Öz
Amaç:
İnsidental mikropapiller karsinom (İMK), tiroid malignitelerinin en yaygın mikropapiller varyantıdır ve son on yılda insidansı artmaktadır. Tiroid bezinde İMK varlığını tahmin etmede nodül boyutunun etkinliğine ilişkin veriler yeterli değildir. Bu retrospektif çalışmada nodül boyutunun, İMK’lerin tiroid bezinde diğer lezyonlarla bir arada bulunmasının öngörülmesine etkisini araştırdık.
Yöntem:
Ocak 2017-Şubat 2020 tarihleri arasında ince iğne aspirasyon sitolojisi ve ardından tiroidektomi için biyopsi yapılan 194 hastanın verileri retrospektif olarak incelendi. Hastalar tiroid nodüllerinin boyutlarına göre 0-10 mm, 11-20 mm ve >20 mm olarak üç gruba ayrıldı.
Bulgular:
Nodül boyutu 0-10 mm arasında olan hastalarda en çok hipotiroidizm (%51,0, %28,8 ve %41,8) görülürken, boyutu 11-20 mm arasındaki hastalarda en çok ötiroidizm görüldü (%44,2, %45,1 ve %41,8, p=0,0175). Hem malignitenin (%51,9, %49,0 ve %42,9, p=0,544) hem de İMK’nin (%65,4, %51,0 ve %56,0, p=0,32), orta büyüklükte (11-20 mm) nodül boyutu olan hastalarda görülme olasılığı yüksekti. Aşağıdaki değişkenlerin İMK’nin görülmesini daha fazla etkilediğini bulduk: halo yokluğu [olasılık oranı (OO): 4,50, %95 güven aralığı (GA): 1,61-14,71, p=0,007], vasküleritede azalma [OO: 0,33, %95 GA: 0,12-0,87, p=0,030] ve total tiroidektomi [OO: 4,55, %95 GA: 2,30-9,56, p<0,001].
Sonuç:
Nodül boyutunda artışla (>2 cm) birlikte tiroid bezi içinde daha fazla İMK’ye rastlanmıştır. Bununla birlikte, nodül boyutunun tiroid bezinde İMK bulunma riski için prediktif bir faktör olma potansiyeli düşüktür.
Anahtar Kelimeler: Malignite, nodül boyutu, tiroidektomi
Kaynakça
Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008;22(6):901-911.
Fink A, Tomlinson G, Freeman JL, Rosen IB, Asa SL. Occult micro-papillary carcinoma associated with benign follicular thyroid disease and untreated thyroid neoplasms. Mod Pallid 1996;9(8):816-820.
Nanjappa N, Kumar A, Swain SK, Aroul TT, Smile SR, Kotasthane D. Incidental thyroid carcinoma. Indian J Otolaryngol Head Neck Surg 2013;65(1):37-39.
Zalzali M, Debreuve A, Richard C, Filieri C, Schvartz C. Micropapillary carcinoma: Description and rise in incidence in the French Marne-Ardennes thyroid cancer registry. Ann Endocrinol (Paris) 2019;80(4):229-233.
Kang KW, Kim SK, Kang HS, Lee ES, Sim JS, Lee IG, et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J Clin Endocrinol Metab 2003;88(9):4100-4104.
Lyu YJ, Shen F, Yan Y, Situ M, Wu W, Jiang G, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules <10 mm in the maximum diameter: does size matter? Cancer Manag Res 2019;11:1231-1236.
Gao X, Zhang X, Zhang Y, Hua W, Maimaiti Y, Gao Z. Is papillary thyroid microcarcinoma an indolent tumor?: a retrospective study on 280 cases treated with radioiodine. Medicine (Baltimore) 2016;95(40):e5067. doi: 10.1097/MD.0000000000005067.
Yaprak Bayrak B, Eruyar AT. Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology. BMC Endocr Disord 2020;20(1):48.
Kim DW, Park AW, Lee EJ, Choo HJ, Kim SH, Lee SH, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules smaller than 5 mm in the maximum diameter: assessment of efficacy and pathological findings. Korean J Radiol 2009;10(5):435-440.
Rosario PW, Silva AL, Calsolari MR. Is fine needle aspiration really not necessary in patients with thyroid nodules ≤ 1 cm with highly suspicious features on ultrasonography and candidates for active surveillance? Diagn Cytopathol 2017;45(4):294-296.
Zhong LC, Lu F, Ma F, Xu HX, Li DD, Guo LH, et al. Ultrasound-guided fine-needle aspiration of thyroid nodules: does the size limit its efficiency? Int J Clin Exp Pathol 2015;8(3):3155-3159.
Haugen BR. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed? Cancer 2017;123(3):372-381.
Wu Q, Li Y, Liu Y, Shen J, Wang Y, Yi X, et al. The value of conventional sonography and ultrasound elastography in decision-making for thyroid nodules in different categories of the Bethesda system for reporting thyroid cytopathology. Clin Hemorheol Microcirc 2020;74(3):255-266.
Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid 2009;19(11):1159-1165.
Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351(17):1764-1771.
Lin JD, Chao TC, Huang BY, Chen ST, Chang HY, Hsueh C, et al. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology. Thyroid 2005;15(7):708-717.
De Matos PS, Ferreira AP, Ward LS. Prevalence of papillary microcarcinoma of the thyroid in Brazilian autopsy and surgical series. Endocr Pathol 2006;17(2):165-173.
Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf) 2004;60(1):21-28.
Kim DW, Lee EJ, Kim SH, Kim TH, Lee SH, Kim DH, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size. Thyroid 2009;19(1):27-31.
Zafón C, Obiols G, Mesa J. Preoperative TSH level and risk of thyroid cancer in patients with nodular thyroid disease: nodule size contribution. Endocrinol Nutr 2015;62(1):24-28.
Kim EK, Park CS, Chung WY, Oh KK, Kim DL, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178(3):687-691.
Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am 2012;96(2):329-349.
Al-Hakami HA, Alqahtani R, Alahmadi A, Almutairi D, Algarni M, Alandejani T. Thyroid nodule size and prediction of cancer: a study at tertiary care hospital in Saudi Arabia. Cureus 2020;12(3):e7478. doi: 10.7759/cureus.7478.
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):564-570.
El-Gammal Ahmed S, E-Balshy Mohammed A, Zahran Kareem M. Relationship between thyroid nodule size and incidence of thyroid cancer. Menoufia Med J 2019; 32(3):1142-1148.
