İki santimetreden küçük, ultrasonografik bulguları kuşkulu ve sitoloji sonucu bening tiroid nodüllerinde ne yapılmalı?
Küçük Resim Yok
Tarih
2013
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Cilt Başlığı
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Tiroid nodülü değerlendirmesinde, her ne kadar ince iğne aspirasyon biyopsisinin (İİAB) duyarlılığı yüksek olduğu kabul edilse de, ultrasonografi (US) bulguları gözardı edilmemelidir. Bu çalışma ile iki santimetreden küçük nodüllerin değerlendirilmesinde, benign İİAB ancak kuşkulu US özellikleri taşıyan nodülleri irdelemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya retrospektif olarak incelenen ve Ocak 2009 - Ocak 2013 tarihleri arasında tiroidektomi uygulanan 31 hasta dahil edildi. Otuz bir hastanın tiroid ultrasonografi ve tiroid İİAB sonuçları incelendi. Hastaların hepsinde tiroid ultrasonografisinde multinodüler doku formasyonu mevcuttu ve bu nodüllerin malignite açısından kuşkulu oldukları (hipoekoik, sınırları düzensiz, halosu bulunmayan, boyu eninden uzun olan, vaskülaritesi artmış veya mikrokalsifikasyonlar içeren nodüllerin olduğu) tespit edildi. En büyük nodül boyutu 2 cm idi. Sitoloji sonucu 'benign' olan bu hasta grubuna, US'de malignite kuşkusu beraberinde klinik kuşku mevcut olduğundan, kozmetik sebeplerden veya hasta isteğinden dolayı tiroidektomi uygulandı. Bulgular: Tümüne total tiroidektomi uygulanan 27'si kadın, 4'ü erkek olan hasta grubunun yaş ortalaması 49,5 idi. Hastalar, patoloji sonuçları açısından irdelendiğinde, 13 hastada multinodüler guatr (%41,9), 2 hastada foliküler adenom (%6,4), 1 hastada Hashimoto tiroiditi (%3,2) ve 15 (%48,3) hastada tiroid kanseri saptandı. Kanserli olgularda en az iki kuşkulu US bulgusu mevcuttu. Kanserin, papiller mikrokarsinomlu 5 hasta dışında, kuşkulu US bulguları taşıyan nodüllerde ortaya çıktığı gözlendi. Malignite açısından en az iki kuşkulu ultrasonografik bulgu taşıyan nodül(-ler)'den alınan İİAB'si benign olan ve aynı nodül(-lerin)'ün patoloji sonucu malign çıkan hasta grubu çalışmaya katılan tüm hastaların %32,2'sini oluşturdu.Sonuç: Literatürde, 2 cm'den küçük ve US'de malignite açısından kuşkulu tiroid nodüllerinin varlığında İİAB altın standardını korumaktadır. Ancak, kuşkulu US bulgularının varlığında, duyarlılığın yüksek olması nedeniyle, klinik kuşku durumunda maligniteyi düşündüren en az iki US bulgusu varlığında cerrahi tedavi seçeneğinin gündeme gelebileceği kanısındayız
Objective: Although fine needle aspiration biopsy has a high sensitivity in thyroid nodule assessment, ultrasonography findings should not be underestimated. With this study we aimed to evaluate cytologically benign nodules smaller than two centimeters, where ultrasonography findings were suspicious. Material and Methods: Thirty-one patients undergoing thyroidectomy between January 2009 January 2013 were included in this retrospectively designed study. Thyroid ultrasonography and thyroid fine needle aspiration biopsy (FNAB) results were evaluated. Ultrasonographically, all patients had multinodular tissue formation and nodules had at least one of the suspicious features (nodules with hypoechogenicity, irregular margins, absence of halo, taller-than-width, increased vascularity and microcalcifications). Maximum size of nodules was 2 cm. Thyroidectomy was performed in this ultrasonographically suspicious, but cytologically benign group due to clinical suspicion, cosmetic reasons or patient preference. Results: All patients underwent a total thyroidectomy. The group consisted of 27 female and 4 male patients, with a mean age of 49.5 years. According to the final pathology reports, there were 13 (41.9%) multinodular goiters, 2 (6.4%) follicular adenomas, 1 (3.2%) Hashimoto’s thyroiditis and 15 (48.3%) thyroid cancers. Patients with cancer had at least two suspicious ultrasound findings. Except five patients with papillary microcarcinoma, cancer was diagnosed in ultrasonographically suspicious nodules in all patients. The percentage of patients with benign FNAB results, but with at least two suspicious ultrasound findings of malignancy in the biopsied nodules, was 32.2%. Conclusion: FNAB remains to be the gold standard in the management of ultrasonographically suspicious nodules smaller than 2 centimeters. Nevertheless, due to its high sensitivity, in case of presence of suspicious features on ultrasonography, we believe that thyroidectomy should be a treatment option if there is a clinical suspicion and the patient carries at least two suspicious ultrasonography findings
Objective: Although fine needle aspiration biopsy has a high sensitivity in thyroid nodule assessment, ultrasonography findings should not be underestimated. With this study we aimed to evaluate cytologically benign nodules smaller than two centimeters, where ultrasonography findings were suspicious. Material and Methods: Thirty-one patients undergoing thyroidectomy between January 2009 January 2013 were included in this retrospectively designed study. Thyroid ultrasonography and thyroid fine needle aspiration biopsy (FNAB) results were evaluated. Ultrasonographically, all patients had multinodular tissue formation and nodules had at least one of the suspicious features (nodules with hypoechogenicity, irregular margins, absence of halo, taller-than-width, increased vascularity and microcalcifications). Maximum size of nodules was 2 cm. Thyroidectomy was performed in this ultrasonographically suspicious, but cytologically benign group due to clinical suspicion, cosmetic reasons or patient preference. Results: All patients underwent a total thyroidectomy. The group consisted of 27 female and 4 male patients, with a mean age of 49.5 years. According to the final pathology reports, there were 13 (41.9%) multinodular goiters, 2 (6.4%) follicular adenomas, 1 (3.2%) Hashimoto’s thyroiditis and 15 (48.3%) thyroid cancers. Patients with cancer had at least two suspicious ultrasound findings. Except five patients with papillary microcarcinoma, cancer was diagnosed in ultrasonographically suspicious nodules in all patients. The percentage of patients with benign FNAB results, but with at least two suspicious ultrasound findings of malignancy in the biopsied nodules, was 32.2%. Conclusion: FNAB remains to be the gold standard in the management of ultrasonographically suspicious nodules smaller than 2 centimeters. Nevertheless, due to its high sensitivity, in case of presence of suspicious features on ultrasonography, we believe that thyroidectomy should be a treatment option if there is a clinical suspicion and the patient carries at least two suspicious ultrasonography findings
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Ulusal Cerrahi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
29
Sayı
4
