Tiroid Nodüllerinin Değerlendirilmesinde Bethesda Sistemi ve İnce İğne Aspirasyon Biopsisinin Yeri

Yıl 2021, Cilt: 26 Sayı: 1, 23 - 30, 30.01.2021

Gizem Akkaş Akgün , Figen Aslan

https://doi.org/10.21673/anadoluklin.763920

Cited By: 1

Öz

Amaç: Bu çalışmada tiroid nodüllerinin tanısında Bethesda Sistemi ile değerlendirilen ince iğne aspirasyon biyopsisinin (İİAB) rolü araştırıldı.

Gereç ve Yöntemler: Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi Patoloji Bölümü’nde 2016-2019 yılları arasında Bethesda kategorisine göre raporlanan 1846 hastaya ait 2284 İİAB materyali incelendi. Bu olgular içerisinden tiroidektomisi yapılan 328 olguda sito-histopatolojik karşılaştırma yapılarak İİAB'nin tanısal duyarlılık, özgüllük, doğruluk, pozitif ve negatif prediktif değerleri araştırıldı.

Bulgular: Çalışmaya alınan 1846 hastanın 1538'i kadın (%83,31), 308'i (%16,68) erkekti. Yaş ortalaması 49,92 idi (Yaş aralığı 19-87). 2284 İİAB'nin son sitolojik tanıları şöyleydi: 287 (%12,57) yetersiz materyal, 1517 (%66,42) benign sitoloji, 316 (%13,83) önemi belirsiz atipi/önemi belirsiz folliküler lezyon, 63 (%2,75) folliküler neoplazi veya folliküler neoplazi kuşkusu, 59 (%2,59) malignite kuşkulu sitoloji ve 42 (%1,84) malign sitoloji. Eksizyonu da yapılan toplam 328 olgunun 245'i (%74,70) benign iken, 83'ü (%25,30) maligndi. Gerçek negatif olgu sayısı 216 (%65,85), gerçek pozitif olgu sayısı 62 (%19,90), yalancı pozitif olgu sayısı 29 (%8,84), yalancı negatif olgu sayısı 21 (%6,40) bulundu. Bu durumda tanısal duyarlılık, özgüllük, doğruluk oranları, pozitif ve negatif prediktif değerleri sırasıyla %74,7, %88,16, %84,76, %68,13 ve %91,14 olarak saptandı.

Sonuç: Çalışmamızda tiroid İİAB’lerindeki duyarlılık, özgüllük, doğruluk oranları ile pozitif ve negatif prediktif değerlerinin literatürle uyumlu olduğu görüldü. Klinisyen ve sitopatoloğun deneyimi arttıkça, yalancı negatif ve pozitif sonuçların azalacağı ve aynı zamanda İİAB’lere uygulanan bazı yeni moleküler yöntemlerin de (BRAF ve RET/PTC, eğer mümkünse PAX8 / PPARG ve RAS) katılımıyla, tiroid İİAB’lerine olan güvenin daha da artacağını düşünmekteyiz.

Anahtar Kelimeler

Bethesda sistemi, ince iğne aspirasyon biyopsisi, tiroid nodülleri, sitoloji

Destekleyen Kurum

YOK

The Role of Fine Needle Aspiration Biopsy with Bethesda System in the Evaluation of Thyroid Nodules

Öz

Aim: In this study, the role of fine needle aspiration biopsy (FNAB) evaluated with the Bethesda System in the diagnosis of thyroid nodules was investigated.

Materials and Methods: Total 2284 FNAB materials of 1846 patients were performed in the Pathology Department of Kutahya Health Sciences University, Evliya Celebi Traning and Research Hospital between 2016 and 2019 and reported according to the Bethesda category. Among these cases, diagnostic sensitivity, specificity, accuracy, positive and negative predictive values of FNAB were calculated by making cytohistopathologica comparison in 328 cases who underwent total thyroidectomy.

Results: In the study, 1538 of the 1846 patients included were female (83.31%) and 308 (16.68%) were male. The average age was 49.92 years (Age range 19-87). The final cytological diagnoses of 2284 FNABs were as follows: 287 (12.57%) nondiagnostic or unsatisfactory, 1517 (66.42%) benign cytology, 316 (13.83%) atypia of undetermined significance/follicular lesion of undetermined significance, 63 (2.75%) follicular neoplasm or suspicious for a follicular neoplasm, 59 (2.59%) suspicious for malignancy and 42 (1.84%) malignant cytology. Histologically, 245 (74.70%) of the 328 cases were benign, while 83 (25.30%) were malignant. The number of true negative cases was 216 (65.85%), the number of true positive cases was 62 (19.90%), the number of false positive cases was 29 (8.84%) and the number of false negative cases was 21 (6.40%). In this case, diagnostic sensitivity, specificity, accuracy rates, positive and negative predictive values were 74.7%, 88.16%, 84.76%, 68.13% and 91.14%, respectively.

Conclusion: In our study, it was observed that the sensitivity, specificity, accuracy rates, positive and negative predictive values of thyroid FNABs were compatible with the literature. We think that as the experience of the clinician and cytopathologist increases, false negative and positive results will decrease and at the same time, the confidence in thyroid FNABs will increase even more with the participation of some recent molecular methods (BRAF and RET/PTC, AX8/PPARG and RAS) applied to FNABs.

