Multinodüler guatrlı hastalarda PRE-OP tiroid ince iğne aspirasyon biyopsisinin post operatif patoloji sonuçları ile korelasyonu
Correlati̇on between results of pre-op fi̇ne needle aspi̇rati̇on bi̇opsy(FNAB) reports and post-op pathology reports i̇n pati̇ents wi̇th multi̇nodular goi̇ter
Yazar: ÖZGÜR SEVİM
Danışman: ÖĞR. GÖR. ŞENER BALAS
Sağlık Bilimleri Üniversitesi / Ankara Dışkapı Yıldırım Beyazıt Eğitim Ve Araştırma Hastanesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2019
Konu: Genel Cerrahi = General Surgery
Dizin: Biyopsi-iğne = Biopsy-needle ; Guatr = Goiter ; Guatr-nodüler = Goiter-nodular ; Neoplazmlar = Neoplasms ; Patoloji = Pathology ; Postoperatif dönem = Postoperative period ; Teşhis = Diagnosis ; Teşhis teknikleri ve prosedürleri = Diagnostic techniques and procedures ; Tiroid neoplazmları = Thyroid neoplasms ; Tiroid nodülleri = Thyroid nodule

Özet:
Amaç: Dominant nodülden alınan ince iğne aspirasyon biyopsisinde (İİAB) benign, önemi belirsiz atipi, foliküler neoplazi açısından kuşkulu, kuşkulu malign ve maign sitoloji ile uyumlu çıkan sonuçların, cerrahi karar verilen hastalardaki post operatif doku tanısı ile korelasyonunu kendi serimizde incelemeyi amaçladık.
Gereç ve Yöntem: Ocak 2015-Mart 2018 tarihleri arasında hastanemizde, nodüler guatr tanısı alarak İİAB uygulanıp opere edilen çalışmaya dahil edilen 413 hastanın dosya kayıtları retrospektif olarak tarandı. Yerel etik kurul onayı alındıktan sonra yaş, cinsiyet gibi demografik verilerinin yanı sıra preoperatif ultrasonografi ve sitopatoloji raporları, operasyon bilgileri, postoperatif patoloji sonuçları ve epikriz verileri kayıt altına alındı.
Bulgular: Çalışmamıza dahil edilen 413 hastanın postoperatif değerlendirmesinde 195 hasta malign, 218 benign olarak bulunmuştur. Malign hastaların 41 tanesi erkek, 154 tanesi kadın hasta olup; çalışma grubumuzdaki kadın/erkek oranı literatürle uyumlu şekilde 5/1 dir.  Hastalarımızın 373 (%90,3)' üne total tiroidektomi, 23 (%5,5)' üne lobektomi, 15 (%3,7)' ine tamamlayıcı tiroidektomi ve 2 (%0,5)' ine de subtotal tiroidektomi yapıldı. Preoperatif ince iğne aspirasyon biyopsileri ile postoperatif patoloji sonuçları alt gruplara göre karşılaştırıldığında preoperatif değerlendirmede ince iğne aspirasyon biyopsisi benign olarak değerlendirilen hastaların 17 (%17,5)' si postoperatif patolojik incelemede papiller mikrokarsinom, 11 (%11,3)' i papiller karsinom, 1 (%1,0)' i foliküler karsinom, 1 (%1,0)' i hurthle hücreli karsinom ve 1 (%1,0)' i de iyi diferansiye karsinom olarak değerlendirildi. Preoperatif sitolojik incelemede önemi belirsiz atipi olarak değerlendirilen hastaların 33 (%29,5)' ü postoperatif patolojik değerlendirmede papiller mikrokarsinom, 24 (%21,4)' ü papiller karsinom, 3 (%2,7)' ü foliküler karsinom, 1 (%0,9)' , foliküler mikrokarsinom, 1 (%0,9)' i hurthle hücreli karsinom ve 1 (%0,9)' i de iyi diferansiye karsinom olarak değerlendirildi. Preoperatif sitolojik değerlendirmede nondiagnostik olarak raporlanan 141 hastanın postoperatif patoloji incelemesinde 37 (%26,2)' si papiller mikrokarsinom, 22 (%15,6)' si papiller karsinom, 1 (%0,7)' i hurthle hücreli karsinom ve 1 (%0,7)' i de iyi diferansiye karsinom olarak raporlandı. Preoperatif sitolojik incelemede foliküler neoplazi kuşkusu olan 27 hastanın 9 (%33,3)' u postoperatif değerlendirmede benign olarak değerlendirilirken 2 (%7,4)' si foliküler karsinom, 1 (%3,7)' i foliküler mikrokarsinom olarak değerlendirildi. Preoperatif incelemede malignite yönünden kuşkulu olan 22 hastanın postoperatif değerlendirmesinde hastaların tamamı malign olarak raporlanmakla birlikte 9 (%40,9)' u papiller mikrokarsinom ve 13 (%64,3)' ü de papiller karsinom olarak değerlendirildi ( Tablo 9). Çalışmamızın preoperatif sitoloji değerlendirmesi ile postoperatif patoloji değerlendirmesi istatistiksel olarak karşılaştırıldığına anlamlı fark bulunmuştur (p=0,0001).
