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The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk

Yıl 2023, Cilt: 8 Sayı: 1, 1 - 9, 07.02.2023

Berkay Kuscu Mustafa Eroğlu

https://doi.org/10.22391/fppc.1173267

Öz

Introduction: Thyroid fine-needle aspiration biopsy (TFNAB), which is basically planned according to the ultrasonographic features is of clinical importance; since it helps early diagnosis of malignancy, facilitates the selection of patients who will undergo thyroid surgery and prevents unnecessary surgical procedures. In our study, we aimed to evaluate the adequacy of TFNAB as well as the retrospective investigation of the link between the estimated malignancy risk and the descriptive features, radiologic findings and biopsy cytology of patients who underwent ultrasonography guided TFNAB.

Methods: In this study, the ultrasonographic characteristics of 659 thyroid nodules belonging to 523 patients who underwent TFNAB between 2018 and 2021 were evaluated. The correlation between the risk of malignancy and demographic data, thyroid hormone levels, and ultrasonographic characteristics of nodules was examined. The diagnostic accuracy performances of European thyroid imaging reporting and data system (EU-TIRADS) classification prepared by the European Thyroid Association (ETA), the risk classification systems recommended by the American Thyroid Association (ATA) and the Society of Endocrinology and Metabolism of Turkey (TEMD) were compared with The Bethesda System for Reporting Thyroid Cytopathology (Bethesda). The adequacy of biopsy was also evaluated. The data which is obtained from the study was statistically analyzed by means of SPSS 20.0 (Statistical Package for the Social Sciences; SPSS Inc. Chicago, IL, USA) program.

Results: In this study, the biopsies of 41 (6.2%) among 659 thyroid nodules appeared to be malignant. A statistically significant correlation was detected between malignancy and hypoechogenicity (p=0.011), microcalcification (p=0.005), irregular margins (p=0.028), and accompanying pathological lymph node (p=0.002). Compared to the surgical pathology results, the accuracy that was closest to that of Bethesda System (AUC: 0.778) (Area Under Curve) was found in EU-TIRADS (AUC:0.715). In the biopsies performed in our own endocrinology clinic (43.7% of the total biopsies), the ratio of non-diagnostic results was found to be 8.3%, whereas it was 29.1% in the biopsies performed in other clinics (56.3% of the total biopsies).

Conclusion: It should always be kept in mind that, in the cytologic evaluation, the ultrasonographic nodule pattern recommended by the guidelines is very important in the management of patients, because cytology may show false negative and false positive results as well as unclear or non-diagnostic pathological findings. However, clinicians should also understand that classification systems may have strengths and weaknesses. Our study also emphasizes the importance of how experienced a clinic performing biopsy is as well as the role of cytopathologist in obtaining diagnostic results in biopsy.

Keywords: Thyroid nodule, neoplasia, ultrasonography, biopsy fine-needle

Anahtar Kelimeler

thyroid nodule neoplasia ultrasonography biopsy fine-needle

Teşekkür

The authors thank Ali Cem Yekdes for his statistical contribution to this study.

