Bethesda IV-V tiroid nodüllerinin değerlendirilmesi: klinik deneyim

Yıl 2022, , 152 - 157, 26.09.2022

Salih Celepli , İrem Bigat , Baki Türkoğlu , Mustafa Tanrıseven , Pınar Celepli , Levent Donmez

https://doi.org/10.47582/jompac.1132934

Öz

Amaç: Tiroidde nodül nedeniyle opere edilen olgularda malignite oranı yaklaşık %5-10 olup, bu oran Bethesda kategorilerine göre önemli farklılıklar göstermekle birlikte diğer kategorilere göre kategori IV ve V’te yüksek malignite riski mevcuttur. Biz çalışmamızda Bethesda IV-V tanısı alan nodüllerde sitolojik tanı başarısını etkileyen klinikopatolojik etkenleri inceledik.
Gereç ve Yöntem: Çalışmaya merkezimizde 2016-2021 yılları arasında tiroid nodülü tanısı alan ve opere edilen 780 hasta dahil edildi. Hastaların preoperatif sitolojik tanıları Bethesda Sistemi kullanılarak sınıflandırıldı. Hastaların demografik verileri, nodüllerin Bethesda sınıflandırması ve postoperatif histopatolojik inceleme sonuçları alt gruplar halinde değerlendirilerek anlamlı sonuçlar raporlandı.
Bulgular: Olguların en yoğun olarak bulunduğu yaş grubu 45-59 olup, K/E oranın 3:1 olduğu görülmektedir. Malign tanı grubundaki nodüllerin %41,8’inin; benign tanı grubundakilerin %58,2’sinin palpabl olduğu görülmektedir. 20 mm Sonuç: Çalışmamız mikrokarsinom ve büyük çaplı nodüllerde İİAB tanı başarısının düştüğünü, sitolojik başarı açısından en uygun nodül boyutunun 10-20 mm nodüller olduğunu göstermektedir. Malignite riski 20 mm’den küçük nodüllerde 20 mm’den büyük nodüllere göre daha yüksektir. DC-IV tanılarda bening patolojiler ön planda düşünülürken; DC-V sitolojik tanılı nodüllerin çapı 20 mm’den büyük ise ön planda DTK, 20mm’den küçük ise PTK düşünülmelidir.

Anahtar Kelimeler

Tiroid neoplazmaları, tiroid nodülü, ince iğne biyopsisi

Evaluation of Bethesda IV-V thyroid nodules: clinical experience

Öz

Introduction: The malignancy rate in cases operated for thyroid nodule is approximately 5-10%, and although this rate shows significant differences according to Bethesda categories, there is a high risk of malignancy in categories IV and V compared to other categories. In our study, we examined the clinicopathological factors affecting the success of cytological diagnosis in nodules diagnosed with Bethesda IV-V.
Material and Method: A total of 780 patients who were diagnosed with thyroid nodules and underwent surgery at our center between 2011 and 2021 were included in the study. The preoperative cytological diagnoses of the patients were categorized using the Bethesda classification system. The demographic data of the patients, Bethesda classification of the nodules, and postoperative histopathological examination results were evaluated in subgroups, and their significance was determined.
Results: The age group with the highest number of cases was 45-59 years, and the female/male ratio of the whole cohort was 3:1. The rate of palpable nodules was 41.8% for the malignant diagnosis group and 58.2% for the benign diagnosis group. In both malignant and benign groups, <20 mm nodules were found at statistically significantly higher rates compared to nodule groups of other diameters (p<0.001 for both). While 50% of those diagnosed with DC-IV have a diameter greater than 20 mm; It was observed that 43.5% of those diagnosed with DC-V were more intense in the 10-20 mm diameter range. When the FNAB cytological diagnoses of the cases are compared with the postoperative histopathological diagnoses, it is seen that 32.5% of the cases diagnosed with DC-IV and 78.3% of those diagnosed with DC-V were diagnosed as malignant. While 69.2% of the cases with a cytological diagnosis of DC-IV were PTC and 30.8% were OTC; 100% of the cases with DC-V diagnosis are PTC histopathologically.
Conclusion: Our study showed that the diagnostic success of FNAB was decreased in microcarcinoma and large-sized nodules, with 10-20-mm nodules being the most suitable size for the success of cytological diagnosis. The risk of malignancy was higher in the nodules smaller than 20 mm compared to those larger than 20 mm. OTC should be primarily considered in >20-mm nodules with a DC-V diagnosis and PTC in smaller nodules. While benign pathologies are considered in DC-IV diagnoses; If the diameter of DC-V cytologically diagnosed nodules is larger than 20 mm, OTC should be considered primarily, and if less than 20 mm, PTC should be considered.

