Maksillofasiyal Radyolojide İnsidental Tiroid Nodüllerinin Prevalansı ve Sonografik Özellikleri: EU-TIRADS Tabanlı Bir Risk Değerlendirmesi

Öz

Amaç: İnsidental tiroid nodülleri (İTN'ler), sıklıkla tiroid dışı nedenlerle yapılan görüntülemeler sırasında tesadüfen saptanmaktadır. Ultrasonografi (US), bu nodüllerin tespiti ve risk değerlendirmesinde temel bir araçtır. Bu çalışmanın amacı, maksillofasiyal radyoloji kliniğinde tiroid dışı endikasyonlarla baş ve boyun ultrasonografisi yapılan hastalarda İTN'lerin prevalansını ve sonografik özelliklerini belirlemek ve risk sınıflandırması için Avrupa Tiroid Görüntüleme Raporlama ve Veri Sistemi'ni (EU-TIRADS) kullanmaktır. Gereç ve Yöntem: Tiroid patolojisi ile ilişkili olmayan endikasyonlarla baş ve boyun ultrasonografisine yönlendirilen hastalar çalışmaya dahil edildi. Bilinen tiroid hastalığı, palpabl tiroid kitlesi, geçirilmiş tiroid cerrahisi veya baş ve boyun radyoterapisi öyküsü olan hastalar çalışmadan dışlandı. Tiroid nodüllerinin boyut, kompozisyon, ekojenite, kenar, şekil ve vaskülarite gibi özellikleri değerlendirildi. Risk sınıflandırması EU-TIRADS sistemi kullanılarak yapıldı ve şüpheli özellik gösteren nodüller ileri değerlendirme için, ince iğne aspirasyon biyopsisi dahil olmak üzere, ilgili birimlere yönlendirildi. Bulgular: Toplam 170 hasta (yaş aralığı: 17–72, ortalama yaş: 29,35) değerlendirildi. İnsidental tiroid nodülü 49 hastada (%28,8) saptandı. Nodüller erkek hastaların %24,29'unda (n=70) ve kadın hastaların %32'sinde (n=100) tespit edildi. Nodül saptanan hastalar arasında 3 hastada (%6,12) papiller tiroid karsinomu (PTK) tanısı konuldu ve 13 hasta (%7,7) tiroidit, hipoplazi veya hiperplazi nedeniyle endokrinoloji konsultasyonuna yönlendirildi. Sonuç: Bu çalışma, maksillofasiyal nedenlerle baş ve boyun ultrasonografisi yapılan hastalarda fırsatçı tiroid değerlendirmesinin önemini vurgulamaktadır. İnsidental tiroid nodüllerinin %28,8'lik prevalansı, şüpheli lezyonların erken tespiti açısından tiroid değerlendirmesinin değerini ortaya koymaktadır.

Anahtar Kelimeler

• tiroid nodülü
• ultrasonografi
• ince iğne aspirasyon biyopsisi
• baş ve boyun görüntülemesi

Prevalence and Sonographic Features of Incidental Thyroid Nodules in Maxillofacial Radiology: An EU-TIRADS-Based Risk Assessment

Öz

Aim: Incidental thyroid nodules (ITNs) are frequently discovered during imaging for non-thyroid-related reasons, with ultrasonography (US) serving as a key tool for their detection and risk assessment. This study aims to determine the prevalence and sonographic characteristics of ITNs in patients undergoing head and neck ultrasonography for non-thyroidal indications at a maxillofacial radiology clinic, using the European Thyroid Imaging Reporting and Data System (EU-TIRADS) for risk stratification. Material and Methods: Patients referred for head and neck ultrasonography for indications unrelated to thyroid pathology were included in this study. Patients with known thyroid disease, palpable thyroid masses, prior thyroid surgery, or head and neck radiotherapy were excluded. Thyroid nodule characteristics, including size, composition, echogenicity, margin, shape, and vascularity, were evaluated. Risk stratification was performed using the EU-TIRADS system, and nodules with suspicious features were referred for further evaluation, including fine-needle aspiration cytology. Results: A total of 170 patients aged between 17 and 72 years (mean age: 29.35 years) were evaluated. Incidental thyroid nodules were identified in 49 patients (28.8%). Nodules were present in 24.29% of males (n=70) and 32% of females (n=100). Among the patients with nodules, 3 patients (6.12%) were diagnosed with papillary thyroid carcinoma (PTC), and 13 patients (7.7%) were referred for endocrinology consultation due to thyroiditis, hypoplasia, or hyperplasia. Conclusion: The findings underscore the importance of opportunistic thyroid evaluation in patients undergoing head and neck ultrasonography for non-thyroidal reasons. With a 28.8% prevalence of incidental thyroid nodules, early detection through such opportunistic screening may facilitate timely management of suspicious lesions.

