Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience
Yıl: 2018 Cilt: 22 Sayı: 2 Sayfa Aralığı: 57 - 63 Metin Dili: İngilizce DOI: 10.25179/tjem.2017-58459 İndeks Tarihi: 13-11-2018
Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience
Öz: Objective: The atypia of undetermined significance or follicular lesion of undetermined significance is a heterogeneous category of Bethesda system. This study aimed to evaluate the malignancy rates in the initial operation and contralateral thyroid lobe after completion thyroidectomy in patients with atypia of undetermined significance/FLUS thyroid nodules who underwent hemithyroidectomy. Material and Methods: We reviewed the medical records of 47 (7 male, 40 female; mean age 40.3±13.3 years) patients with cytological atypia of undetermined significance/follicular lesion of undetermined significance nodules (total 48 nodules). Results: The preoperative cytology was evaluated as atypia of undetermined significance in 32 (66.7%) nodules and follicular lesion of undetermined significance in 16 (33.3%) nodules. The histopathology was reported as benign in 34 (72.3%) patients and malignant in 13 (27.7%) patients. Out of these 13 patients, complementary thyroidectomy was performed in 11 (23.4%) patients, of which 9 (81.8%) patients had benign histopathology and 2 (18.2%) had malignant histopathology. Conclusion: Lobectomy seems to be a reasonable initial surgical approach in patients with atypia of undetermined significance/follicular lesion of undetermined significance thyroid nodules in cytology.
Anahtar Kelime: Konular:
Önemi Belirsiz Atipi/Önemi Belirsiz Foliküler Lezyon Tiroid Nodüllerinde İlk Cerrahi Yaklaşım Olarak Hemitiroidektomi Mantıklı Gibi Görünmektedir
Öz: Amaç: Önemi belirsiz atipi/önemi belirsiz foliküler lezyon Bethesda sisteminin heterojen bir kategorisidir. Bu çalış- mada, sitolojide önemi belirsiz atipi/önemi belirsiz foliküler lezyon nodülü olduğu için hemitiroidektomi yapılan hastalardaki başlangıç malignite oranının, tamamlayıcı tiroidektomi ihtiyacının, karşı lobdaki malignite oranının belirlenmeye çalışılması amaçlanmıştır. Gereç ve Yöntemler: Merkezimizde hemitiroidektomi operasyonu geçiren tiroid nodül sitolojileri (n=48) ÖBA/ÖBFL olan 47 (yedi erkek, 40 kadın; ortalama yaş 40,3±13,3 yıl) hasta çalışmaya dâhil edildi. Bulgular: Preoperatif sitolojide önemi belirsiz atipi nodül sayısı 32 (%66,7), önemi belirsiz foliküler lezyon nodül sayısı 16 (%33,3) idi. Histopatoloji sonuçları incelendiğinde 34 (%72,3) hasta benign, 13 (%27,7) hasta malign olarak rapor edildi. Malignite saptanan 13 hastadan 11 (%23,4)’ine tamamlayıcı tiroidektomi yapılmıştı. Tamamlayıcı tiroidektomi yapılan hastaların karşı lob histopatolojileri incelendiğinde 9 (%81,8)’unun benign, 2 (%18,2)’sinin malign olduğu saptandı. Sonuç: Hemitiroidektomi önemi belirsiz atipi/önemi belirsiz foliküler lezyon sitolojili tiroid nodüllerinde başlangıç için makul bir cerrahi yaklaşım gibi görünmektedir.
Anahtar Kelime: Konular:
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- Posillico SE, Wilhelm SM, McHenry CR. The utility of frozen section examination for determining the extent of thyroidectomy in patients with a thyroid nodule and “atypia/follicular lesion of undetermined significance.” Am J Surg. 2015;209:552-556.
- Osmólski A, Frenkiel Z, Osmólski R. Complications in surgical treatment of thyroid diseases. Otolaryngol Pol. 2006;60:165-170.
- Donatini G, Castagnet M, Desurmont T, Rudolph N, Othman D, Kraimps JL. Partial thyroidectomy for papillary thyroid microcarcinoma: is completion total thyroidectomy indicated? World J Surg. 2016;40:510-515.
