Tiroit kanserinde mikronükleus testi ile malignite ilişkisinin araştırılması
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Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Tiroit nodülü ile takipli, takibi cerrahi ile sonuçlanan hastalarda, elde edilen
cerrahi materyalden nodül ve normal tiroit dokusunda MN(Mikronükleus) ve
BN(Binükleus) sayılarının farklı bethesda ve cerrahi patoloji gruplarında karşılaştırılması
amaçlandı.
grupları arasında karşılaştırıldı. İstatistiksel değerlendirmeler R 4.4.1(R Core Team, 2024)
programı ile yapıldı. Sayısal değişkenlerin analizinde karma etki modellerinden (mixed
effects models) faydalanıldı. Sonuçlar p<0.05 olacak şekilde anlamlı olarak kabul edildi.
Malign ve benign tiroit lezyonlarının ayırt edilmesinde MN ve BN sayılarını
değerlendirmek amacıyla Receiver Operating Characteristic (ROC) analizi kullanıldı.
Bulgular: Preop ince iğne aspirasyon biyopsi (İİAB) değerlendirmesinde 39
hastanın 3’ü Bethesda 1, 10’u Bethesda 2, 8’i Bethesda 3, 1’i Bethesda 4, 4’ü Bethesda 5,
13’ü Bethesda 6 idi. Cerrahi patoloji değerlendirmesinde 39 hastanın 16’sı benign, 19’u
papiller tiroit karsinom(PTK), 4’ü foliküler tiroit karsinom(FTK) idi. Normal tiroit
dokusundaki MN sayısı (n=0.08±0.35), BN sayısı (n=0.10±0.38) idi. Nodül tiroit
dokusundaki MN sayısı (n=4.23±2.99), BN sayısı (n=3.28±3.05) idi. Normal tiroit dokusu
ile nodül tiroit dokusu arasında MN ve BN sayıları açısından istatistiksel olarak anlamlı fark
vardı (Nondiagnostik ve benign grubundaki BN karşılaştırılması haricinde) (p<0,05). Cerrahi patoloji grubunda benign, papiller karsinom ve foliküler karsinom olmak
üzere 3 grup vardı. Benign tanılı nodül biyopsilerinde MN sayısı (n=1,87±1,62), BN sayısı
(n=1,12±1,58) idi. Papiller tiroit karsinom tanılı nodül biyopsilerinde MN sayısı (n=6,21
±2,65), BN sayısı (n=5,05±2,83) idi. Foliküler tiroit karsinom tanılı nodül biyopsilerinde
MN sayısı (n=4,25±1,70), BN sayısı (n=3,50±3,51) idi. Bu gruplar kendi arasında
kıyaslandığında malign(papiller ve foliküler) gruplarda, MN ve BN sayıları benign gruba
göre istatistiksel olarak anlamlı şekilde yüksekti (p<0,05). Foliküler karsinom ve papiller
karsinom grupları kendi arasında kıyaslandığında, MN ve BN sayıları açısından istatistiksel
olarak anlamlı bir fark saptanmadı (p>0,05). Bethesda sınıflamasına göre 1.(Non-dianostik)
ve 2.(Benign) kategoride değerlendirilen nodül biyopsilerinde MN sayısı (n=2±1,79), BN
sayısı (n=1,42±2,06) idi. 3.(Önemi Belirsiz Atipi/Önemi Belirlenemeyen Foliküler
Lezyon) kategoride değerlendirilen nodül biyopsilerinde MN sayısı (n=4,71± 3,77), BN
sayısı (n=4,71±5,05) idi. 4.(Foliküler neoplasm veya foliküler neoplasm şüphesi),
5.(Malignite şüphesi) ve 6.(Malign) kategoride değerlendirilen nodül biyopsilerinde MN
sayısı (n=6±2,33), BN sayısı (n=4,31±1,95) idi. Bethesda gruplarında Non-dianostik ve
benign kategoriyi oluşturan gruba göre diğer gruplarda MN ve BN sayıları açısından
istatistiksel olarak anlamlı bir artış saptandı (p<0,05). Normal tiroit dokusundaki MN ve
BN sayılarında patolojiden bağımsız olarak hiçbir kategoride istatistiksel açıdan anlamlı bir
farklılık saptanmadı (p>0,05).
Sonuç: Tiroit nodülü ile takipli hastalarda preoperatif incelemede MN, BN
sayılarının malign benign nodül ayrımında faydalı olacağı sonucuna varıldı.
Bethesda sınıflaması kategorilerine göre oluşturulmuş gruplar ve cerrahi patoloji
gruplarının her ikisinde de patoloji sonucu malign olanlarda benignlere göre MN ve BN
sayılarının artış gösterdiği ve ayırıcı tanıya katkı sağladığı gösterildi.
Şüpheli hastalarda preop patolojik değerlendirmeye ilave olarak mikronükleus ve
binükleus sayılarının tanı açısından katkı sağlayacağı düşünüldü. Geniş hasta serilerinde
İİAB ile MN ve BN çalışılmasına ihtiyaç vardır.
