학술논문
Evaluation of Thyroid Nodules in Children and Adolescents: Multicenter Study in Turkey/Cocuk ve Adolesanlarda Tiroid Nodullerinin Degerlendirilmesi: Turkiyede Cok Merkezli Calisma
ORIGINAL ARTICLE/OZGUN ARASTIRMA
ORIGINAL ARTICLE/OZGUN ARASTIRMA
Document Type
Report
Author
Source
The Journal of Current Pediatrics. December 2021, Vol. 19 Issue 3, p354, 9 p.
Subject
Language
Turkish
ISSN
1304-9054
Abstract
Introduction Although thyroid nodules are less frequent among children than adults, they are more likely to be malignant in children. Published case series suggest that the rate of malignancy in [...]
Introduction: Ultrasonography and fine needle aspiration biopsy are reliable diagnostic methods used to predict malignancy in thyroid nodules. They are useful in identifying patients for therapy or preventing unnecessary surgery. Materials and Methods: The aim of this study was to compare clinical and ultrasonographic findings with fine needle aspiration biopsy and histopathological examination results in children with thyroid nodules. Retrospective study. This multicentre study included pediatric patients with thyroid nodules, followed up between July 2002 and November 2019 in nine Turkish Pediatric Endocrinology Units. Clinical, ultrasonographic, cytological and histopathological findings (malignant or benign) were analyzed retrospectively. Fine needle aspiration biopsy findings were classified according to American Thyroid Association criteria. Results: A total of 203 children were included, of whom 82.3% (n=167) were female. Mean [+ or -] standard deviation age was 14.06 [+ or -] 2.26 (range 3.7-19) years. Cytological diagnoses were: non-diagnostic or unsatisfactory 1.9%; benign 59.6%; atypia or follicular lesion of undetermined significance, suspicious for follicular neoplasm in 2.4%; suspicious for malignancy 12.8%; and malignant in 1.9%. Surgery was performed in 59 (29.1%) patients. In total 33 (16.3%) patients were diagnosed with malignancy. In patients with benign fine needle aspiration biopsy results, malignancy was detected in 17.6% when they underwent surgery. Malignancy was present in 44.4% of the patients with cytologically determined atypia or follicular lesion of undetermined significance. The diagnostic accuracy of fine needle aspiration biopsy was 79%. Conclusion: This study is first multicentre study investigating thyroid nodules in children and adolescents in Turkey. In this population fine needle aspiration biopsy has an important role in diagnosis, but ultrasonographic features of nodule should also be taken into consideration. Atypia or follicular lesion of undetermined significance may be of greater clinical significance than has previously been reported. Keywords Childhood, fine needle aspiration biopsy, thyroid, ultrasonography Giris: Ultrasonografi ve ince igne aspirasyon biyopsisi, tiroid nodullerinde maligniteyi ongormede kullanilan guvenilir tani yontemleridir. Dogru hastayi bulmada ve gereksiz ameliyatlari onlemede faydalidirlar. Bu calismanin amaci tiroid nodulu bulunan cocuklarda ince igne aspirasyon biyopsisi ile klinik, ultrasonografik bulgular ve histopatolojik inceleme sonuclarini karsilastirmaktir. Gerec ve Yontem: Bu cok merkezli calismada, Turkiye'den 9 farkli Pediatrik Endokrinoloji Unitesinde Temmuz 2002-Kasim 2019 tarihleri arasinda takip edilen tiroid nodullu hastalarin verileri incelendi. Tiroid nodullu cocuk hastalarin klinik, ultrasonografik, sitolojik ve histopatolojik bulgulari (malign veya benign) retrospektif olarak incelendi. Ince igne aspirasyon biyopsisi ile takip edilen hastalarin bulgulari Amerikan Tiroid Birligi'ne gore siniflandirildi. Bulgular: Calismaya toplam 203 cocuk dahil edildi, hastalarin %82,3'u (n=167) kadindi. Hastalarin ortalama yasi 14,06 [+ or -] 2,26 yil (dagilim 3,7-19 yil) idi. Hastalarin sitolojik tanilari su sekildeydi: %1,9'u tani disi veya yetersiz, %59,6'si benign, onemi belirsiz atipi veya folikuler lezyon, %2,4'u folikuler neoplazm supheli, %12,8'i malignite suphesi, %1,9'u malign idi. 59 hastaya cerrahi uygulandi. Otuz uc hastaya malignite tanisi konuldu. Benign ince igne aspirasyon biyopsisi sonucu olan hastalarin %17,6'sinda ameliyat olduklarinda malignite saptandi. Onemi belirlenemeyen sitolojiye sahip atipi veya folikuler lezyonu olan hastalarin %44,4'unde malignite mevcuttu. Ince igne aspirasyon biyopsisinin tanisal dogrulugu %79 idi. Sonuc: Bu calisma, Turkiye'de cocuk ve ergenlerde tiroid nodullerini arastiran ilk cok merkezli calismadir. Tiroid nodulu olan cocuklarda ince igne aspirasyon biyopsisi tanida onemli bir yere sahiptir ancak nodulun ultrasonografik ozellikleri de dikkate alinmalidir. Atipi veya onemi belirsiz folikuler lezyon bilinenden daha onemli olabilir. Anahtar kelimeler Cocukluk cagi, ince igne aspirasyon biyopsisi, tiroid, ultrasonografi
