THE EVALUATION OF PATIENTS DIAGNOSED WITH ATYPIA OF UNIDENTIFIED SIGNIFICANCE AFTER A FINE NEEDLE ASPIRATION BIOPSY OF THE THYROID

Yıl 2020, , 322 - 328, 31.12.2020

Serdar Sahin , Turgut Çavuşoğlu , Mehmet Kubat , Hüseyin Üstün

https://doi.org/10.24938/kutfd.670331

Cited By: 1

Öz

Objective: Thyroid gland diseases are one of the most important endocrine
problems. The main role of thyroid fine needle aspiration biopsy (TFNAC); to
distinguish patients in terms of surgical and conservative treatment options.
The aim of this study was to compare the results of thyroid fine needle
aspiration biopsy (TFNAC) and histopathology report of patients who underwent
thyroidectomy at the Ankara Training and Research Hospital, and to evaluate the
TFNAC efficacy in thyroid nodules.

Material and Methods: The histopathological data
of patients who were diagnosed with atypia of unidentified
significance (AUS) at the Ankara Training and Research Hospital
between 2007 and 2012 and who underwent a thyroidectomy operation were
compared.

Results: A total of 87 patients were included in
our study. 77 (88.5%) patients were female and 10 (11.5%) patients were male.
77 female patients were diagnosed as benign nodules, 55 (71.4%) and 22 (28.6%)
malignant nodules. Eight (80%) of 10 male patients were diagnosed as benign,
and 2 (20%) of malignant nodules.

Conclusion: Patients diagnosed with atypical
significance should be evaluated clinically as a whole, including demographic
features such as age and gender, radiological examination, detailed history and
physical examination, and surgical decisions should be made according to these
features.

Anahtar Kelimeler

: Thyroid, nodule, fine needle aspiration biopsy, atypia of unidentified significance

TİROİD İNCE İĞNE ASPİRASYON BİYOPSİSİ SONUCU ÖNEMİ BELİRSİZ ATİPİ TANISI KONULAN HASTALARIN DEĞERLENDİRİLMESİ

Öz

Amaç: Tiroid bez
hastalıkları en önemli endokrin sorunlarından biridir. Tiroid
ince iğne aspirasyon biyopsisi (TİİAB)'nin ana
rolü; hastaları cerrahi ve konservatif tedavi seçenekleri açısından ayırt
etmektir. Bu çalışma ile Ankara Eğitim ve Araştırma Hastanesi’nde
tiroidektomi operasyonu uygulanmış hastalara ilişkin tiroid ince iğne
aspirasyon biyopsisi (TİİAB) sonuçları ile histopatoloji rapor sonuçlarının
karşılaştırılarak, tiroid nodüllerindeki İİAB etkinliğinin değerlendirilmesi
amaçlanmıştır.

Gereç ve Yöntemler: Ankara
Eğitim ve Araştırma Hastanesi’nde 2007-2012 yılları arasında TİİAB sonucu önemi
belirsiz atipi (AUS) tanısı konulan ve  troidektomi operasyonu yapılan hastaların
histopatolojik verileri karşılaştırıldı.

Bulgular: Çalışmamıza
toplam 87 hasta dahil edildi. 77 (% 88.5) hasta kadın, 10 (% 11.5) hasta
erkekti. 77 kadın hastaya 55'i (% 71.4) benign, 22'si (% 28.6) malign nodül
teşhisi konuldu. On erkek hastanın 8'ine (% 80) benign, 2'sine (% 20) malign
nodül teşhisi konmuştur.

Sonuç: Önemi belirsiz atipi
teşhisi konan hastalar, yaş ve cinsiyet gibi demografik özellikleri, radyolojik
inceleme, ayrıntılı öykü ve fizik muayene dahil olmak üzere klinik olarak bir
bütün olarak değerlendirilmeli ve cerrahi kararları bu özelliklere göre
verilmelidir.