Sonuç; Klinik muayene ve ultrasonografik incelemeden sonra esas tanı koydurucu yöntem ince iğne aspirasyon biyopsisidir (İİAB). Yanlış negatiflik ve pozitiflik oranlarını en aza indirebilmek için şüphesiz ki İİAB' nin mümkünse ultrasonografi eşliğinde konusunda uzman hekimlerce referans kılavuzlarda belirtilen şekilde patoloji değerlendirmesi sağlayabilecek kadar yeterli miktarda örnek alınarak yapılması, uygun ve en kısa sürede sitopatoloji değerlendirmesi yapılacak birime ulaştırılması ve yine konusunda uzman sitopatologlarca tekniğine uygun boyanma ve preparat hazırlanmasını takiben dikkatle incelenmesi son derece önemlidir.

Abstract:
Purpose: To observe the correlation between biopsies from dominant thyroid nodula which resulted as atypia of undetermined significance, suspicious for a follicular neoplasm, suspected malignancy or malignancy and pathology reports from post-op patients in our review.
Methodology:  Files of 413 patients who were diagnosed with multinodular goiter and underwent fine needle aspiration biopsy(FNAB) and thyroidectomy afterwards between January 2015 and March 2018 were retrospectively analysed. After  ethics committee approval; data were gathered from those files such as age, gender, pre-op ultrasonography reports, cytopathology reports, operation notes, post-op pathology reports and epicrisis reports.
Findings:  In 413 patients 195 of them were postoperatively reported as malign and 218 as benign cytology. 41 patients of malign cytology group were found as to be male gender and 154 of them  female which is parallel to the 1/5 ratio in common literature. Patients underwent various surgeries, 373 (%90.3) of them were total thyroidectomy, 23 of them (%5.5) were lobectomy, 15 of them (%3.7) were completion thyroidectomy and 2 of them (%0.5) were subtotal thyroidectomy. When results of pre-op fine needle aspiration biopsy reports and post-op pathology reports in patients with multinodular goiter were compared in subgroups;  in 14 patients who were preoperatively diagnosed with malignancy by FNAB, 1 of them (%7.1) was postoperatively reported as nodular hyperplasia. In patients who were diagnosed with benign cytology by FNAB 17 of them (%17.5) were postoperatively reported as papillary microcarcinoma, 11 of them (%11.3) were postoperatively reported as papillary carcinoma, 1 of them (%1) was postoperatively reported as follicular carcinoma, 1 of them (%1) was postoperatively reported as hurtle cell carcinoma and 1 of them (%1) was postoperatively reported as well differentiated carcinoma. In patients who were diagnosed with undetermined significance by FNAB, 33 of them (%29.5) were postoperatively reported as papillary microcarcinoma, 24 of them (%21.4) were postoperatively reported as papillary carcinoma, 3 of them (%2.7)were postoperatively reported as follicular carcinoma, 1 of them (%0.9) was postoperatively reported as follicular microcarcinoma, 1 of them (%0.9) was postoperatively reported as hurtle cell carcinoma and  1 of them (%0.9) was postoperatively reported as well differentiated carcinoma. In 141 patients who were diagnosed with non-diagnostic cytology by FNAB; 37 of them (%26.2) were postoperatively reported as papillary microcarcinoma, 22 of them (%15.6) were postoperatively reported as papillary carcinoma, 1 of them (%0.7) was postoperatively reported as hurtle cell carcinoma and  1 of them (%0.7) was postoperatively reported as well differentiated carcinoma.  In 27 patients who were diagnosed with suspicious for a follicular neoplasm by FNAB; 9 of them (%33.3) were postoperatively reported as benign cytology, 2 of them (%7.4) were postoperatively reported as follicular carcinoma and 1 of them (%3.7) was postoperatively reported as follicular microcarcinoma.
In 22 patients who were diagnosed with suspicious for malignancy by FNAB, all of them were postoperatively reported as malign cytology. 9 of them (%40.9) were postoperatively reported as papillary microcarcinoma, 13 of them (%64.3) was postoperatively reported as papillary carcinoma.When preoperative cytology reports and postoperative pathology reports were compared, statistically significant difference was found. (p=0.0001)
Results: Regarding nodula of the goiter; after physical examination and ultrasonography tests, golden standart is accepted as fine needle aspiration biopsy(FNAB). To eliminate false negative and positive results, this test should be performed by certified specialists, - if available - assisted with an ultrasound device, within international standarts and enough cytology material, with short material transportation time and lastly examination of the material - again by certified specialists within international standarts and procedures.