Öz
Objectives: The main determinants of surgery
decision for thyroid nodules are cytology and ultrasonography. It is still
debated in the literature if the giant nodules should be routinely operated
despite benign cytology reports. This study aimed to determine the malignancy
rate in operated giant nodules and calculate the false negativity of cytology
in that group.
Materials and Methods We enrolled 675 patients with giant
nodules who were followed in our clinics between the dates of June 2015 and
April 2019. We evaluated the malignancy rates and other hormonal and
demographic parameters of 226 patients who underwent an operation and had
histopathology result, retrospectively
Results: According to the
histopathology results; 37 (14.40%) of the giant nodules were malignant whereas
220 (85.60%) were benign. There was no statistically significant difference
between malign and benign groups regarding preoperative ultrasonographic
features, nodule size and demographic properties. TSH was higher in the
malignant group. False negativity of the cytology was calculated as 11.65%.
Conclusion: Decision of surgery
should be based on ultrasonography findings and FNAC in giant thyroid nodules.
Routine surgery is not recommended. Repeated biopsies and sampling the
different parts of the nodule during a biopsy can decrease the false negative
results.
Anahtar Kelimeler
Kaynakça
- Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009;39:699-706.
- Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM 2007;100:29-35.
- Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019;144:1941-53.
- Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2017;27:1341-6.
- 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.
- Cibas ES, Baloch ZW, Fellegara G, et al. A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Ann Intern Med 2013;159:325-32.
- Krauss EA, Mahon M, Fede JM, Zhang L. Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis. Arch Pathol Lab Med 2016;140:1121-31.
- Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head Neck 2009;31:856-66.
- Ucar AE, Sarikaya SM, Parlak O, Yalcin A. Effect of nodule size on the reliability of fine-needle aspiration biopsy in thyroid nodules. Turk J Med Sci 2014;44:1002-9.
- Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98:564-70.
- Cipriani NA, White MG, Angelos P, Grogan RH. Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis. Thyroid 2018, doi: 10.1089/thy.2018.0221, Erişim tarihi:01.06.2019.
- Giles WH, Maclellan RA, Gawande AA, et al. False negative cytology in large thyroid nodules. Ann Surg Oncol 2015;22:152-7.
- Khalife S, Bouhabel S, Forest VI, et al. The McGill Thyroid Nodule Score's (MTNS+) role in the investigation of thyroid nodules with benign ultrasound guided fine needle aspiration biopsies: a retrospective review. J Otolaryngol Head Neck Surg 2016;45:29.
- Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol 2012;19:45-51.
- Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J Surg Res 2013;181:6-10.
- Cavallo A, Johnson DN, White MG, et al. Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size. Thyroid 2017;27:641-50.
- Ucler R, Usluogullari CA, Tam AA, et al. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015;43:622-8.
- Deveci MS, Deveci G, LiVolsi VA, Gupta PK, Baloch ZW. Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: effect on patient management. Diagn Cytopathol 2007;35:579-83.
- Koo DH, Song K, Kwon H, et al. Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules? Int J Endocrinol 2016;2016:3803647.
- Wharry LI, McCoy KL, Stang MT, et al. Thyroid nodules (>/=4 cm): can ultrasound and cytology reliably exclude cancer? World J Surg 2014;38:614-21.
- Cohen O, Zornitzki T, Yarkoni TR, et al. Follow-up of large thyroid nodules without surgery: Patient selection and long-term outcomes. Head Neck 2019;41:1696-1702.
- Persichetti A, Di Stasio E, Guglielmi R, et al. Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. J Clin Endocrinol Metab2018;103:1359-68.
Öz
Amaç: Tiroid nodüllerinde operasyon
kararının en önemli belirleyicisi ultrason özellikleri ile birlikte altın
standart olarak kabul edilen sitolojidir. Dev nodüller sitoloji benignse takip
mi edilmeli yoksa sitoloji sonucundan bağımsız olarak opere mi edilmeli henüz
netleştirilmemiştir. Bu çalışmanın amacı opere olmuş dev nodüllerde malignite
ve İİAB'ın yanlış negatiflik oranlarını belirlemektir.