Anahtar Kelimeler

Tiroid, nodül, ince iğne aspirasyon biyopsisi, önemi belirsiz atipi

Kaynakça

• 1. Yetkin E. Tiroidektomi komplikasyonları. In: İşgör A. Tiroid hastalıkları ve Cerrahisi. 1.baskı. İstanbul. Avrupa Tıp Kitapçılık, 2000:583-95.
• 2. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer Cytopathol. 2007;111(5):306-15.
• 3. Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of ‘follicular neoplasm’: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol. 2002;26(1):41-4. 4. Rıfat S, Ruffin M. Management of thyroid nodules. Am Fam Physician. 1994;50(4):692-785.
• 5. Bender Ö, Yüney E, Çapar H, Höbek A, Ağca B, Akat O ve ark. Total tireidektomi deneyimlerimiz. Endokrin Diyalog. 2004;1:15-8.
• 6. Ding X, Xu Y, Wang Y, Li X, Lu C, Su J et al. Gender disparity in the relationship between prevalence of thyroid nodules and metabolic syndrome components: The SHDC-CDPC community-based study mediators of inflammation. 2017;2017:8481049. Doi:10.1155/2017/8481049.
• 7. Franco L, Lucia 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(4):2531-4.
• 8. Tan GH, Gharib H. Thyroid incidentalomas: manegement approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126(3):226-231.
• 9. Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Malignancy risk stratification of thyroid nodules: Comparison between the thyroid ımaging reporting and data system and the 2014 american thyroid association management guidelines. Radiology. 2016;278(3):917-24. Doi:10.1148/radiol.2015150056.
• 10. Layfield LJ, Cibas ES, Gharib H, Mandel SJ. Thyroid aspiration cytology: current status. CA Cancer J Clin. 2009;59(2):99-110.
• 11. Liu X, Medici M, Kwong N, Angell TE, Marqusee E, Kim MI et al. Bethesda categorization of thyroid nodule cytology and prediction of thyroid cancer type and prognosis. Thyroid. 2016;26(2):256-61. Doi:10.1089/thy.2015.0376.
• 12. Melillo RM, Santoro M, Vecchio G. Differential diagnosis of thyroid nodules using fine-needle aspiration cytology and oncogene mutation screening: are we ready? F1000 Med Rep. 2010; 19;2: 62. Doi:10.3410/M2-62.
• 13. Greenblatt D, Woltman T, Harter J, Starling J, Mack E, Chen H. Fine-needle aspiration optimizes surgical management in patients with thyroid cancer. Ann Surg Oncol. 2006;13(6):859-63.
• 14. Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid today and tomorrow. Best Pract Res Clin Endocrinol Metab. 2008;22(6):929-39.
• 15. Layfield LJ, Morton MJ, Cramer HM, Hirschowitz S. Implications of the proposed thyroid fine-needle aspiration category of “follicular lesion of undetermined significance”: a five-year multi-institutional analysis. Diagn Cytopathol. 2009;37(10):710-4.
• 16. Shi Y, Ding X, Klein M, Sugrue C, Matano S, Edelman M et al. Thyroid fine-needle aspiration with atypia of undetermined significance: a necessary or optional category? Cancer Cytopathol. 2009;117(5):298-304.
• 17. Baloch ZW, Tam D, Langer J, Mandel S, LiVolsi VA, Gupta PK. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytologic preparations. Diagn Cytopathol. 2000;23(6):425-9.
• 18. Ghofrani M, Beckman D, Rimm DL. The value of onsite adequacy assessment of thyroid fine-needle aspirations is function of operator experience. Cancer. 2006;108(2):110-3.
• 19. Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol. 2010;162(4):763-70.
• 20. Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clinic Proceedings. 1994;69(1):44-9.
• 21. Rojeski MT, Gharib H. Nodular thyroid disease. Evaluation and management. New England J Med. 1985;313(7):428-36.
• 22. Christensen SB, Ljungberg O, Tibblin S. Thyroid carcinoma in Malmö, 1960–1977. Epidemiologic, clinical, and prognostic findings in a defined urban population. Cancer. 1984;53(7):1625-33.
• 23. Renshaw A. Focal features of papillary carcinoma of the thyroid in fine-needle aspiration material are strongly associated with papillary carcinoma at resection. Am J Clin Pathol. 2002;118(2):208-10.
• 24. Weber D, Brainard J, Chen L. Atypical epithelial cells cannot exclude papillary carcinoma in fine needle aspiration of the thyroid. Acta Cytol. 2007;52(3):320-24.
• 25. Ozluk Y, Pehlivan E, Gulluoglu MG, Poyanli A, Salmaslioglu A, Colak N et al. The use of the Bethesda terminology in thyroid fine-needle aspiration results in a lower rate ofsurgery for nonmalignant nodules: a report from a reference center in Turkey. Int J Surg Pathol. 2011;19(6):761-71.
• 26. Can N, Aytürk S, Taştekin E, Sezer YA, Çelik M, Öz Puyan F et al. Malignancy rates in Bethesda category AUS/FLUS: Single center experience. Acta Oncol Tur. 2016;49(3):158-63.
• 27. Cibas ES, Ali SZ. The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009;132(5):658-65.
• 28. Pinchot SN, Al Wagih H, Schaefer S, Sippel R, Chen H. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144(7):649-55.
• 29. Baloch ZW, Hendreen S, Gupta PK, LiVolsi VA, Mandel SJ, Weber R et al. Interinstitutional review of thyroid fine-needle aspirations: impact on clinical management of thyroid nodules. Diagn Cytopathol. 2001;25(4):231-4.
• 30. Raparia K, Min SK, Mody DR, Anton R, Amrikachi M. Clinical outcomes for “suspicious” category in thyroid fineneedle aspiration biopsy: patient’s sex and nodule size are possible predictors of malignancy. Arch Pathol Lab Med. 2009;133(5):787-90.
• 31. Choi YJ, Yun JS, Kim DH. Clinical and ultrasound features of cytology diagnosed follicular neoplasm. Endocr J. 2009;56(3):383-9.
• 32. Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: areview of 932 cases. Can J Surg. 2009;52(1):39-44.