ÖNEMİ BELİRSİZ ATİPİLİ HASTALARDAKİ POSTOPERATİF HİSTOPATOLOJİK MALİGNİTE VARLIĞI

Yıl 2023, Cilt: 30 Sayı: 1, 119 - 122, 14.03.2023

Salim İlksen Başçeken , Deniz Tikici

https://doi.org/10.17343/sdutfd.1236410

Öz

Amaç
Tiroid kanseri en sık görülen endokrin malignitesidir
ve klinik görünümü nodüllerle karakterizedir. Tiroid
patolojileri için yapılan biyopsilerde ‘Önemi belirsiz
atipi’ (ÖBA) literatürdeki farklı malignite oranları nedeniyle
klinisyenler için önemli bir endişe kaynağıdır. Bu
çalışmada, AUS tanısı alan ve tiroid cerrahisi geçiren
hastalarda malignite oranlarını güncel literatür ışığında
sunmayı amaçladık.
Gereç ve Yöntem
2016-2021 yılları arasında kliniğimizde ince iğne aspirasyon
biyopsisinde (İİAB) ÖBA tanısı alan ve tiroid
cerrahisi uygulanan 174 hastanın demografik ve histopatolojik
verileri retrospektif olarak analiz edildi. Hastalar
histopatolojik özelliklerine göre malign ve benign
olarak iki gruba ayrıldı. Gruplar arasındaki istatistiksel
anlamlılık Ki-kare ve Student t-testleri kullanılarak belirlenmiştir.
P değeri <0.05 olarak kabul edilmiştir.
Bulgular
Yaş ortalaması 47.9±12 yıl (dağılım, 20-81) idi. Malignite
oranı %43,5 idi. Kadınların %42,1'inde, erkeklerin
ise %50'sinde malignite tespit edildi. Ortalama nodül
çapı 19,1±13,7 mm (1-97 mm) idi. Cinsiyet, yaş ve
nodül çapı ile malignite arasında istatistiksel olarak
anlamlı ilişki saptanmadı (p>0.05).
Sonuç
Bethesda sınıflamasına göre ÖBA için malignite oranı
%15-30 olarak belirtilmiştir. Çalışmamızda malignite
oranı, ülkemizde yapılan benzer çalışmalara benzer
olarak, %43.5 saptanmıştır. ÖBA tanısıyla tiroid cerrahisi
planlanan vakalarda, yüksek malignite olasılığı
nedeniyle, lobektomiye alternatif olarak total tiroidektomi
de bir seçenek olarak düşünülmelidir.

Anahtar Kelimeler

ATA kılavuzu, Bethesda sınıflaması, İİAB, Önemi belirsiz atipi, Tiroid kanseri

PRESENCE OF POSTOPERATIVE HISTOPATHOLOGICAL MALIGNANCY IN PATIENTS WITH ATYPIA OF UNDETERMINED SIGNIFICANCE

Öz

Objective
Thyroid cancer is the most common endocrine
Malignancy, and nodules characterize its clinical
presentation. 'Atypia of undetermined significance'
(AUS) in biopsies performed for thyroid pathologies
is an essential concern for clinicians due to different
malignancy rates in the literature. In this study, we
aimed to discuss the malignancy rates in patients who
underwent thyroid surgery for AUS.
Material and Method
The demographic and histopathologic data of 174
patients diagnosed with AUS on fine needle aspiration
biopsy (FNAB) and who underwent thyroid surgery in
our clinic between 2016 and 2021 were retrospectively
analyzed. According to histopathologic features,
patients were divided into two groups, malignant
and benign, and the relationship with age, gender,
and nodule diameter was investigated. Statistical
significance between groups was determined using
Chi-square and Student t-tests. P value <0.05 was
accepted.
Results
The mean age was 47.9±12 years (range, 20-81).
The malignancy rate was 43.5%. Malignancy was
detected in 42.1% of females and 50% of males. The
mean nodule diameter was 19.1±13.7 mm (range,
1-97 mm). There was no statistically significant
difference between gender, age, nodule diameter, and
Malignancy (p>0.05).
Conclusion
According to the Bethesda classification, the
malignancy rate for AUS is 15-30%. In our study, the
malignancy rate was 43.5%, similar to studies published
in our country. Because of the high malignancy
rate, total thyroidectomy should be considered an
alternative to lobectomy in cases planned for surgery
with a diagnosis of AUS.

Anahtar Kelimeler

ATA guideline, Atypia of undetermined significance, Bethesda Classification, FNAB, Thyroid malignancy

Kaynakça

• 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
• 2. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–1214.
• 3. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009;19(11):1159-65.
• 4. Nayar R, Ivanovic M. The indeterminate thyroid fine needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009;117:195-202.
• 5. Ryu YJ, Jung YS, Yoon HC, Hwang MJ, Shin SH, Cho JS, Lee JS, Kim HK, Kang HC, Lim HS, Yoon JH, Park MH. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res. 2014;86(3):109-14
• 6. Akın Ş, Helvacı N, Çınar N, Önder S, Bayraktar M. Atypia of Undetermined Significance in Thyroid Fine-Needle Aspiration Cytology: Pathological Evaluation and Risk Factors for Malignancy. South Clin Ist Euras. 2017; 28(2): 82-86
• 7. Kakudo K, Higuchi M, Hirokawa M, et al. Thyroid FNA cytology in Asian practice-Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas. Cytopathology. 2017;28:455-66
• 8. Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology: definitions, criteria, and explanatory notes. New York: Springer; 2010
• 9. Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology: definitions, criteria, and explanatory notes. 2nd ed. Cham: Springer; 2018.
• 10. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 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):1-133.
• 11. Abelardo AD, Sotalbo KCJ. Clinical management of thyroid aspirates diagnosed as atypia of undetermined significance in the Philippines. Gland Surg. 2020;9(5):1788-1796.