Kaynakça

  • 1. Society of Endocrinology and Metabolism of Turkey. [Diagnosis and treatment guide for thyroid diseases] (in Turkish). 2020. 1–245 p. https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1 (Access Date: January 17, 2023)
  • 2. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6. https://doi.org/10.1089/thy.2017.0500
  • 3. Yunhai Li, Cheng Jin, Jie Li, Mingkun Tong, Mengxue Wang, Jiefeng Huang, et al. Prevalence of thyroid nodules in China: A health examination cohort-based study. Front Endocrinol (Lausanne). 2021; 12: 676144. https://doi.org/10.3389/fendo.2021.676144
  • 4. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1 968 Sep;69(3):537-40. https://doi.org/10.7326/0003-4819-69-3-537
  • 5. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: Relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992;93(4):363–9. https://doi.org/10.1016/0002-9343(92)90164-7
  • 6. Miller JM. Cancer in thyroid nodules. Arch Intern Med. 1984;144(9):1898. https://doi.org/10.1001/archinte.1984.00350210228057
  • 7. Belfiore A, Giuffrida D, La Rosa GL, Ippolito O, Russo G, Fiumara A, et al. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh). 1989;121(2):197–202. https://doi.org/10.1530/acta.0.1210197
  • 8. Shin JJ, Caragacianu D, Randolph GW. Impact of thyroid nodule size on prevalence and posttest probability of malignancy: A systematic review. Laryngoscope. 2015;125(1):263-72. https://doi.org/10.1002/lary.24784
  • 9. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab. 2013;98(2):564–70. https://doi.org/10.1210/jc.2012-2968
  • 10. Sipos JA, Ross DS, Mulder JE. Overview of the clinical utility of ultrasonography in thyroid disease. Available at: https://www.uptodate.com/contents/overview-of-the-clinical-utility-of-ultrasonography-in-thyroid-disease (Access Date: January 17, 2023)
  • 11. Moon W-J, Jung SL, Lee JH, Na DG, Baek J-H, Lee LH et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008;247(3):762–70. https://doi.org/10.1148/radiol.2473070944
  • 12. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS. Eur Thyroid J. 2017;6(5):225–37. https://doi.org/10.1159/000478927
  • 13. Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93(3):809–14. https://doi.org/10.1210/jc.2007-2215
  • 14. Cappelli C, Pirola I, Cumetti D, Micheletti L, Tironi A, Gandossi E, et al. Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology? Clin Endocrinol (Oxf). 2005;63(6):689–93. https://doi.org/10.1111/j.1365-2265.2005.02406.x
  • 15. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: Predictive value of ultrasound and color-doppler features. J Clin Endocrinol Metab. 2002;87(5):1941–6. https://doi.org/10.1210/jcem.87.5.8504
  • 16. Yang GCH, Fried KO. Most thyroid cancers detected by sonography lack intranodular vascularity on color doppler imaging review of the literature and sonographic-pathologic correlations for 698 thyroid neoplasms. J Ultrasound Med. 2017;36(1):89–94. https://doi.org/10.7863/ultra.16.03043
  • 17. Solbiati L, Volterrani L, Rizzatto G, Bazzocchi M, Busilacci P, Candiani F, et al. The thyroid gland with low uptake lesions: Evaluation by ultrasound. Radiology. 1985;155(1):187–91. https://doi.org/10.1148/radiology.155.1.3883413
  • 18. Ross DS, Cooper DS, Mulder JE. Atlas of thyroid cytopathology. Available at: https://www.uptodate.com/contents/atlas-of-thyroid-cytopathology (Access Date: January 17, 2023)
  • 19. Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, et al. Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: Toward the “Right” TIRADS. J Clin Endocrinol Metab. 2019;104(1):95–102. https://doi.org/10.1210/jc.2018-01674
  • 20. Koc AM, Adibelli ZH, Erkul Z, Sahin Y, Dilek I. Comparison of diagnostic accuracy of ACRTIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy. Eur J Radiol. 2020;133:109390. https://doi.org/10.1016/j.ejrad.2020.109390

Tiroid malignitesi riskinin değerlendirilmesinde nodülün sonografik paterni ve tiroid ince iğne aspirasyon sitolojileri

Yıl 2023, Cilt: 8 Sayı: 1, 1 - 9, 07.02.2023

Berkay Kuscu Mustafa Eroğlu

https://doi.org/10.22391/fppc.1173267

Öz

Giriş: Temel olarak ultrasonografik özelliklere göre planlanan tiroid ince iğne aspirasyon biyopsisi (TİİAB); malignitenin erken tanısının yanında, tiroid cerrahisi yapılacak hastaların seçimini kolaylaştırmak ve gereksiz cerrahi işlemleri önlemek için de klinik önem arz etmektedir. Çalışmamızda, ultrasonografi (US) eşliğinde TİİAB uygulanan hastaların tanımlayıcı özelliklerinin, radyolojik bulgularının ve biyopsi sitolojilerinin hastalarda malignite riskinin tahmini ile ilişkisinin retrospektif araştırılmasını ve TİİAB yeterliliğini değerlendirmeyi amaçladık.

Yöntem: Çalışmamız kapsamında, 2018-2021 yılları arasında TİİAB yapılmış olan 523 hastaya ait toplam 659 tiroid nodülünün ultrason özellikleri değerlendirilmiştir. Hastaların demografik verileri, tiroid hormonu düzeyleri ve nodüllerin ultrasonografik özelliklerinin malignite riski ile korelasyonu incelendi. Avrupa Tiroid Derneği’nin (ETA) hazırladığı EU-TIRADS sınıflandırmasının yanında Amerikan Tiroid Derneği (ATA) ve Türkiye Endokrinoloji ve Metabolizma Derneği’nin (TEMD) önermiş olduğu risk sınıflandırma sistemleri ile sitopatoloji tanısal sınıflandırma (Bethesda) sisteminin tanısal doğruluk performansları karşılaştırıldı. Ayrıca biyopsi yeterliliği değerlendirildi. Elde edilen veriler istatistiksel olarak SPSS 20.0 (Statistical Package for the Social Sciences; SPSS Inc. Chicago, IL, USA) programı yardımıyla analiz edildi.

