Tiroid-dışı baş-boyun ince iğne aspirasyonlarında sito-histopatolojik tanıların korelasyonu, uyumsuzluk nedenleri ve tuzaklar (10 yıllık kalite kontrolü çalışması)

Tez Türü: Tıpta Uzmanlık

Tezin Yürütüldüğü Kurum: Kocaeli Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Türkiye

Tez Danışmanı: Sevgiye Özkara

Tezin Onay Tarihi: 2016

Tezin Dili: Türkçe

Özet:

FINE NEEDLE ASPIRATION OF NON-THYROIDAL HEAD AND NECK MASSES; CORRELATION OF THE CYTO-HISTOPATHOLOGICAL DIAGNOSES, CAUSES OF INCONSISTENCY AND TRAPS (QUALITY CONTROL STUDY OF 10 YEARS)

Objective: In this thesis, we planned a comprehensive quality control study of FNAC experience in our institution on non-thyroidal head and neck masses, to assess the FNAC performance.

Material - Method: Data obtained from the records of FNAC cases of non-thyroidal masses of head and neck region, having both cytopathologic and histopathologic examination within the last 10-year period, October 2005 to October 2015, in Kocaeli University Medical Faculty Pathology Department. FNAC results were compared to the histopathological diagnoses within three groups according to the location of the masses (salivary glands, head and neck lymph nodes and other tissues of the head and neck); the sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV), diagnostic accuracy were calculated for each group.True positive (TP), true negative (TN), false positive (FP) and false negative (FN) cases were identified. When compared with cytopathological and histopathological results, the cases showing inconsistency, false positives and false negatives were reexamined for possible causes.

Results: In 536 patients the FNAC's overall sensitivity, specificity, PPV, NPV, and accuracy values were 93.7%, 80.2%, 86.9%, 82.6% and 92.6%. For FNAC cases of salivary glands, in terms of benign / malignant discrimination in our series, 90.7% of accuracy, 95.7% of sensitivity, 89.4% of specificity, 71.0% of PPV, 98.7% of NPV were detected. In benign / malignant diagnosis in head and neck FNAC of lymph nodes, 92.9% sensitivity, 43.6% specificity, 83.4% PPV, 66.7% NPV, and 80.7% of accuracy were calculated. FNAC of other head and neck tissues in benign / malignant discrimination revealed sensitivity of 94.6%, specificity of 90.5%, the diagnostic accuracy of 92.8%, PPV of 92.9%, NPV of 92.7%.

Conclusion: In our institution, when looking at the overall non-thyroidal head and neck FNAC experience, the quality control measures are in line with the international literature. Salivary gland FNAC cases were observed to reveal the highest sensitivity and negative predictive values. In case of clinical and cytopathological findings of ambiguity in terms of malignancy, lymph node FNAC cases have been reported as, “suspicious / atypical lymphoproliferative lesion”; followed by the comment of “Cytopathological findings are suspicious for malignant lymph node involvement. Histopathological and immunohistochemical evaluation is recommended with an excisional biopsy for the definitive diagnosis.” This appears to be an effective approach to guide the patients to excisional biopsy. FNAC of other head and neck tissues showed the best results of diagnostic accuracy, specificity and PPV.