Malignancy risk assessment in adenomatoid nodules and suspicious follicular lesions of the thyroid obtained by fine needle aspiration cytology [Procjena rizika od malignosti u adenomatoidnih čvorova i suspektnih folikularnih promjena štitnjače dobivenih citološkom punkcijom]

Dabelić, Nina and Mateša, Neven and Mateša-Anić, Dubravka and Kusić, Zvonko (2010) Malignancy risk assessment in adenomatoid nodules and suspicious follicular lesions of the thyroid obtained by fine needle aspiration cytology [Procjena rizika od malignosti u adenomatoidnih čvorova i suspektnih folikularnih promjena štitnjače dobivenih citološkom punkcijom]. Collegium Antropologicum, 34 (2). pp. 349-354. ISSN 0350-6134

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Abstract

Our aim was to assess malignancy risk in adenomatoid nodules and suspicious follicular lesions of the thyroid obtained by fine needle aspiration (FNA) cytology. Retrospective research was performed of 276 patients who underwent thyroid surgery after preoperative ultrasound-guided FNA diagnosis of either adenomatoid nodule, cellular follicular lesion, "suspicious for follicular neoplasm" or follicular neoplasm. Out of 276 patients, FNA reports showed 15 diagnoses (5%) of adenomatoid nodules, 73 (26%) cellular follicular lesions, 76 (28%) "suspicious for follicular neoplasm", and 112 diagnoses (41%) of follicular neoplasm. FNA reports were compared with pathohistological findings. In FNA reports of adenomatoid nodule (N = 15), there were seven (47%) pathohistological diagnoses (PHDs) of nodular goiter, and eight (53%) PHDs of follicular adenoma. In FNA reports of cellular follicular lesion (N = 73), there were 2 (3%) PHDs of thyroiditis, 32 (44%) PHDs of nodular goiter, 38 (52%) PHDs of follicular adenoma, and one (1%) PHD of papillary carcinoma. In FNA reports of "suspicious for follicular neoplasm" (N = 76), there was one (1%) PHD of thyroiditis, 24 (32%) PHDs of nodular goiter, 47 (62%) PHDs of follicular adenoma and four (5%) diagnoses of papillary carcinoma. In FNA reports of follicular neoplasm (N = 112), there were 25 (22%) PHDs of nodular goiter, 72 (64%) PHDs of follicular adenoma, and 15 (14%) PHDs of thyroid carcinoma. We found significant difference (p < 0.01) between investigated FNA report groups according to malignancy risk. Stratification of cytologic diagnoses of follicular thyroid lesions into different subcategories with various probabilities of malignancy allows more accurate estimation of malignancy risk and individualized patient treatment, when deciding between immediate operation and close follow-ups with repeat FNA.

Abstract in Croatian

Cilj istraživanja bio je procijeniti rizik od malignosti u adenomatoidnih čvorova i suspektnih folikularnih promjena štitnjače dobivenih citološkom punkcijom. Učinjena je retrospektivna analiza 276 bolesnika kojima je provedena operacija štitnjače nakon predoperacijske citološke punkcije pod kontrolom ultrazvuka i citološke dijagnoze bilo adenomatoidnog čvora, celularne folikularne promjene, »suspektnog folikularnog tumora« ili folikularnog tumora. Od 276 bolesnika, nalazi citološke punkcije ukazali su na 15 dijagnoza (5%) adenomatoidnih čvorova, 73 (26%) celularnih folikularnih promjena, 76 (28%) »suspektnih folikularnih tumora« i 112 (41%) folikularnih tumora. Citološke dijagnoze uspoređivane su s patohistološkim dijagnozama (PHD). Kod citološke dijagnoze adenomatoidnog čvora (N=15), PHD je u 7 slučajeva (47%) ukazao na nodularnu strumu, a u 8 (53%) na folikularni adenom. Kod citološke dijagnoze celularne folikularne promjene (N=73), PHD je u 2 slučaja (3%) ukazao na tireoiditis, u 32 (44%) na nodularnu strumu, u 38 slučajeva (52%) na folikularni adenom, te u 1 bolesnika (1%) na papilarni karcinom. U slučaju citološke dijagnoze »suspektnog folikularnog tumora« (N=76), PHD je u 1 slučaju (1%) ukazao na tireoiditis, u 24 slučaja (32%) na nodularnu strumu, u 47 bolesnika (62%) na folikularni adenom i u 4 bolesnika (5%) na papilarni karcinom. Kod citološke dijagnoze folikularnog tumora (N=112), PHD je u 25 slučajeva (22%) odgovarao nodularnoj strumi, u 72 slučaja (64%) folikularnom adenomu, te u 15 bolesnika (14%) karcinomu štitnjače. Utvrđena je značajna razlika (p<0,01) između ispitivanih skupina citoloških dijagnoza u odnosu na rizik od malignosti. Raspodjela citoloških dijagnoza folikularnih promjena štitnjače u podskupine s različitom vjerojatnošću malignosti omogućuje točniju procjenu rizika od malignosti i individualizirani pristup liječenju, kada je potrebno odlučiti treba li bolesnika odmah uputiti na operaciju ili preporučiti česte kontrole s ponavljanjem citološke punkcije.

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