Introduction: Ultrasonography and fine needle aspiration biopsy are reliable diagnostic methods used to predict malignancy in thyroid nodules. They are useful in identifying patients for therapy or preventing unnecessary surgery. Materials and Methods: The aim of this study was to compare clinical and ultrasonographic findings with fine needle aspiration biopsy and histopathological examination results in children with thyroid nodules. Retrospective study. This multicentre study included pediatric patients with thyroid nodules, followed up between July 2002 and November 2019 in nine Turkish Pediatric Endocrinology Units. Clinical, ultrasonographic, cytological and histopathological findings (malignant or benign) were analyzed retrospectively. Fine needle aspiration biopsy findings were classified according to American Thyroid Association criteria. Results: A total of 203 children were included, of whom 82.3% (n=167) were female. Mean [+ or -] standard deviation age was 14.06 [+ or -] 2.26 (range 3.7-19) years. Cytological diagnoses were: non-diagnostic or unsatisfactory 1.9%; benign 59.6%; atypia or follicular lesion of undetermined significance, suspicious for follicular neoplasm in 2.4%; suspicious for malignancy 12.8%; and malignant in 1.9%. Surgery was performed in 59 (29.1%) patients. In total 33 (16.3%) patients were diagnosed with malignancy. In patients with benign fine needle aspiration biopsy results, malignancy was detected in 17.6% when they underwent surgery. Malignancy was present in 44.4% of the patients with cytologically determined atypia or follicular lesion of undetermined significance. The diagnostic accuracy of fine needle aspiration biopsy was 79%. Conclusion: This study is first multicentre study investigating thyroid nodules in children and adolescents in Turkey. In this population fine needle aspiration biopsy has an important role in diagnosis, but ultrasonographic features of nodule should also be taken into consideration. Atypia or follicular lesion of undetermined significance may be of greater clinical significance than has previously been reported. Keywords Childhood, fine needle aspiration biopsy, thyroid, ultrasonography Giris: Ultrasonografi ve ince igne aspirasyon biyopsisi, tiroid nodullerinde maligniteyi ongormede kullanilan guvenilir tani yontemleridir. Dogru hastayi bulmada ve gereksiz ameliyatlari onlemede faydalidirlar. Bu calismanin amaci tiroid nodulu bulunan cocuklarda ince igne aspirasyon biyopsisi ile klinik, ultrasonografik bulgular ve histopatolojik inceleme sonuclarini karsilastirmaktir. Gerec ve Yontem: Bu cok merkezli calismada, Turkiye'den 9 farkli Pediatrik Endokrinoloji Unitesinde Temmuz 2002-Kasim 2019 tarihleri arasinda takip edilen tiroid nodullu hastalarin verileri incelendi. Tiroid nodullu cocuk hastalarin klinik, ultrasonografik, sitolojik ve histopatolojik bulgulari (malign veya benign) retrospektif olarak incelendi. Ince igne aspirasyon biyopsisi ile takip edilen hastalarin bulgulari Amerikan Tiroid Birligi'ne gore siniflandirildi. Bulgular: Calismaya toplam 203 cocuk dahil edildi, hastalarin %82,3'u (n=167) kadindi. Hastalarin ortalama yasi 14,06 [+ or -] 2,26 yil (dagilim 3,7-19 yil) idi. Hastalarin sitolojik tanilari su sekildeydi: %1,9'u tani disi veya yetersiz, %59,6'si benign, onemi belirsiz atipi veya folikuler lezyon, %2,4'u folikuler neoplazm supheli, %12,8'i malignite suphesi, %1,9'u malign idi. 59 hastaya cerrahi uygulandi. Otuz uc hastaya malignite tanisi konuldu. Benign ince igne aspirasyon biyopsisi sonucu olan hastalarin %17,6'sinda ameliyat olduklarinda malignite saptandi. Onemi belirlenemeyen sitolojiye sahip atipi veya folikuler lezyonu olan hastalarin %44,4'unde malignite mevcuttu. Ince igne aspirasyon biyopsisinin tanisal dogrulugu %79 idi. Sonuc: Bu calisma, Turkiye'de cocuk ve ergenlerde tiroid nodullerini arastiran ilk cok merkezli calismadir. Tiroid nodulu olan cocuklarda ince igne aspirasyon biyopsisi tanida onemli bir yere sahiptir ancak nodulun ultrasonografik ozellikleri de dikkate alinmalidir. Atipi veya onemi belirsiz folikuler lezyon bilinenden daha onemli olabilir. Anahtar kelimeler Cocukluk cagi, ince igne aspirasyon biyopsisi, tiroid, ultrasonografi