FINE-NEEDLE ASPIRATION PUNCTURE BIOPSY IN VERIFICATION OF MALIGNANT THYROID NODULES
DOI:
https://doi.org/10.21856/j-PEP.2023.4.04Keywords:
carcinoma, Bethesda system, thyroid gland, fine-needle aspiration biopsyAbstract
When nodule formations are detected, the main task is to stratify their malignancy risk, considering clinical, laboratory findings and ultrasound results. With all this, the only preoperative method of direct assessment of the thyroid gland structural changes is fine-needle aspiration puncture biopsy.
The aim of the study. Comparative study between cytology of thyroid nodule formations biopsy and thyroid postoperative histology results, and assessment of accuracy of fine-needle aspiration puncture biopsy method in carcinoma verification.
Material and methods. During 2019, 4,982 patients with the thyroid nodule formations were consulted, 2,158 of them underwent fine needle aspiration puncture biopsy.
Cytology findings included descriptions and were classified as Bethesda categories I-VI. The data were processed statistically according to the absolute frequency of signs (Bethesda categories, neoplasm malignancy, etc.) and the sensitivity and specificity values.
Results. Among 212 patients who underwent operation, thyroid gland malignancies were detected in 176 (83.01%). The sensitivity of cytology examination in detecting carcinoma as IV+V+VI categories was 92.4% (95% CI, 74-97.3). In category IV, the specificity was 47.1% (36.2-59.0), category V – 98.3% (89.0-99.4), category VI – 100% (95.6-100.0). Thus, the percentage of coincidence of the cytology results and morphology studies confirmed the possibility of this system to detect malignant formations. The low specificity of the category IV cytology results, on the one hand, may be related to a small number of samples, and on the other hand, to the fact that this category is the most difficult to diagnose and the most controversial when deciding on treatment tactics.
Conclusions. The Bethesda system is the most informative method for the diagnosis of thyroid carcinoma using a cytological study of a fine-needle aspiration puncture biopsy. This is confirmed by a high rate of specificity, which makes it a valuable tool in the field of thyroid cancer diagnosis. As a cytological diagnosis, the Bethesda IV classification for thyroid cancer is considered the least reliable. This emphasizes the need for the development of new diagnostic techniques, in particular molecular genetic ones, to confirm the presence of thyroid carcinoma.
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