Ultrasonographic Risk Factors for Non-Diagnostic Cytology and Malignant Histopathology in Thyroid Nodules: Results of 607 Biopsies, 138 Thyroidectomies Performed by a Single Surgeon

Öz

Introduction: Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) is the cornerstone of thyroid nodule evaluation. Although traditionally performed by radiologists, the increasing involvement of endocrine surgeons in this procedure necessitates assessment of its effectiveness. This study aims to evaluate the diagnostic adequacy of US-FNAB performed by a single endocrine surgeon and to identify ultrasonographic risk factors associated with non-diagnostic cytology and malignancy. Materials and Methods: Data from 607 US-FNAB procedures performed by a single surgeon and histopathology of 161 nodules from 138 thyroidectomies were retrospectively reviewed. Nodule characteristics (composition, location, echogenicity, shape, margins, echogenic foci) were correlated with Bethesda cytology categories and final histopathology. Statistical analyses were performed to identify factors associated with non-diagnostic results and malignancy. Results: The non-diagnostic cytology rate was 8.73%. Anterior location was associated with reduced risk of non-diagnostic cytology (p=0.019), while peripheral calcification significantly increased this risk (p=0.0039). Malignancy rates were consistent with Bethesda categories, ranging from 13.69% (Bethesda 2) to 100% (Bethesda 6). Marked hypoechogenicity (43.08%, p<0.001), taller-than-wide shape (35.29%, p<0.001), irregular margins (33.75%, p<0.001), and punctate calcifications (25.26%, p<0.001) were strong predictors of malignancy. Inferior location was associated with lower malignancy risk (p=0.029). Discussion: US-FNAB performed by an experienced endocrine surgeon demonstrates high diagnostic adequacy. Anterior location reduces the risk of non-diagnostic cytology, while inferior location lowers malignancy risk. Peripheral calcification increases non-diagnostic risk, whereas marked hypoechogenicity, taller-than-wide shape, irregular margins, and punctate calcifications elevate malignancy risk. These findings support the important and complementary role of endocrine surgeons in thyroid nodule management.

Anahtar Kelimeler

• Thyroid nodule
• US-FNAB
• Cytology
• Malignancy
• Ultrasonography

Tiroid Nodüllerinde Tanısal Olmayan Sitoloji ve Malign Histopatoloji İçin Ultrasonografik Risk Faktörleri: Tek Cerrah Tarafından Gerçekleştirilen 607 Biyopsi ve 138 Tiroidektominin Sonuçları

Öz

Giriş: Ultrason eşliğinde ince iğne aspirasyon biyopsisi (US-İİAB), tiroid nodülü değerlendirmesinin temel yöntemidir. Geleneksel olarak radyologlar tarafından uygulanmasına karşın, endokrin cerrahların bu işleme artan katılımı etkinliğin değerlendirilmesini gerektirmektedir. Bu çalışma, tek bir endokrin cerrah tarafından gerçekleştirilen US-İİAB'nin tanısal yeterliliğini incelemeyi ve tanısal olmayan sitoloji ile maligniteyi öngören ultrasonografik risk faktörlerini belirlemeyi amaçlamaktadır. Gereç ve Yöntemler: Retrospektif olarak, tek cerrah tarafından uygulanan 607 US-İİAB ve 138 tiroidektomiden elde edilen 161 nodül değerlendirildi. Nodül özellikleri (kompozisyon, lokalizasyon, ekojenite, şekil, sınır, ekojenik odaklar) Bethesda sitoloji kategorileri ve nihai histopatoloji ile korele edildi. Tanısal olmayan sonuçlar ve malignite ile ilişkili faktörler istatistiksel olarak analiz edildi. Sonuç: Tanısal olmayan sitoloji oranı %8,73 bulundu. Anterior yerleşim tanısal yetersizlik riskini azaltırken (p=0,019), periferik kalsifikasyon riski artırdı (p=0,0039). Malignite oranları Bethesda kategorileriyle uyumluydu (%13,69 Bethesda 2; %100 Bethesda 6). Belirgin hipoekojenite (%43,08, p<0,001), taller-than-wide şekil (%35,29, p<0,001), irregüler sınırlar (%33,75, p<0,001), punktat kalsifikasyonlar (%25,26, p<0,001) malignite ile güçlü ilişkiliydi. İnferior yerleşim ise malignite riskini azalttı (p=0,029). Tartışma: Deneyimli endokrin cerrah tarafından yapılan US-İİAB yüksek tanısal yeterlilik sergilemektedir. Anterior yerleşim tanısal yetersizlik riskini azaltırken, inferior lokalizasyon malignite riskini düşürmektedir. Periferik kalsifikasyon tanısal yetersizlik riskini artırırken, belirgin hipoekojenite, taller-than-wide şekil, irregüler sınırlar ve punktat kalsifikasyonlar malignite riskini yükseltmektedir. Bu bulgular, endokrin cerrahların tiroid nodülü yönetimindeki önemli ve tamamlayıcı rolünü desteklemektedir.

Anahtar Kelimeler

• Tiroid nodülü
• US-İİAB
• Sitoloji
• Malignite
• Ultrasonografi

Kaynakça

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