Anahtar Kelimeler

Bethesda system, fine needle aspiration biopsy, thyroid nodule, cytology

Kaynakça

• 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. 2009:25;117(5):298-304.
• Tae HJ, Lim DJ, Baek KH, Park WC, Lee YS, Choi JE et al. Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules. Thyroid. 2007;17(5):461-6.
• Haberal AN, Toru S, Ozen O, Arat Z, Bilezikçi B. Diagnostic Pitfalls in the Evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology. 2009;20(2):103-8.
• Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658-665.
• Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341-1346.
• Albores-Saavedra J, Wu J. The many faces and mimics of papillary thyroid carcinoma. Endocr Pathol. 2006;17(1):1-18.
• Muratli A, Erdogan N, Sevim S, Unal I, Akyuz S. Diagnostic efficacy and importance of fine-needle aspiration cytology of thyroid nodules. J Cytol. 2014;31(2):73-8.
• Ugurluoglu C, Dobur F, Karabagli P, Celik ZE. Fine needle aspiration biopsy of thyroid nodules: cytologic and histopathologic correlation of 1.096 patients. Int J Clin Exp Pathol. 2015;8(11):14800-5.
• Rong R, Wu Y, Yao Q, Wu YS, Zhang ZH. Fine needle aspiration cytology of thyroid nodules: a cytopathologic study of 2.043 cases. Zhonghua Bing Li Xue Za Zhi. 2016;45(6):368-71.
• Wang D, Fu HJ, Xu HX, Guo LH, Li XL, He YP et al. Comparison of fine needle aspiration and non-aspiration cytology for diagnosis of thyroid nodules: a prospective, randomized, and controlled trial. Clin Hemorheol Microcirc. 2017;66(1):67-81.
• Roy PK, Bandyopadhyay S, Dubey AB, Sengupta A. A comparative study on aspiration cytology and histopathology in diagnosis of thyroid nodule and ıts correlation. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):997-1001.
• Erkinüresin T, Demirci H. Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules. Diagnosis (Berl). 2020;7(1):61-66.
• Guo HQ, Zhao H, Cao J, Zhao LL, Sun Y, Wang C, Zhang ZH. Implementation of the Bethesda system for reporting the thyroid cytopathology: study on 5 729 cases from a cancer center. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020;7;55(3):258-262.
• Anand B, Ramdas A, Ambroise MM, Kumar NP. The Bethesda system for reporting thyroid cytopathology: A cytohistological study. J Thyroid Res. 2020;2020:8095378.
• Önver H, Özbey AO, Duymuş M, Yılmaz Ö, Koşar PN. Tiroit nodüllerinin ultrasonografik, sitolojik ve histopatolojik bulgularının incelenmesi. Kafkas J Med Sci. 2013;3:80-7
• Altavilla G, Pascale M, Nenci I. Fine needle aspiration cytology of thyroid gland diseases. Acta Cytol. 1990;34(2):251-6.
• Caplan RH, Strutt PJ, Kisken WA, Wester SM. Fine needle aspiration biopsy of thyroid nodules. Wis Med J. 1991;90(6):285-8.
• Ylagan LR, Farkas T, Dehner LP. Fine needle aspiration of the thyroid: a cytohistologic correlation and study of discrepant cases. Thyroid. 2004;14(1):35-41.
• Karataş S, Giray Ö, Peker Ö, Aydın Ö, İnce U, Alagöl F et al. Tiroid nodüllerinin değerlendirilmesinde Bethesda 2007 sınıflamasının klinik sonuçları. Ulusal Cerrahi Derg. 2009;25:92-6
• Ríos A, Rodríguez JM, Galindo PJ, Montoya M, Tebar FJ, Sola J et al. Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre. Clin Endocrinol (Oxf). 2004;61(6):732-7.
• Han K, Ha HJ, Kong JS, Kim JS, Myung JK, Koh JS et al. Cytological features that differentiate follicular neoplasm from mimicking lesions. J Pathol Transl Med. 2018;52(2):110-120.
• Aron M, Mallik A, Verma K. Fine needle aspiration cytology of follicular variant of papillary carcinoma of the thyroid: Morphologic pointers to its diagnosis. Acta Cytol. 2006;50:663.
• Chui MH, Cassol CA, Asa SL, Mete O. Follicular epithelial dysplasia of the thyroid: morphological and ımmunohistochemical characterization of a putative preneoplastic lesion to papillary thyroid carcinoma in chronic lymphocytic thyroiditis. Virchows Arch. 2013;462(5):557-63.
• Renshaw A. Significance of repeatedly nondiagnostic thyroid fine-needle aspirations. Am J Clin Pathol. 2011;135(5):750-752.
• Jo VY, Vanderlaan PA, Marqusee E, Krane JF. Repeatedly nondiagnostic thyroid fine-needle aspirations do not modify malignancy risk. Acta Cytol. 2011;55(6):539-43.
• Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Am J Clin Pathol. 2006;125 Suppl:S135-44.
• Paschke R, Cantara S, Crescenzi A, Jarzab B, Musholt TJ, Sobrinho Simoes M. European Thyroid Association Guidelines regarding thyroid nodule molecular fine-needle aspiration cytology diagnostics Eur Thyroid J. 2017;6(3):115-129.
• Al-Marzooq YM, Chopra R, Al-Bahrani AT, Younis M, Al-Mulhim AS, Al-Mommatten MI. Comparison of specimen adequacy in fine-needle aspiration biopsies performed by surgeons and pathologists. Ann Saudi Med. 2004;24:124–6.
• Nasuti JF, Gupta PK, Baloch ZW. Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: Review of 5.688 cases. Diagn Cytopathol. 2002;27:1–4.
• Vander Noot MR, 3rd, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N, et al. Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2004;102:157–63.