Importanța diagnosticului citologic preoperator în patologia nodulară a glandei tiroide

Abstract

Scopul: aprecierea importanţei evaluării preoperatorii a nodulilor tiroidieni prin ecografie şi puncție biopsie tiroidiană cu ac fin (FNAB) și corelația dintre citodiagnosticul și examenul histopatologic. Material și metode: Studiul a inclus 153 subiecţi diagnosticaţi cu noduli tiroidieni, care au fost supuşi FNAB. Rezultatele citologiei au fost clasificate în funcție de recenta clasificare Bethesda în: non-diagnostic, benign, suspicios de malignitate și malign. Examenul histologic a fost considerat standardul de aur pentru diagnosticul final al leziunilor non-neoplazice. Rezultate: Studiul a relevat o prevalenţă a nodulilor tiroidieni net superioară la femei comparativ cu bărbaţii ( raportul femei/barbaţi=4/1). Vîrsta medie a pacienţilor a fost de 43.9 ani. Prin FNAB 103 cazuri (67,7%) au fost diagnosticate ca benigne, 9 cazuri (6,2%) ca suspecte de malignitate, 13 cazuri (7,8%) ca maligne, și 28 de cazuri (18,4%) ca fiind non-diagnostice. Diagnosticul citologic a fost comparat cu rezultatele examenului histologic. Concluzie: FNAB reprezintă evaluarea de primă intenţie în diagnosticul nodulilor tiroidieni. FNAB este un test de diagnostic inițial sensibil, specific, și precis pentru evaluarea pacienților cu noduli tiroidieni.

The importance of preoperatve cytological diagnosis in nodular thyroid disease Purpose: Evaluation of accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of different thyroid lesions. Assess the correlation between preoperative cytodiagnosis and postoperative histopathological diagnosis. Patients and methods: This is a retrospective study of 153 diagnosed cases of thyroid nodules referred to cytology unit, pathology department, who underwent FNAC for diagnosis. The results were categorized according to the recent Bethesda classification into: insufficient for diagnosis, benign, suspicious for malignancy, and malignant sampling. The final histologic diagnosis follow-up assessment for non-neoplastic lesions were considered the gold standard. Results: The study included 153 cases presented with thyroid nodules who underwent diagnostic thyroid FNAC. Female to male ratio was 4.7:1, and the median age was 43.9 years. One hundred and three cases (67.7%) were diagnosed as benign, 9 cases (6.2%) as suspicious for malignancy, 13 cases (7.8%) as malignant, and 28 cases (18.4%) as unsatisfactory. Cytologic diagnoses were compared with their corresponding final histologic ones. Conclusion: FNAC is reliable, safe and accurate method as a first line of evaluation in thyroid gland nodules before surgery. FNA cytology is a sensitive, specific, and accurate initial diagnostic test for the evaluation of patients with thyroid swellings.