| Abstract | Cilj istraživanja: Osnovni cilj istraživanja bio je utvrditi pouzdanost citološke dijagnoze prema Bethesda kategorijama i patohistološke dijagnoze u malignim tumorima štitnjače
Materijali i metode: Studija je strukturirana kao retrospektivno istraživanje. Istraživanje je provedeno na Kliničkom zavodu za patologiju, sudsku medicinu i citologiju KBC-a Split. U istraživanje je uključen 121 pacijent koji je operiran u KBC-u Split te mu je dijagnosticiran karcinom u razdoblju od 1.1.2019. do 31.12.2019. godine. Uvidom u medicinsku dokumentaciju KBC-a Split dobiveni su podaci o spolu bolesnika, dobi, citološkom nalazu, veličini tumora, histološkom tipu, multifokalnosti, bilateralnosti, zahvaćenosti resekcijskih rubova, prisutnosti Hashimotovog tireoiditisa i metastaza u limfne čvorove, ekstratireoidnog širenja, angioinvaziji i tipu kirurškog liječenja.
Rezultati: Od karcinoma štitnjače operirano je 147 bolesnika 2019. godine u KBC-u Split. Od ukupnog broja uključenih ispitanika (121) bilo je 93 (77%) žene i 28 (23%) muškaraca. Medijan životne dobi je 53 godine. Medijan životne dobi žena iznosio je 52 godine, a muškaraca 57 godina. Žene i muškarci se nisu statistički značajno razlikovali prema životnoj dobi (Z=1,48; P=0,138). Pouzdanost citološke dijagnoze prema Bethesda kategorijama i patohistološkog nalaza u malignim tumorima štitnjače iznosi 69%. Ukoliko se iz analize isključe tumori s folikularnom slikom koji nemaju citoloških kriterija za razlikovanje benignih od malignih lezija, podudarnost iznosi 81%. Svi tumori citološki klasificirani kao Bethesda kategorija V i VI (suspektno na papilarni karcinom i maligno – papilarni karcinom) potvrđeni su patohistološkom analizom. Udio pojavnosti Hashimota u tumoru s PHD-om (papilarni i medularni karcinom) je za 3,2 puta veći nego udio pojavnosti Hashimota u ostalim skupinama zajedno (χ2=6,3; P=0,023). Postoji statistički značajna povezanost angioinvazije sa pojavom metastaza u limfne čvorove (χ2=5,7; P=0,017). Udio angioinvazije u skupini bolesnika s metastazama za 3,5 puta je veća nego udio angioinvazije u skupini bolesnika bez metastaza. Medijan vremena proteklog od citološke punkcije do operativnog zahvata (uzimanja uzorka za patohistološku analizu) iznosila je 71 (Q1-Q3: 45-121;min-max: 8-371).
Zaključak: Istraživanje nije pokazalo visoku podudarnost citološke dijagnoze prema Bethesda kategorijama III – VI ukupno i patohistološkog nalaza u malignim tumorima štitnjače zbog nedostatka citoloških kriterija razlikovanja benignih od malignih folikularnih lezija, dok analiza izdvojenih kategorija V i VI značajno podižu podudarnost u odnosu na patohistološki nalaz. Problem ostaju varijante papilarnih tumora s folikularnom slikom i drugi inkapsulirani tumori štitnjače s folikularnom slikom. |
| Abstract (english) | Objectives: The main purpose of this study was to determine the reliability of cytological diagnosis according to Bethesda categories and pathohistological diagnosis in malignant thyroid tumors
Materials and methods: The study is structured as a retrospective study. The research was conducted at the Clinical Department of Pathology, Forensic Medicine and Cytology of the Clinical Hospital Center Split. The study included 121 patients who underwent surgery at the Clinical Hospital Center Split and were diagnosed with cancer in the period from January 1, 2019 to December 31, 2019. Clinical data was obtained from the medical documentation of University hospital Split including patients' sex, age, cytologic findings, tumor size, histologic type, multifocality, bilaterality, resection edges, Hashimoto's thyroiditis and lymph node metastasis, extrathyroid dissemination, angioinvasion and type of surgical procedure.
Results: In 2019, 147 patients underwent surgery for thyroid cancer at the Clinical Hospital Center Split. Of the total number of respondents (121), 93 (77%) were women and 28 (23%) were men. The median age is 53 years. The median age of women was 52 years and that of men was 57 years. Women and men did not differ statistically significantly according to age (Z =1.48; P=0.138). The reliability of cytological diagnosis according to Bethesda categories and pathohistological findings in malignant thyroid tumors is 69%. If tumors with a follicular picture that do not have cytological criteria for distinguishing benign from malignant lesions are excluded from the analysis, the concordance is 81%. All tumors cytologically classified as Bethesda category V and VI (suspected of papillary carcinoma and malignant - papillary carcinoma) were confirmed by pathohistological analysis. The proportion of Hashimoto incidence in tumor with PHD (papillary and medullary carcinoma) was 3.2 times higher than the incidence of Hashimoto in other groups combined (χ2=6.3; P=0.023). There is a statistically significant association of angioinvasion with the appearance of lymph node metastases (χ2=5.7; P=0.017). The proportion of angioinvasion in the group of patients with metastases is 3.5 times higher than the proportion of angioinvasion in the group of patients without metastases. The median time elapsed from cytological puncture to surgery (sampling for pathohistological findings) was 71 (Q1-Q3: 45-121; min-max: 8-371).
Conclusion: The study did not show high congruence of cytological diagnosis according to Bethesda categories III - VI in total and pathohistological findings in malignant thyroid tumors due to lack of cytological criteria for distinguishing benign from malignant follicular lesions, while analysis of selected categories V. and VI. significantly increases concordance with pathohistological findings. Variants of papillary tumors with a follicular pattern and other encapsulated thyroid tumors with a follicular pattern remain a problem. |
