Turkkan Ebru, Uzum Yusuf
Internal Medicine, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, TUR.
Cureus. 2023 Sep 2;15(9):e44569. doi: 10.7759/cureus.44569. eCollection 2023 Sep.
The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules.
In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy.
Within this research's scope, 411 patients over 16 years old who were evaluated in Izmir Katip Celebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between 2018 and 2022 and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis.
No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05) Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed as benign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa (κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign.
Although FNAB remains the most important diagnostic tool to identify benign cases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results and helps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.
由于成像方法的广泛应用以及小甲状腺结节的偶然发现，甲状腺结节的发病率在过去50年中有所上升。甲状腺细针穿刺活检（FNAB）是评估甲状腺结节最准确、可靠且具有成本效益的检查方法。
在本研究中，我们旨在阐明甲状腺细针穿刺细胞学检查（FNAC），以了解可疑病例如何预测恶性肿瘤。
在本研究范围内，对2018年至2022年间在土耳其伊兹密尔卡迪普·切莱比大学阿塔图尔克培训与研究医院内科门诊接受甲状腺结节评估、进行甲状腺FNAC并随后接受甲状腺手术的411名16岁以上患者进行回顾性分析。审查了所有患者的年龄、性别、甲状腺FNAC、手术类型和组织病理学。有头颈癌病史的个体被排除在分析之外。
未发现病理结果与人口统计学特征之间存在统计学显著关系。病理结果与FNAB结果之间存在统计学显著相关性（p<0.05）。虽然在FNAC中84.5%的患者被诊断为良性，14.7%为可疑，0.8%为恶性，但所有这些病例在最终组织病理学结果中均被诊断为良性。同样，在FNAC中21.9%的患者被诊断为良性，58.8%为可疑，19.4%为恶性，所有这些病例在最终组织病理学结果中均被诊断为恶性。确定了两种测量方法之间的相关性（科恩kappa（κ）=0.557；p<0.001）。该检查的敏感性为47%，特异性为99.1%。根据FNAC结果，最初被诊断为良性的个体被诊断为恶性的比率（阳性预测值（PPV））为93.9%，被诊断为良性的比率（阴性预测值（NPV））为85.8%。
虽然FNAB仍然是识别良性病例的最重要诊断工具，准确率很高，但在意义未明的非典型性/意义未明的滤泡性病变（AUS/FLUS）细胞学检查结果可疑的情况下，手术决策并不明确。总之，本研究强调了FNA结果的重要性，并通过强调术后最终组织病理学报告中恶性肿瘤的可能性更高，特别是在FNAC结果可疑的情况下，有助于手术决策。