Anahtar Kelimeler

• thyroid nodule
• ultrasonography
• fine-needle aspiration biopsy
• head and neck imaging

Kaynakça

1. Hoang JK, Langer JE, Middleton WD, et al. Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol. 2015;12(2):143-50.
2. Nguyen XV, Job J, Fiorillo LE, Sipos J. Thyroid incidentalomas: practice considerations for radiologists in the age of incidental findings. Radiol Clin North Am. 2020;58(6):1019-31.
3. Russ G, Bonnema SJ, Erdogan MF, et al. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. EurThyroid J. 2017;6(5):225-37.
4. Yu J. Trends in the incidence of thyroid cancer among US persons from 2000 to 2019. Eur J Cancer Prev. 2024;33(1):5-10.
5. Brander AE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importance of thyroid abnormalities detected at US screening: a year follow-up. Radiology. 2000;215(3):801-6.
6. Bartolotta T, Midiri M, Runza G, et al. Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography. Radiol Med. 2006;111(7):989-98.
7. Moon JH, Hyun MK, Lee JY, et al. Prevalence of thyroid nodules and their associated clinical parameters: a large-scale, multicenter-based health checkup study. Korean J Intern Med. 2018;33(4):753.
8. Dahlberg J, Carlqvist J, Larsson E, et al. Effects of Implementation of European Thyroid Imaging Reporting and Data System Risk Stratification in a Thyroid Cancer Program in Western Sweden: A Retrospective Cohort Study. Endocr Pract. 2024;30:830e6.

9. Uludag M, Unlu MT, Kostek M, et al. Management of thyroid nodules. Med Bull Sisli Etfal Hosp. 2023;57(3):287.
10. Wilhelm SM. Evaluation of thyroid incidentaloma. Surg Clin North Am. 2014;94 3:485-97.
11. Guth S, Theune U, Aberle J, et al. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Investig. 2009;39(8):699-706.
12. Arğun D, Basim P. Rates of incidental thyroid nodule and thyroid cancer detection in routine check-up examinations: a single-center study. Bagcilar Med Bull. 2021;6(3).
13. Bukasa-Kakamba J, Bayauli P, Sabbah N, et al. Ultrasound performance using the EU-TIRADS score in the di- agnosis of thyroid cancer in Congolese hospitals. Sci Rep. 2022;12(1):18442. Epub 2022/11/04. doi: 10.1038/s41598022-22954-y. PubMed PMID: 36323772; PubMed Central PMCID: PMCPMC9630411.
14. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult pa- tients 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):1-133.
15. Chooi JE, Ravindiran A, Balasubramanian SP. The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis—A systematic review. Clin Endocrinol (Oxf). 2022;96(2):246-54.
16. McCrory D, Li C, Devlin B. Five-year review of incidental thyroid nodule management in the ENT outpatient department. Ann Thyroid. 2023;8.
17. Eidt LB, Nunes de Oliveira C, Lagos YBB, et al. A prospective comparison of ACR-TIRADS and EU-TIRADS in thyroid nodule assessment for FNA-US. Clin Endocrinol (Oxf). 2023;98(3):415-25. Epub 2022/07/22. doi: 10.1111/ cen.14799. PubMed PMID: 35864563.
18. Fisher SB, Perrier ND. The incidental thyroid nodule. CA Cancer J Clin. 2018;68(2):97-105.
19. Xia M, Song F, Zhao Y, et al. Ultrasonography-based radiomics and computer-aided diagnosis in thyroid nodule management: performance comparison and clinical strategy optimization. Front Endocrinol (Lausanne). 2023;14:1140816. Epub 2023/05/30. doi: 10.3389/fendo.2023.1140816. PubMed PMID: 37251675; PubMed Central PMCID: PMCPMC10213653.
20. Borges AP, Antunes C, Caseiro-Alves F, Donato P. Analysis of 665 thyroid nodules using both EU-TIRADS and ACR TI-RADS classification systems. Thyroid Res. 2023;16(1):12. Epub 2023/05/08. doi: 10.1186/s13044-023-00155-7. PubMed PMID:37150822; PubMed Central PMCID: PMCPMC10165776.
21. Abraham PJ, Lindeman BM. Management of incidental thyroid nodules. Surg Clin North Am. 2024;104(4):711-23.
22. Kim PH, Suh CH, Baek JH, et al. Diagnostic performancenof four ultrasound risk stratification systems: a systematic review and meta-analysis. Thyroid. 2020;30(8):1159-68.
23. Marukatat N, Parklug P, Chanasriyotin C. Comparison of the diagnostic accuracy of K-TIRADS and EU-TIRADS guide lines for detection of thyroid malignancy on ultrasound. Radiography (Lond). 2023;29(5):862-6. Epub 2023/07/07. doi: 10.1016/j.radi.2023.06.011. PubMed PMID: 37413957.
24. Orhan K. Introduction to Ultrasonography in Dentomaxillofacial Imaging. In: Orhan K, ed, Ultrasonography in dentomaxillofacial diagnostics. Cham: Springer. 2021.p.1-4. https:// doi.org/10.1007/978-3-030-62179-7_1