Soliter nonfonksiyonel tiroid nodüllerinde malignite kriterleri ve cerrahi tedavinin planlanması
Küçük Resim Yok
Tarih
2000
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Ülkemizde oldukça sık görülen tiroid nodüllerinin malignite yönünden çeşitli inceleme yöntemleri ile değerlendirilerek bu yöntemler içinde hangisinin daha yararlı olduğunun belirlenmesi ve cerrahi tedavinin planlanması araştırıldı. 1 Mart 1997- 1 Mayıs 2000 tarihleri arasmda TÜTF Genel Cerrahi AD'na başvuran soüter nonfonksiyone nodulu olan hastalardan 63 'ü tiroid USG, sesta-MİBİ sintigrafi, ÜAB, peroperatuar frozen section inceleme, parafın inceleme ve elektron mikroskopik inceleme ile değerlendirilerek bu yöntemlerin malignitenin tanınmasındaki yeri prospektif olarak irdelendi. USG incelemede nodüller solid ve semisolid olmak üzere iki gruba ayrıldı. USG incelemenin malign lezyonlan benign olanlardan ayırmada istatistiksel açıdan yetersiz (McNemar testinde p=0.000, kappa değeri= 0.031) olduğu görüldü. Sesta-MİBİ sintigrafi de tutulum olması malignite açısından pozitif kabul edilerek yapılan değerlendirmede bu yönteminde malignite tanısında istatistiksel olarak geçerliliği olmadığı (McNemar testinde p= 0.007, kappa değeri= 0.118) görüldü. Ameliyat öncesi yapılan incelemeler içinde ÜAB'nin sensitivitesi %55, spesifisitesi %80 ve doğruluğu %75 olarak bulundu. Hem aspirasyonu hazırlayan hemde sitolojik incelemeyi yapan hekimin tecrübesinin önemli olduğu bu yöntem istatistiksel olarak USG ve sintigrafiden anlamlı ölçüde daha faydalı bulunmuştur. Peroperatuar frozen section inceleme malignite tanısındaki sorunları henüz çözememiştir. Frozen section incelemenin kanser tanısı koymadaki başarısı %75 seviyelerinde kalmıştır. Elektron mikroskopik inceleme malignite tanısında çok duyarlı olmakla birlikte rutin klinik kullanımı "cost-effective" değildir. Ameliyattan önce yapılan incelemelerle malignite kesin olarak ekarte edilebilirse gereksiz cerrahi girişimler önlenecektir. Malignitenin ameliyat öncesi yada en azından ameliyat sırasında frozen section inceleme ile belirlenebilmesi cerrahi tedavinin tek seansta bitirilerek reoperasyonlann büyük ölçüde azalmasına neden olacaktır. 45Ameliyat öncesi hücresel düzeyde malignite varlığını belirleyebilecek tek yöntem ÜAB olduğundan bu yöntemin tecrübeli kişilerce hazırlanıp değerlendirilmesi daha faydalı olacaktır. 46
SUMMARY THE CRITERIA OF MALIGNANCY IN THE NON-FUNCTIONAL SOLITARY THYROID NODULES AND THE PLANNING OF THE SURGICAL TREATMENT Thyroid nodules, which have frequently seen in our country, have been evaluated by different examination methods for the diagnosis of malignancy. It was searched to verify that which of the laboratory tests were more useful and to plan the surgical treatment. The study is carried out at Trakya University, Medical Faculty, Department Of General Surgery, between the dates 1st March 1997- Is* May 2000. 63 of 1he patients with solitary, nonfunctional thyroid nodules were evaluated by thyroid ultrasound, sesta-mibi scintigraphy, FNAB, frozen section, permanent section and electron microscopic examinations. The value of these studies to clarify the presence of malignancy in the the thyroid nodule were evaluated prospectively. The nodules are divided into two groups as solid and semi-solid with the ultrasound examination. Statistically, it was verified that ultrasound examination is unsatisfactory for differentiation of malignant lesions from the benign ones (McNemar test, p= 0.000, kappa value=0.031). In sesta-mibi scintigraphy, the accumulation of the radioactivity is considered positive for the possible malignancy. It was found out that sesta-mibi scintigraphyis also not valid statistically for the diagnosis of malignancy (McNemar test, p=0.007, kappa value=0. 1 18). The sensitivity and spesificity for FNAB were 55% and 80% respectively. The accuracy of the FNAB was 75%. The experience of the cytologist and the doctor who makes FNAB is very important. Statistically, FNA was found more valueable than ultrasound and scintigraphy to detect thyroid malignancy. 47Peroperative frozen section examination has not solved the difficulties in the diagnosis of thyroid malignancy yet. Positive predictive value of the frozen section was found 75%. Although electron microscopic examination was found highly sensitive in the diagnosis of malignancy, it is not cost-effective in clinical use. If the malignancy of the thyroid nodule could be eliminated preoperatively, unnecessary surgical operations will be prevented. If the malignancy could be proved preoperatively or during the operation, complet surgical resection could be applied at the first attempt. So, reoperations would be decreased. As, the only test to detect malignancy at cellular level is the FNAB, it will be more useful when FNAB was applied by experienced person. 48
SUMMARY THE CRITERIA OF MALIGNANCY IN THE NON-FUNCTIONAL SOLITARY THYROID NODULES AND THE PLANNING OF THE SURGICAL TREATMENT Thyroid nodules, which have frequently seen in our country, have been evaluated by different examination methods for the diagnosis of malignancy. It was searched to verify that which of the laboratory tests were more useful and to plan the surgical treatment. The study is carried out at Trakya University, Medical Faculty, Department Of General Surgery, between the dates 1st March 1997- Is* May 2000. 63 of 1he patients with solitary, nonfunctional thyroid nodules were evaluated by thyroid ultrasound, sesta-mibi scintigraphy, FNAB, frozen section, permanent section and electron microscopic examinations. The value of these studies to clarify the presence of malignancy in the the thyroid nodule were evaluated prospectively. The nodules are divided into two groups as solid and semi-solid with the ultrasound examination. Statistically, it was verified that ultrasound examination is unsatisfactory for differentiation of malignant lesions from the benign ones (McNemar test, p= 0.000, kappa value=0.031). In sesta-mibi scintigraphy, the accumulation of the radioactivity is considered positive for the possible malignancy. It was found out that sesta-mibi scintigraphyis also not valid statistically for the diagnosis of malignancy (McNemar test, p=0.007, kappa value=0. 1 18). The sensitivity and spesificity for FNAB were 55% and 80% respectively. The accuracy of the FNAB was 75%. The experience of the cytologist and the doctor who makes FNAB is very important. Statistically, FNA was found more valueable than ultrasound and scintigraphy to detect thyroid malignancy. 47Peroperative frozen section examination has not solved the difficulties in the diagnosis of thyroid malignancy yet. Positive predictive value of the frozen section was found 75%. Although electron microscopic examination was found highly sensitive in the diagnosis of malignancy, it is not cost-effective in clinical use. If the malignancy of the thyroid nodule could be eliminated preoperatively, unnecessary surgical operations will be prevented. If the malignancy could be proved preoperatively or during the operation, complet surgical resection could be applied at the first attempt. So, reoperations would be decreased. As, the only test to detect malignancy at cellular level is the FNAB, it will be more useful when FNAB was applied by experienced person. 48
Açıklama
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Tıpta Uzmanlık
Tıpta Uzmanlık
Anahtar Kelimeler
Genel Cerrahi, General Surgery