- Kim ES, Kim TY, Koh JM, Kim YI, Hong SJ, Kim WB, Shong YK. Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol (Oxf). 2004;61:145-148.
- Pacini F, Elisei R, Capezzone M, Miccoli P, Molinaro E, Basolo F, Agate L, Bottici V, Raffaelli M, Pinchera A. Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in lowand high-risk patients. Thyroid. 2001;11:877-881.
- Dobrinja C, Trevisan G, Piscopello L, Fava M, Liguori G. Comparison between thyroidectomy and hemithyroidectomy in treatment of single thyroid nodules identified as indeterminate follicular lesions by fine-needle aspiration cytology. Ann Ital Chir. 2010;81:403-410.
- Ibrahim B, Forest VI, Hier M, Mlynarek AM, Caglar D, Payne RJ. Completion thyroidectomy: predicting bilateral disease. J Otolaryngol Head Neck Surg. 2015;44:23.
- Kuru B, Atmaca A, Tarim IA, Kefeli M, Topgul K, Yoruker S, Elmali M, Danaci M. Risk factors associated with malignancy and with triage to surgery in thyroid nodules classified as Bethesda category III (AUS/FLUS). Eur J Surg Oncol. 2016;42:87-93.
- Ryu YJ, Jung YS, Yoon HC, Hwang MJ, Shin SH, Cho JS, Lee JS, Kim HK, Kang HC, Lim HS, Yoon JH, Park MH. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res. 2014;86:109-114.
- Topaloglu O, Baser H, Cuhaci FN, Sungu N, Yalcin A, Ersoy R, Cakir B. Malignancy is associated with microcalcification and higher AP/T ratio in ultrasonography, but not with Hashimoto’s thyroiditis in histopathology in patients with thyroid nodules evaluated as Bethesda Category III (AUS/FLUS) in cytology. Endocrine. 2016;54:156-168.
- Bongiovanni M, Crippa S, Baloch Z, Piana S, Spitale A, Pagni F, Mazzucchelli L, Di Bella C, Faquin W. Comparison of 5-tiered and 6-tiered diagnostic systems for the reporting of thyroid cytopathology: a multi-institutional study. Cancer Cytopathol. 2012;120:117-125.
- Renshaw AA. Should “atypical follicular cells” in thyroid fine-needle aspirates be subclassified? Cancer Cytopathol. 2010;118:186-189.
- VanderLaan PA, Marqusee E, Krane JF. Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated fna be the preferred initial approach? Am J Clin Pathol. 2011;135:770-775.
- Layfield LJ, Morton MJ, Cramer HM, Hirschowitz S. Implications of the proposed thyroid fine-needle aspiration category of “follicular lesion of undetermined significance”: a five-year multi-institutional analysis. Diagn Cytopathol. 2009;37:710-714.
- Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract. 2010;16:468-475.
- Erdem E, Gülçelik MA, Kuru B, Alagöl H. Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma. Eur J Surg Oncol. 2003;29:747-749.
- Kelman AS, Rathan A, Leibowitz J, Burstein DE, Haber RS. Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens. Thyroid. 2001;11:271-277.
- Tyler DS, Winchester DJ, Caraway NP, Hickey RC, Evans DB. Indeterminate fine-needle aspiration biopsy of the thyroid: identification of subgroups at high risk for invasive carcinoma. Surgery. 1994;116:1054-1060.
- Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1-133.
- Tuttle RM, Lemar H, Burch HB. Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration. Thyroid. 1998;8:377-383.
- Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009;132:658-665.
- Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, Abati A. The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation. Cytojournal. 2008;5:6.
| APA | ÇAKIR B, BİLGİNER M, ÖZDEMİR D, TOPALOĞLU O, Aydın C, DUMLU E, TATLI DOĞAN H, ERSOY R (2018). Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. , 57 - 63. 10.25179/tjem.2017-58459 |
| Chicago | ÇAKIR Bekir,BİLGİNER Muhammet Cüneyt,ÖZDEMİR DİDEM,TOPALOĞLU Oya,Aydın Cevdet,DUMLU Ersin Gürkan,TATLI DOĞAN Hayriye,ERSOY Reyhan Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. (2018): 57 - 63. 10.25179/tjem.2017-58459 |
| MLA | ÇAKIR Bekir,BİLGİNER Muhammet Cüneyt,ÖZDEMİR DİDEM,TOPALOĞLU Oya,Aydın Cevdet,DUMLU Ersin Gürkan,TATLI DOĞAN Hayriye,ERSOY Reyhan Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. , 2018, ss.57 - 63. 10.25179/tjem.2017-58459 |
| AMA | ÇAKIR B,BİLGİNER M,ÖZDEMİR D,TOPALOĞLU O,Aydın C,DUMLU E,TATLI DOĞAN H,ERSOY R Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. . 2018; 57 - 63. 10.25179/tjem.2017-58459 |
| Vancouver | ÇAKIR B,BİLGİNER M,ÖZDEMİR D,TOPALOĞLU O,Aydın C,DUMLU E,TATLI DOĞAN H,ERSOY R Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. . 2018; 57 - 63. 10.25179/tjem.2017-58459 |
| IEEE | ÇAKIR B,BİLGİNER M,ÖZDEMİR D,TOPALOĞLU O,Aydın C,DUMLU E,TATLI DOĞAN H,ERSOY R "Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience." , ss.57 - 63, 2018. 10.25179/tjem.2017-58459 |
| ISNAD | ÇAKIR, Bekir vd. "Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience". (2018), 57-63. https://doi.org/10.25179/tjem.2017-58459 |
| APA | ÇAKIR B, BİLGİNER M, ÖZDEMİR D, TOPALOĞLU O, Aydın C, DUMLU E, TATLI DOĞAN H, ERSOY R (2018). Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. Turkish Journal of Endocrinology and Metabolism, 22(2), 57 - 63. 10.25179/tjem.2017-58459 |
| Chicago | ÇAKIR Bekir,BİLGİNER Muhammet Cüneyt,ÖZDEMİR DİDEM,TOPALOĞLU Oya,Aydın Cevdet,DUMLU Ersin Gürkan,TATLI DOĞAN Hayriye,ERSOY Reyhan Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. Turkish Journal of Endocrinology and Metabolism 22, no.2 (2018): 57 - 63. 10.25179/tjem.2017-58459 |
| MLA | ÇAKIR Bekir,BİLGİNER Muhammet Cüneyt,ÖZDEMİR DİDEM,TOPALOĞLU Oya,Aydın Cevdet,DUMLU Ersin Gürkan,TATLI DOĞAN Hayriye,ERSOY Reyhan Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. Turkish Journal of Endocrinology and Metabolism, vol.22, no.2, 2018, ss.57 - 63. 10.25179/tjem.2017-58459 |
| AMA | ÇAKIR B,BİLGİNER M,ÖZDEMİR D,TOPALOĞLU O,Aydın C,DUMLU E,TATLI DOĞAN H,ERSOY R Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. Turkish Journal of Endocrinology and Metabolism. 2018; 22(2): 57 - 63. 10.25179/tjem.2017-58459 |
| Vancouver | ÇAKIR B,BİLGİNER M,ÖZDEMİR D,TOPALOĞLU O,Aydın C,DUMLU E,TATLI DOĞAN H,ERSOY R Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience. Turkish Journal of Endocrinology and Metabolism. 2018; 22(2): 57 - 63. 10.25179/tjem.2017-58459 |
| IEEE | ÇAKIR B,BİLGİNER M,ÖZDEMİR D,TOPALOĞLU O,Aydın C,DUMLU E,TATLI DOĞAN H,ERSOY R "Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience." Turkish Journal of Endocrinology and Metabolism, 22, ss.57 - 63, 2018. 10.25179/tjem.2017-58459 |
| ISNAD | ÇAKIR, Bekir vd. "Hemithyroidectomy Seems to be a Reasonable Initial Surgical Approach in Patients with Cytological Bethesda Category III Thyroid Nodules: An Institutional Experience". Turkish Journal of Endocrinology and Metabolism 22/2 (2018), 57-63. https://doi.org/10.25179/tjem.2017-58459 |