Anahtar Kelimeler

Thyroid neoplasms, thyroid nodule, fine-needle biopsy

Kaynakça

• Murbeth S, Rousarova M, Scherb H, Lengfelder E. Thyroid cancer has increased in the adult populations of countries moderately affected by Chernobyl fallout. Med Sci Monit 2004; 10: CR300–CR306.
• Mitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130: 150–60.
• Ha SM, Kim JK, Baek JH. Detection of malignancy among suspicious thyroid nodules <1 cm on ultrasound with various thyroid image reporting and data systems. Thyroid 2017; 27: 1307-15.
• 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.
• Lupoli GA, Fonderico F, Colarusso S, et al. Current management of differentiated thyroid carcinoma. Med Sci Monit 2005; 11: RA368-373.
• Bombil I, Bentley A, Kruger D, Luvhengo TE. Incidental cancer in multinodular goiter post thyroidectomy. S Afr J Surg 2014; 52: 5-9.
• He Y, Liu S, Guo H, Shi B. Incidental finding of papillary thyroid carcinoma with BRAFV600E mutation in a patient with coexistent primary hyperparathyroidism and Graves’ hyperthyroidism. BMJ Case Rep 2014; 2014: bcr2013203436.
• Farrell E, Heffron C, Murphy M, O’Leary G, Sheahan P. Impact of lymphocytic thyroiditis on incidence of pathological incidental thyroid carcinoma. Head Neck 2017; 39: 122-7.
• Yazgan A, Balci S, Dincer N, et al. Hurthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology. Cytopathology 2014; 25: 185-9.
• Aschebrook-Kilfoy B, Grogan RH, Ward MH, Kaplan E, Devesa, SS. Follicular thyroid cancer incidence patterns in the United States, 1980–2009. Thyroid 2013; 23: 1015–21.
• Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid 2009; 19: 1159-65.
• Jung CK, Little MP, Lubin JH, et al. The increase in thyroid cancer incidence during the last four decades is accompanied by a high frequency of BRAF mutations and a sharp increase in RAS mutations. J. Clin. Endocrinol Metab 2014; 99; 276– 85.
• Grani G, Sponziello M, Pecce V, Ramundo V, Durante C. Contemporary thyroid nodule evaluation and management., J Clin Endocrinol Metab Review 2020; 105: 2869-83.
• Segovia IG, Gallowitsch HJ, Kresnik E et al. Descriptive epidemiology of thyroid carcinoma in Carinthia, Austria: 1984–2001. Histopathologic features and tumor classification of 734 cases under elevated general iodination of table salt since 1990: population-based age-stratified analysis on thyroid carcinoma incidence. Thyroid 2004; 14: 277–86.
• Durante C, Costante G, Lucisano G, et al. The natural history of benign thyroid nodules. JAMA 2015; 313: 926–35.
• Evranos B, Polat SB, Cuhaci FN, et al. A cancer of undetermined significance: Incidental thyroid carcinoma. Diagn Cytopathol. 2019; 47: 412-6.
• Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013; 98: 564–70.
• Auger M. Hurthle cells in fine-needle aspirates of the thyroid: a review of their diagnostic criteria and significance. Cancer Cytopathol 2014; 122: 241-9.
• Schatz-Siemers N, Brandler TC, Oweity T, Sun W, Hernandez A, Levine P. Hurthle cell lesions on thyroid fine needle aspiration cytology: Molecular and histologic correlation. Diagnostic Cytopathology 2019; 1–9.
• Ganly I, Ricarte Filho J, Eng S, et al. Genomic dissection of Hurthle cell carcinoma reveals a unique class of thyroid malignancy. J Clin Endocrinol Metab 2013; 98: E962-E972.
• Baloch Z, Li Volsi VA. The Bethesda System for reporting thyroid cytology (TBSRTC): from lookbacks to look-ahead. Diagn Cytopathol 2020; 48: 862-6.
• Pagni F, Jaconi M, Delitala A, et al. Incidental papillary thyroid carcinoma: diagnostic findings in a series of 287 carcinomas. Endocr Pathol 2014; 25: 288–96.