Aspirasyon yerinin tiroid nodüllerinin ultrason destekli jet iğne biyopsisi verimliliği üzerindeki etkileri

Clinical Research ENT Updates 2015;5(1):13–18 doi:10.2399/jmu.2015001004 Does the site of aspiration affect the efficacy of ultrasound-guided fine needle aspiration biopsy of thyroid nodules? Emin Çakmakc›1, Safiye Tokgöz Özal2, Özlem Kolçak Türko¤lu2, Berna Uçan3, Umut Kaygusuz4, Tolga Dinç5, Dilek Ece6 1 Department of Radiology, Kelkit Government Hospital, Gümüflhane, Turkey Department of Radiology, Istanbul Dr. Lütfi K›rdar Kartal Training and Research Hospital, Istanbul, Turkey 3 Department of Radiology, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey 4 Department of Otorhinolaryngology, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey 5 Department of General Surgery, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey 6 Department of Pathology, Istanbul Dr. Lütfi K›rdar Kartal Training and Research Hospital, Istanbul, Turkey 2 Abstract Özet: Aspirasyon yerinin tiroid nodüllerinin ultrason destekli jet i¤ne biyopsisi verimlili¤i üzerindeki etkileri Objective: To investigate whether the choice of a hypovascular or a hypervascular site of a thyroid nodule affects the efficacy of the ultrasound-guided fine needle aspiration procedure or not. Amaç: Çal›flman›n amac› ultrason destekli jet i¤ne biyopsisinde hipovasküler ya da hipervasküler tiroid nodül tercihinin prosedür verimlili¤ine etkisinin incelenmesidir. Methods: Sixty solid thyroid nodules in 60 patients with hypo- and hypervascular parts were included in this prospective clinical study. Under color Doppler sonographic guidance, the fine needle aspiration was made with 22-gauge needle. Radiological and cytological features as well as the adequacy of samples were noted and compared. Yöntem: Bu prospektif çal›flmada hipovasküler ve hipervasküler tiroid nodülleri olan 60 hasta de¤erlendirilmifltir. Renkli Doppler sonografik yönlendirme alt›nda 22 numara i¤ne ile jet i¤ne biyopsisi gerçeklefltirmifltir. Radyolojik ve sitolojik faktörler ve numunelerin yeterlili¤i de¤erlendirilmifl ve karfl›laflt›r›lm›flt›r. Results: Sonographically, 25 nodules (41.7%) were hetereogenous and calcified, 21 were hypoechoic (35%), 10 were isoechoic (16.7%) and 4 were hyperechoic (6.6%). Rate of adequate sampling when only hypervascular was used or hypovascular sites were evaluated were 81.7% and 83.3%, respectively. When both sites were evaluated together, rate of adequate sampling was found to be 91.7% in total. Presence and distribution of endothelial cells in the sample seems not to influence the diagnostic value of the procedure. Bulgular: Sonografik olarak 25 nodül (%41.7) heterojen ve kalsifiye, 21 nodül hipoekoik (%35), 10 nodül izoekoik (%16.7) ve 4 nodül (%6.6) hiperekoik olarak tan›mlanm›flt›r. Yaln›zca hipervasküler ve hipovasküler nodüller de¤erlendirildi¤inde yeterli örneklem oran› %81.7 ve %83.3 olarak ölçülmüfltür. Her iki grup beraber de¤erlendirildi¤inde toplam yeterli örneklem oran› %91.7 olarak bulunmufltur. Örneklerde endotelyal hücrelerin bulunmas›n›n ya da bu hücrelerin da¤›l›m›n›n prosedürün teflhis de¤erini etkilemedi¤i görülmüfltür. Conclusion: Our results indicate that vascularity of a thyroid nodule outlined by color Doppler sonography can aid in optimizing the efficiency of fine-needle aspiration biopsy. The samples obtained from aspirates of hypo- and hypervascular sites are both complementary and assessment of these sites together yields better results in terms of diagnostic accuracy. Keywords: Thyroid, nodule, diagnosis, ultrasonography, fine-needle aspiration, color Doppler. Sonuç: Elde etti¤imiz sonuçlara göre renkli Doppler sonografisi ile tiroid nodüllerinin vaskülaritesinin incelenmesinin jet i¤ne biyopsisinin etkinli¤ini optimize edebilece¤i görülmüfltür. Hipovasküler ve hipervasküler bölgelerde yap›lan biyopsiler birbirini tamamlay›c›d›r ve bu verilerin birlikte kullan›lmas› teflhis do¤rulu¤unu artt›rmaktad›r. Anahtar sözcükler: Tiroid, nodül, tan›, ultrason, ince i¤ne aspirasyonu, renkli Doppler. Correspondence: Emin Çakmakc›, MD. Department of Radiology, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey. e-mail: Received: January 28, 2015; Accepted: February 20, 2015 ©2015 Continuous Education and Scientific Research Association (CESRA) Online available at: www.entupdates.org doi:10.2399/jmu.2015001004 QR code: Çakmakc› E et al. Fine-needle aspiration biopsy (FNAB) is routinely used to evaluate nodular thyroid disease. Cytological outcome may be important for selection of the optimal treatment approach. However, since the results of blind FNAB are often inconclusive, ultrasound guided fine-needle aspiration (UG-FNA) is accepted as the least invasive and most accurate method for identification of the nature of thyroid nodules.[1-3] The aim is to obtain the most cellular specimen that represents the target nodule during FNAB. In the literature, UG-FNA specimen cellularity ranges from 66.4% to 96.6% depending on the different specimen obtaining techniques.[4] Even though the rate of specimen inadequacy with UG-FNA is lower than that of palpationguided aspiration, rate of inadequacy is still about 10–20% of all procedures.[5] Color Doppler sonography (CDS) can be used to identify the perinodular and intranodular vessels, to obtain a safe access site and to minimize the amount of blood in the aspirate during FNAB.[1-3] For nodules consisting solid and cystic components placement of the needle into the solid part may provide aspirates with higher cellularity, resulting in a better diagnosis. The FNAB is a simple, well-known and practical intervention but the question where to place the needle tip with regard to the vascularity of the nodule during aspiration remains to be elucidated.[2,4–6] This study was designed to investigate whether the hypervascular site or the hypovascular site of a solid thyroid nodule reveals more cellular aspirates when UG-FNA is performed under CDS guidance. Materials and Methods The local institutional review board approved the study protocol and informed consents were obtained from all the patients included in the study. This prospective, clinical study included 60 consecutive euthyroid patients referred for UG-FNA for the first time in two centers (Kelkit Government Hospital, Gümüflhane, and Istanbul Dr. Lütfi K›rdar Kartal Training and Research Hospital, Istanbul). Between March 2012 and March 2013, a total of 60 cases with solid thyroid nodules >10 mm with clear distinction between the hypervascular and hypovascular sections were investigated prospectively. Nodules smaller than 1 cm were excluded since discrimination of hyper- and a hypovascular zones via Doppler US was not feasible for such lesions. Nodules that did not reflect any signals under power and color Doppler US were termed as “hypovascular zone”, while those which reflect signals were described as “hypervascular zone”. Nodules that have compl (...truncated)