Bulgular: Çalışmada, biyopsi yapılan 659 tiroid nodülünün 41’i (%6,2) malign idi. Hipoekojenite (p=0,011), mikrokalsifikasyon (p=0,005), kenar düzensizliği (p=0,028) ve tiroid nodülüne patolojik lenf nodunun eşlik etmesi (p=0,002) ile malignite arasında istatistiksel anlamlı ilişki saptandı. Cerrahi patoloji sonuçları ile kıyaslandığında, Bethesda Sistemine (AUC:0,778) (Area Under Curve) en yakın doğruluğun EU-TIRADS’ta (AUC:0,715) olduğu görülmüştür. Merkezimizde endokrinoloji kliniğince yapılan biyopsilerde (toplam biyopsilerin %43,7’si) tanısal olmayan sonuçların oranının %8,3 olduğu görülmüştür. Diğer kliniklerce yapılan biyopsilerde ise (toplam biyopsilerin %56,3’si) tanısal olmayan sonuçların oranının %29,1 olduğu görülmüştür.

Sonuç: Sitolojik değerlendirmede, yanlış negatif ve yanlış pozitif sonuçların yanında belirsiz veya tanısal olmayan patolojik bulgular gösterebilen sitolojiler nedeniyle, hastaların yönetiminde kılavuzların önerdiği ultrasonografik nodül paterninin önemli olduğu unutulmamalıdır. Ancak sınıflandırma sistemlerinin zayıf ve güçlü yanlarının olabileceği klinisyenlerce göz önüne alınmalıdır. Ayrıca çalışmamız biyopside tanısal sonuçların alınmasında, sitopatolog rolü olduğu kadar biyopsiyi yapan kliniğin deneyiminin önemine de işaret etmektedir.

Anahtar kelimeler: Tiroid nodülü, neoplazi, ultrasonografi, ince-iğne biyopsisi

Anahtar Kelimeler

Tiroid nodülü neoplazi Ultrasonografi ince-iğne biyopsisi

Kaynakça

  • 1. Society of Endocrinology and Metabolism of Turkey. [Diagnosis and treatment guide for thyroid diseases] (in Turkish). 2020. 1–245 p. https://file.temd.org.tr/Uploads/publications/guides/documents/20200929134733-2020tbl_kilavuzf527c34496.pdf?a=1 (Access Date: January 17, 2023)
  • 2. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6. https://doi.org/10.1089/thy.2017.0500
  • 3. Yunhai Li, Cheng Jin, Jie Li, Mingkun Tong, Mengxue Wang, Jiefeng Huang, et al. Prevalence of thyroid nodules in China: A health examination cohort-based study. Front Endocrinol (Lausanne). 2021; 12: 676144. https://doi.org/10.3389/fendo.2021.676144
  • 4. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1 968 Sep;69(3):537-40. https://doi.org/10.7326/0003-4819-69-3-537
  • 5. Belfiore A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L, et al. Cancer risk in patients with cold thyroid nodules: Relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992;93(4):363–9. https://doi.org/10.1016/0002-9343(92)90164-7
  • 6. Miller JM. Cancer in thyroid nodules. Arch Intern Med. 1984;144(9):1898. https://doi.org/10.1001/archinte.1984.00350210228057
  • 7. Belfiore A, Giuffrida D, La Rosa GL, Ippolito O, Russo G, Fiumara A, et al. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh). 1989;121(2):197–202. https://doi.org/10.1530/acta.0.1210197
  • 8. Shin JJ, Caragacianu D, Randolph GW. Impact of thyroid nodule size on prevalence and posttest probability of malignancy: A systematic review. Laryngoscope. 2015;125(1):263-72. https://doi.org/10.1002/lary.24784
  • 9. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab. 2013;98(2):564–70. https://doi.org/10.1210/jc.2012-2968
  • 10. Sipos JA, Ross DS, Mulder JE. Overview of the clinical utility of ultrasonography in thyroid disease. Available at: https://www.uptodate.com/contents/overview-of-the-clinical-utility-of-ultrasonography-in-thyroid-disease (Access Date: January 17, 2023)
  • 11. Moon W-J, Jung SL, Lee JH, Na DG, Baek J-H, Lee LH et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008;247(3):762–70. https://doi.org/10.1148/radiol.2473070944
  • 12. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS. Eur Thyroid J. 2017;6(5):225–37. https://doi.org/10.1159/000478927
  • 13. Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93(3):809–14. https://doi.org/10.1210/jc.2007-2215
  • 14. Cappelli C, Pirola I, Cumetti D, Micheletti L, Tironi A, Gandossi E, et al. Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology? Clin Endocrinol (Oxf). 2005;63(6):689–93. https://doi.org/10.1111/j.1365-2265.2005.02406.x
  • 15. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: Predictive value of ultrasound and color-doppler features. J Clin Endocrinol Metab. 2002;87(5):1941–6. https://doi.org/10.1210/jcem.87.5.8504
  • 16. Yang GCH, Fried KO. Most thyroid cancers detected by sonography lack intranodular vascularity on color doppler imaging review of the literature and sonographic-pathologic correlations for 698 thyroid neoplasms. J Ultrasound Med. 2017;36(1):89–94. https://doi.org/10.7863/ultra.16.03043
  • 17. Solbiati L, Volterrani L, Rizzatto G, Bazzocchi M, Busilacci P, Candiani F, et al. The thyroid gland with low uptake lesions: Evaluation by ultrasound. Radiology. 1985;155(1):187–91. https://doi.org/10.1148/radiology.155.1.3883413
  • 18. Ross DS, Cooper DS, Mulder JE. Atlas of thyroid cytopathology. Available at: https://www.uptodate.com/contents/atlas-of-thyroid-cytopathology (Access Date: January 17, 2023)
  • 19. Grani G, Lamartina L, Ascoli V, Bosco D, Biffoni M, Giacomelli L, et al. Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: Toward the “Right” TIRADS. J Clin Endocrinol Metab. 2019;104(1):95–102. https://doi.org/10.1210/jc.2018-01674
  • 20. Koc AM, Adibelli ZH, Erkul Z, Sahin Y, Dilek I. Comparison of diagnostic accuracy of ACRTIRADS, American Thyroid Association (ATA), and EU-TIRADS guidelines in detecting thyroid malignancy. Eur J Radiol. 2020;133:109390. https://doi.org/10.1016/j.ejrad.2020.109390
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Endokrinoloji
Bölüm Araştırma Makalesi (Original Article)
Yazarlar

