J 2004; 81: 459–462.
) Benzarti S, Miled I, Bassoumi T, Ben Mrad B, Akkari K, Bacha O, Chebbi MK. Thyroid surgery (356cases): risks and complications. Rev Laryngol Otol Rhinol (Board) 2002; 123: 33-7.
) Alagic-Smailbegovic J, Kapidzic A, Sutalo K, Resic M, Hadzic E. Surgical treatment of thyroid gland disease. Med Arh 2005; 59: 241–3.
) Prades JM, Dumollard JM, Timoshenko A, Chelikh L, MichelF, Estour B, et al. Multinodular goiter: surgical management and histopathological findings. Eur Arch Otolaryngol 2002; 259: 217–21.
) Senyurek G Y, Tunca F, Boztepe H, Kapran Y, Terzioglu T, Tezelman S. The risk factors for malignancy in surgically treated patients for Graves' disease, toxic multinodular goiter, and toxic adenoma. Surgery 2008; 144: 1028-36.
) Suvak O, Saylam B, Coşkun F, Oktay M, Albayrak A, Suvak B, ve ark. Tiroid Nodülü Tanısıyla Takip Edilen Hastalarda Tiroid Kanser İnsidansı: Bir Referans Merkezi Çalışması. Yeni Tıp Dergisi 2012; 29: 37-42. 19) Rios A, Rodriguez JM, Canteras M, Galindo PJ, Balsarobre MD, Parrilla P. Risk factors for malignancy in multinodüler goitres. Eur J Surg. Oncol 2004: 30: 58- 62.
) Abu Eshy SA ,Khan. AR, Khan GM, al Humanidi MA, al Shehri MY Malatani TS. Thyroid malignancy in multinodüler goitre and solitary nodüle. JR Coll Surg Edınb 1995; 40: 310- 312.
) Mumcuoğlu SA, Mecit M, İğdem A, Yücel O; Multinodüler Guatr Olgularında Kanser Görülme Sıklığı: Çağdaş Cerrahi Dergisi 2003; 17: 72.
) Gandolfi PP, Frisina A, Rafa M, Ronda F, Rocchetti O, Ruggeri C, et al. The incidence of thyroid carcinoma in multinoduler goiter: retrospective analysis, Acta Biomed Ateneo Parmense 2004;72: 114-7.
) Franco L, Lucıa V, Simonetta B, Alberto T, Pietro Z, Maria Cristiana M, et al. Usefull of 99m Tc-pertechnetate Scintigraphy and Fine-needle Aspiration Cytology in Patients with Solitary Thyroid Nodules and Thyroid Cancer. Anticancer Research 2004; 24: 2531- 4.
) Altun G, Altun B, Salihoğlu Y, Altaner Ş, Üstün F, Berkarda Ş. Non-Diagnostic Fine- Needle Aspiration of the Thyroid Gland. Turkısh Journal of Endocrinolgy and Metabolism 2004; 8: 15-7.
) Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer Risk in Patıents with cold thyroid nodules:relevance of iodine intake, sex, age and multınodularity. Am J Med. 1992; 93: 363-9.
) Mazzaferri EL. Thyroid Cancer in Thyroid Nodules: Finding a needle in the haystack. AM Journal Med. 1992; 93: 359-62. 27) Hamming JF, Vriens M R, Goslings B M, Songun I, Fleuren G J, van de Velde C J.Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy. World J Surg 1998; 22: 575-80.
) Bildik N, Altintaş M M, Aslan E, Çevik A, Ekinci H, Dalkiliç G, ve ark. Tiroid hastalıklarında postoperatif histopatolojik inceleme ile preoperatif testler arasındaki ilişki. Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi 2009; 1: 29-36.
) Şengöz T, Çubuk R, Kaya H, Arıbal E. Tiroid nodüllerinde ultrason rehberliğinde ince iğne aspirasyon biyopsisi. Düzce Tıp Fakültesi Dergisi 2009; 11: 26-32.
) Ceresini G L, Corcione S, Morganti B, Milli L, Bertone R, Prampolini S et al.Ultrasound guided fine needle capillary biopsy of thyroid nodules, coupled with on site cytologic review, improves results. Thyroid 2004; 14: 385-89.
) Terzioğlu T, Tezelman S, Onaran Y, Tanakol R. Concurrent hyperthyroidism and thyroid carcinoma. Br J Surg 1993; 80: 1301-2.
) Rojeski TM, Gharrib H. Noduler thyroid disease: Medical progress. N Eng J Med 1984; 313: 428-34.
) Greenspan FS: The thyroid gland. In: Basic&Clinical Endocrinology. (Greenspan FS&Gradner DG, eds). New York, McGraw-Hill, 2002; pp 201-72.
) Ashcraft MW, Van Herle AJ. Management Of Thyroid Nodules. II. Scanning
Techniques, Thyroid Suppressive Therapy, And Fine Needle Aspiration. Head Neck Surg 1981; 3:297-322.
) Griffin JE. Management of thyroid nodules. Am J Med Sci 1988; 296: 336-47.
) Hawkins F, Bellido D, Bernal C, Rigopoulou D, Ruiz Valdepeñas MP, Lazaro E, et al. Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease. Cancer 1987; 59: 1206-9.
) Kronenberg MH et al. Williams textbook of endocrinology.In: Schlumberger JM, Filetti S, HayDL. Nontoxic diffuse and nodular goiter andthyroid neoplasia. Saunders Elsevier, 11th edition,Philadelphia 2008: 411-42.
) Malloy MK, Cunnane FM. Pathology and cytologic features of thyroid neoplasms. Surg Oncol Clin N Am 2008; 17: 57-70.

Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Bölüm	Research Article
Yazarlar	Hakan Şarlar Bu kişi benim Enver İlhan Bu kişi benim Mehmet Akif Üstüner Bu kişi benim Abdullah Şenlikci Bu kişi benim Orhan Üreyen Bu kişi benim
Yayımlanma Tarihi	1 Mart 2013
Yayımlandığı Sayı	Yıl 2013 Cilt: 17 Sayı: 1

Kaynak Göster

APA	Şarlar, H., İlhan, E., Üstüner, M. A., Şenlikci, A., vd. (2013). NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI. İzmir Eğitim Ve Araştırma Hastanesi Tıp Dergisi, 17(1), 15-24.
AMA	Şarlar H, İlhan E, Üstüner MA, Şenlikci A, Üreyen O. NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI. İzmir EAH Tıp Der. Mart 2013;17(1):15-24.
Chicago	Şarlar, Hakan, Enver İlhan, Mehmet Akif Üstüner, Abdullah Şenlikci, ve Orhan Üreyen. “NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI”. İzmir Eğitim Ve Araştırma Hastanesi Tıp Dergisi 17, sy. 1 (Mart 2013): 15-24.
EndNote	Şarlar H, İlhan E, Üstüner MA, Şenlikci A, Üreyen O (01 Mart 2013) NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 17 1 15–24.
IEEE	H. Şarlar, E. İlhan, M. A. Üstüner, A. Şenlikci, ve O. Üreyen, “NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI”, İzmir EAH Tıp Der, c. 17, sy. 1, ss. 15–24, 2013.
ISNAD	Şarlar, Hakan vd. “NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI”. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 17/1 (Mart 2013), 15-24.
JAMA	Şarlar H, İlhan E, Üstüner MA, Şenlikci A, Üreyen O. NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI. İzmir EAH Tıp Der. 2013;17:15–24.
MLA	Şarlar, Hakan vd. “NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI”. İzmir Eğitim Ve Araştırma Hastanesi Tıp Dergisi, c. 17, sy. 1, 2013, ss. 15-24.
Vancouver	Şarlar H, İlhan E, Üstüner MA, Şenlikci A, Üreyen O. NODÜLER GUATR TANISI İLE AMELİYAT EDİLEN VAKALARDA MALİGNİTE SIKLIĞI. İzmir EAH Tıp Der. 2013;17(1):15-24.

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