Abstract
Amaç: Ultrasonografi ile yapılan değerlendirmeler, tiroid bezinde sıkça rastlanan nodüllere yaklaşımın temelini oluşturmaktadır. Nodülün sonografik olarak değerlendirilmesi kritik bir öneme sahip olmasına rağmen, birçok ultrasonografi raporu nodül için sonografik risk sınıflaması yapılması konusunda yeterli kalite düzeyinde değildir. Bu çalışmada ultrasonografide saptanan nodül boyutu ile patolojik nodül boyutu arasındaki uyumluluk durumunu tiroidektomi yapılan hastalarda değerlendirmeyi amaçladık. Yöntem: Ocak 2011-Aralık 2018 yılları arasında Genel Cerrahi Bölümü’nde tiroidektomi yapılan 1222 hasta retrospektif olarak değerlendirilmiştir. Preoperatif dönemde ultrasonografi bilgilerine ulaşılabilen, izole tek (soliter) indeks tiroid nodülü olan veya birden fazla tanımlı nodülü olmasına rağmen lobda tanımlı indeks nodülü olan, hemitiroidektomi veya total tiroidektomi uygulanmış 534 hasta ayrıntılı olarak değerlendirilmiştir. İki sayısal değişken arasındaki ilişkiyi incelemek amacıyla Spearman Korelasyon Katsayısı’ndan yararlanılmıştır. İki sürekli ölçümün uyumu için Uyumluluk Korelasyon Katsayısı, kategorik değişkenlerin uyumu için ise Kappa Katsayısı hesaplanmıştır. Analizler için Statistica 13.3.1 paket programı kullanılmıştır. Bulgular: Nodüllerin sonografik ve patolojik boyutlarının uyumlu olduğu saptanırken, nodül boyutları kategorik olarak ayrıldığında; uyumluluk devam etmekle birlikte uyumun azaldığı saptanmıştır. İndeks nodülün patolojik olarak incelemesinde hastaların %30’unda malignite saptanmıştır. Hastaların %16,5’inde (n=88) ise indeks nodülden bağımsız olarak ayrı bir odakta insidental olarak papiller mikrokarsinoma saptanmıştır. Hastaların %10,1’inde (n=54) ise multifokal tümör varlığı saptanmıştır. Sonuç: Sonuç olarak ultrasonografide saptanan nodül boyutu ile nodülün nihai patolojik boyutu uyum gösterse de kategorik değerlendirmede boyutlar arasında farklılıklar saptanmaktadır. İncelenen nodül benign olsa da ayrı bir odakta mikrokarsinoma saptanabilmektedir. Kılavuzlara göre özellikle boyut bakımından ileri incelemeye gerek görülmeyen hastaların değerlendirilmesinde; ek tümör odaklarının görülebileceği, multifokal tümör olabileceği ve nodül boyutlarında hatalı ölçümler olabileceği akılda tutulmalıdır.
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References
- 1. Kim E, Pudhucode R, Chen H, Lindeman B. Discordance Between the American Thyroid Association and the American College of Radiology Guideline Systems for Thyroid Nodule Biopsy. J Surg Res 2020;30:469-474.
- 2. Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am 2012;96:329-349.
- 3. Langer JE. Sonography of the Thyroid. Radiol Clin North Am 2019;57:469-483.
- 4. Kim BW, Yousman W, Wong WX, Cheng C, McAninch EA. Less is More: Comparing the 2015 and 2009 American Thyroid Association Guidelines for Thyroid Nodules and Cancer. Thyroid 2016;26:759-764.
- 5. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017;6:225-237.
- 6. Zhao L, Yan H, Pang P, Fan X, Jia X, Zang L, Luo Y, Wang F, Yang G, Gu W, Du J, Wang X, Lyu Z, Dou J, Mu Y. Thyroid nodule size calculated using ultrasound and gross pathology as predictors of cancer: A 23-year retrospective study. Diagn Cytopathol 2019;47:187-193.
- 7. Bachar G, Buda I, Cohen M, Hadar T, Hilly O, Schwartz N, Shpitzer T, Segal K. Size discrepancy between sonographic and pathological evaluation of solitary papillary thyroid carcinoma. Eur J Radiol 2013;82:1899-1903.
- 8. Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, Grogan RH, Angelos P, Kaplan EL, Cipriani NA. Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size. Thyroid 2017;27:641-650.
- 9. Yim Y, Na DG, Ha EJ, Baek JH, Sung JY, Kim JH, Moon WJ. Concordance of Three International Guidelines for Thyroid Nodules Classified by Ultrasonography and Diagnostic Performance of Biopsy Criteria. Korean J Radiol 2020;21:108-116.
- 10. Symonds CJ, Seal P, Ghaznavi S, Cheung WY, Paschke R. Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy. Endocrine 2018;61:303-307.
- 11. Deveci MS, Deveci G, LiVolsi VA, Gupta PK, Baloch ZW. Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: effect on patient management. Diagn Cytopathol 2007;35:579-583.
- 12. Chan DS, Gong K, Roskies MG, Forest VI, Hier MP, Payne RJ. Re-visiting the ATA 2015 sonographic guidelines - who are we missing?: A retrospective review. J Otolaryngol Head Neck Surg 2018;47:51.
- 13. Moon HJ, Lee HS, Kim EK, Ko SY, Seo JY, Park WJ, Park HY, Kwak JY. Thyroid nodules ≤ 5 mm on ultrasonography: are they "leave me alone" lesions? Endocrine 2015;49:735-744.