Materyal ve Metot: Bu çalışmaya
Haziran 2015- Nisan 2019 tarihleri arasında ≥ 4 cm çaplı nodülü olan 675 hasta
dahil edilmiştir. Bu hastaların 226 'sı opere edilmiş ve verileri retrospektif
olarak incelenmiştir.
Bulgular: Histopatolojik incelemede
bu nodüllerin 37'si (14.40%) malign, 220’si (85.60%) benigndi. Benign ve malign
nodüllerin ultrasonografik özellikleri ve nodül çapları arasında anlamlı
farklılık saptanmadı. İki grup demografik özellikler açısından benzer
bulunurken, TSH düzeyi malign nodüllerde daha yüksekti. Sitolojinin yanlış
negatiflik oranı dev nodüller için %11.65’di.
Sonuç: Sonuç olarak dev nodüllerde
cerrahi kararı verirken sitoloji ve ultrason özellikleri ve bası semptomu
varlığı veya kozmetik problem varlığı göz önünde bulundurulmalıdır. Sitolojide
yanlış negatiflik oranı küçük nodüllerden yüksek olabilir bu nedenle takipte
ultrason ve gerektiğinde tekrarlayan biyopsi yapmak gerekir. Bu bulgular rutin
cerrahi önermek için yeterli değildir.
Anahtar Kelimeler
Kaynakça
- Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009;39:699-706.
- Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM 2007;100:29-35.
- Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019;144:1941-53.
- Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2017;27:1341-6.
- 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.
- Cibas ES, Baloch ZW, Fellegara G, et al. A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Ann Intern Med 2013;159:325-32.
- Krauss EA, Mahon M, Fede JM, Zhang L. Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis. Arch Pathol Lab Med 2016;140:1121-31.
- Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head Neck 2009;31:856-66.
- Ucar AE, Sarikaya SM, Parlak O, Yalcin A. Effect of nodule size on the reliability of fine-needle aspiration biopsy in thyroid nodules. Turk J Med Sci 2014;44:1002-9.
- Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98:564-70.
- Cipriani NA, White MG, Angelos P, Grogan RH. Large Cytologically Benign Thyroid Nodules Do Not Have High Rates of Malignancy or False-Negative Rates and Clinical Observation Should be Considered: A Meta-Analysis. Thyroid 2018, doi: 10.1089/thy.2018.0221, Erişim tarihi:01.06.2019.
- Giles WH, Maclellan RA, Gawande AA, et al. False negative cytology in large thyroid nodules. Ann Surg Oncol 2015;22:152-7.
- Khalife S, Bouhabel S, Forest VI, et al. The McGill Thyroid Nodule Score's (MTNS+) role in the investigation of thyroid nodules with benign ultrasound guided fine needle aspiration biopsies: a retrospective review. J Otolaryngol Head Neck Surg 2016;45:29.
- Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Ann Surg Oncol 2012;19:45-51.
- Albuja-Cruz MB, Goldfarb M, Gondek SS, Allan BJ, Lew JI. Reliability of fine-needle aspiration for thyroid nodules greater than or equal to 4 cm. J Surg Res 2013;181:6-10.
- Cavallo A, Johnson DN, White MG, et al. Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size. Thyroid 2017;27:641-50.
- Ucler R, Usluogullari CA, Tam AA, et al. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules three centimeters or larger in size. Diagn Cytopathol 2015;43:622-8.
- Deveci MS, Deveci G, LiVolsi VA, Gupta PK, Baloch ZW. Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: effect on patient management. Diagn Cytopathol 2007;35:579-83.
- Koo DH, Song K, Kwon H, et al. Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules? Int J Endocrinol 2016;2016:3803647.
- Wharry LI, McCoy KL, Stang MT, et al. Thyroid nodules (>/=4 cm): can ultrasound and cytology reliably exclude cancer? World J Surg 2014;38:614-21.
- Cohen O, Zornitzki T, Yarkoni TR, et al. Follow-up of large thyroid nodules without surgery: Patient selection and long-term outcomes. Head Neck 2019;41:1696-1702.
- Persichetti A, Di Stasio E, Guglielmi R, et al. Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. J Clin Endocrinol Metab2018;103:1359-68.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Araştırmalar |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 19 Sayı: 3 |