Berkay Kuscu 0000-0003-0800-1756

Mustafa Eroğlu 0000-0002-7526-7151

Yayımlanma Tarihi 7 Şubat 2023
Gönderilme Tarihi 9 Eylül 2022
Kabul Tarihi 28 Aralık 2022
Yayımlandığı Sayı Yıl 2023Cilt: 8 Sayı: 1

Kaynak Göster

APA Kuscu, B., & Eroğlu, M. (2023). The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk. Family Practice and Palliative Care, 8(1), 1-9. https://doi.org/10.22391/fppc.1173267
AMA Kuscu B, Eroğlu M. The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk. Fam Pract Palliat Care. Şubat 2023;8(1):1-9. doi:10.22391/fppc.1173267
Chicago Kuscu, Berkay, ve Mustafa Eroğlu. “The Sonographic Pattern of Nodule and Thyroid Fine Needle Aspiration Cytology in the Evaluation of Thyroid Malignancy Risk”. Family Practice and Palliative Care 8, sy. 1 (Şubat 2023): 1-9. https://doi.org/10.22391/fppc.1173267.
EndNote Kuscu B, Eroğlu M (01 Şubat 2023) The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk. Family Practice and Palliative Care 8 1 1–9.
IEEE B. Kuscu ve M. Eroğlu, “The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk”, Fam Pract Palliat Care, c. 8, sy. 1, ss. 1–9, 2023, doi: 10.22391/fppc.1173267.
ISNAD Kuscu, Berkay - Eroğlu, Mustafa. “The Sonographic Pattern of Nodule and Thyroid Fine Needle Aspiration Cytology in the Evaluation of Thyroid Malignancy Risk”. Family Practice and Palliative Care 8/1 (Şubat 2023), 1-9. https://doi.org/10.22391/fppc.1173267.
JAMA Kuscu B, Eroğlu M. The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk. Fam Pract Palliat Care. 2023;8:1–9.
MLA Kuscu, Berkay ve Mustafa Eroğlu. “The Sonographic Pattern of Nodule and Thyroid Fine Needle Aspiration Cytology in the Evaluation of Thyroid Malignancy Risk”. Family Practice and Palliative Care, c. 8, sy. 1, 2023, ss. 1-9, doi:10.22391/fppc.1173267.
Vancouver Kuscu B, Eroğlu M. The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk. Fam Pract Palliat Care. 2023;8(1):1-9.
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Family Practice and Palliative Care      ISSN 2458-8865       E-ISSN 2459-1505