- 14. Qadan L, Ahmed A, Kapila K. Thyroid Ultrasound Reports: Deficiencies and Recommendations. Med Princ Pract 2019;28:280-283.
- 15. Jiang L, Lee CY, Sloan DA, Randle RW. Variation in the Quality of Thyroid Nodule Evaluations Before Surgical Referral. J Surg Res 2019;244:9-14.
- 16. Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol 2015;12:1272-1279.
Abstract
Aim: Prevalence of thyroid nodules is common and assessment with ultrasonography is very important in management of thyroid nodules. Although assessment with ultrasonography of the nodule is critical, many ultrasonography reports include insufficient quality in terms of sonographic risk classification of the nodule. In this study, we aimed to evaluate the concordance of nodule size between sonographic nodule size and pathological nodule size in patients underwent thyroidectomy. Methods: Of 1222 patients who underwent thyroidectomy in the General Surgery Department between January 2011 and December 2018 were evaluated retrospectively. In the preoperative period, 534 patients with an isolated solitary index nodule in thyroid, or a single index nodule in the thyroid lobe, who underwent hemithyroidectomy or total thyroidectomy were evaluated in detail. Spearman Correlation Coefficient was used to examine the relationship between two numerical variables. The Concordance Correlation Coefficient for two continuous measurements and the Kappa Coefficient for the categorical variables were calculated. Statistica 13.3.1 package program was used for analysis. Results: The sonographic and pathological sizes of the nodules were found to be concordant. However, when the nodule sizes were categorically separated, it was found that concordance decreased but continued. In the pathological examination of the index nodule, malignancy was detected in 30% of the patients. In 16.5% of the patients (n = 88), papillary microcarcinoma was detected incidentally in a separate focus, and multifocal tumor was detected in 10.1% of the patients (n = 54). Conclusion: Although the size of the nodule was found quite concordant in sonographic and pathological assessment, it was found that concordance of nodule sizes was decreased in categorical classification of nodule size. While the index nodule was found benign, microcarcinoma can be detected in a separate focus. In the evaluation of patients who do not require further examination especially in terms of nodule size according to the guidelines, it should be kept in mind that in addition to the fact that there may be inaccurate measurements in nodule size, additional tumor focus and multifocal tumor may be detected.
Project Number
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References
- 1. Kim E, Pudhucode R, Chen H, Lindeman B. Discordance Between the American Thyroid Association and the American College of Radiology Guideline Systems for Thyroid Nodule Biopsy. J Surg Res 2020;30:469-474.
- 2. Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am 2012;96:329-349.
- 3. Langer JE. Sonography of the Thyroid. Radiol Clin North Am 2019;57:469-483.
- 4. Kim BW, Yousman W, Wong WX, Cheng C, McAninch EA. Less is More: Comparing the 2015 and 2009 American Thyroid Association Guidelines for Thyroid Nodules and Cancer. Thyroid 2016;26:759-764.
- 5. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017;6:225-237.
- 6. Zhao L, Yan H, Pang P, Fan X, Jia X, Zang L, Luo Y, Wang F, Yang G, Gu W, Du J, Wang X, Lyu Z, Dou J, Mu Y. Thyroid nodule size calculated using ultrasound and gross pathology as predictors of cancer: A 23-year retrospective study. Diagn Cytopathol 2019;47:187-193.
- 7. Bachar G, Buda I, Cohen M, Hadar T, Hilly O, Schwartz N, Shpitzer T, Segal K. Size discrepancy between sonographic and pathological evaluation of solitary papillary thyroid carcinoma. Eur J Radiol 2013;82:1899-1903.
- 8. Cavallo A, Johnson DN, White MG, Siddiqui S, Antic T, Mathew M, Grogan RH, Angelos P, Kaplan EL, Cipriani NA. Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size. Thyroid 2017;27:641-650.
- 9. Yim Y, Na DG, Ha EJ, Baek JH, Sung JY, Kim JH, Moon WJ. Concordance of Three International Guidelines for Thyroid Nodules Classified by Ultrasonography and Diagnostic Performance of Biopsy Criteria. Korean J Radiol 2020;21:108-116.
- 10. Symonds CJ, Seal P, Ghaznavi S, Cheung WY, Paschke R. Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy. Endocrine 2018;61:303-307.
- 11. Deveci MS, Deveci G, LiVolsi VA, Gupta PK, Baloch ZW. Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: effect on patient management. Diagn Cytopathol 2007;35:579-583.
- 12. Chan DS, Gong K, Roskies MG, Forest VI, Hier MP, Payne RJ. Re-visiting the ATA 2015 sonographic guidelines - who are we missing?: A retrospective review. J Otolaryngol Head Neck Surg 2018;47:51.
- 13. Moon HJ, Lee HS, Kim EK, Ko SY, Seo JY, Park WJ, Park HY, Kwak JY. Thyroid nodules ≤ 5 mm on ultrasonography: are they "leave me alone" lesions? Endocrine 2015;49:735-744.
- 14. Qadan L, Ahmed A, Kapila K. Thyroid Ultrasound Reports: Deficiencies and Recommendations. Med Princ Pract 2019;28:280-283.
- 15. Jiang L, Lee CY, Sloan DA, Randle RW. Variation in the Quality of Thyroid Nodule Evaluations Before Surgical Referral. J Surg Res 2019;244:9-14.
- 16. Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol 2015;12:1272-1279.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Project Number | - |
| Publication Date | December 5, 2020 |
| Submission Date | September 25, 2020 |
| Acceptance Date | October 27, 2020 |
| Published in Issue | Year 2020 Volume: 13 Issue: 3 |
Cite
MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.
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