Aim: The aim was to compare the numbers of MN (Micronuclei) and BN (Binuclei) in thyroid nodules and normal thyroid tissue from surgical specimens in patients followed up with thyroid nodules, whose follow-up resulted in surgery, across different Bethesda and surgical pathology groups. Materials and Method: A total of 39 patients (6 male, 15.38% and 33 female, 84.61%), with a mean age of 47.90 ± 10.7 years, who were followed up for thyroid nodules and underwent surgical treatment at the Department of Otorhinolaryngology, Faculty of Medicine, Necmettin Erbakan University, were included in the study. Samples obtained from surgical specimens were placed in FBS and PBS solutions prepared by the Department of Genetics and sent to the laboratory. In normal and nodular thyroid cells, 1,000 cells were counted, and the numbers of MN (Micronuclei) and BN (Binuclei) were evaluated on slides stained with 5% Giemsa and May-Grunwald. The MN and BN counts obtained were compared between Bethesda and surgical pathology groups. Statistical analyses were performed using R 4.4.1 (R Core Team, 2024). Mixed effects models were used to analyze numerical variables. A p-value of <0.05 was considered statistically significant. Receiver Operating Characteristic (ROC) curves were used to evaluate the numbers of MN and BN in distinguishing between malignant and benign thyroid lesions. Results: In the preoperative fine-needle aspiration biopsy (FNAB) evaluation, 3 out of 39 patients were classified as Bethesda 1, 10 as Bethesda 2, 8 as Bethesda 3, 1 as Bethesda 4, 4 as Bethesda 5, and 13 as Bethesda 6. In the surgical pathology assessment, 16 of the 39 patients were diagnosed as benign, 19 as papillary thyroid carcinoma (PTC), and 4 as follicular thyroid carcinoma (FTC). The number of MN in normal thyroid tissue was (n=0.08±0.35), while the number of BN was (n=0.10±0.38). In nodular thyroid tissue, the number of MN was (n=4.23±2.99), and the number of BN was (n=3.28±3.05). A statistically significant difference was found between normal thyroid tissue and nodular thyroid tissue in terms of MN and BN counts, except for the comparison in the nondiagnostic and benign groups (p<0.05). In the surgical pathology group, patients were categorized into three groups: benign papillary carcinoma and follicular carcinoma. In nodules diagnosed as benign, the MN count was (n=1.87±1.62), and the BN count was (n=1.12±1.58). In nodules diagnosed with papillary thyroid carcinoma, the MN count was (n=6.21±2.65), and the BN count was (n=5.05±2.83). In nodules diagnosed with follicular thyroid carcinoma, the MN count was (n=4.25±1.70), and the BN count was (n=3.50±3.51). When these groups were compared among themselves, the MN and BN counts in malignant (papillary and follicular) groups were significantly higher than in the benign group (p<0.05). However, no statistically significant difference was found between the follicular carcinoma and papillary carcinoma groups in terms of MN and BN counts (p>0.05). According to the Bethesda classification, the MN count was (n=2±1.79) and the BN count was (n=1.42±2.06) in nodule biopsies classified as category 1 (Nondiagnostic) and category 2 (Benign). In category 3 (Atypia of undetermined significance/Follicular lesion of undetermined significance), the MN count was (n=4.71±3.77) and the BN count was (n=4.71±5.05). In biopsies classified as category 4 (Follicular neoplasm or suspicion of follicular neoplasm), category 5 (Suspicious for malignancy), and category 6 (Malignant), the MN count was (n=6±2.33) and the BN count was (n=4.31±1.95). A statistically significant increase in the number of MN and BN was detected in other groups compared to the group consisting of the Non-diagnostic and Benign categories in the Bethesda classification (p<0.05). However, no statistically significant difference was found in MN and BN counts in normal thyroid tissue across different pathology categories (p>0.05). Conclusion: In patients followed up for thyroid nodules, it was concluded that the preoperative evaluation of MN and BN counts could be useful in distinguishing malignant from benign nodules. In both the Bethesda classification-based groups and the surgical pathology groups, MN and BN counts were found to be higher in malignant cases compared to benign ones, contributing to differential diagnosis.It was considered that, in addition to preoperative pathological evaluation, the assessment of micronucleus (MN) and binucleus (BN) counts could aid in diagnosis in suspicious cases. Further studies with larger patient series are needed to evaluate MN and BN counts in FNAB.
Aim: The aim was to compare the numbers of MN (Micronuclei) and BN (Binuclei) in thyroid nodules and normal thyroid tissue from surgical specimens in patients followed up with thyroid nodules, whose follow-up resulted in surgery, across different Bethesda and surgical pathology groups. Materials and Method: A total of 39 patients (6 male, 15.38% and 33 female, 84.61%), with a mean age of 47.90 ± 10.7 years, who were followed up for thyroid nodules and underwent surgical treatment at the Department of Otorhinolaryngology, Faculty of Medicine, Necmettin Erbakan University, were included in the study. Samples obtained from surgical specimens were placed in FBS and PBS solutions prepared by the Department of Genetics and sent to the laboratory. In normal and nodular thyroid cells, 1,000 cells were counted, and the numbers of MN (Micronuclei) and BN (Binuclei) were evaluated on slides stained with 5% Giemsa and May-Grunwald. The MN and BN counts obtained were compared between Bethesda and surgical pathology groups. Statistical analyses were performed using R 4.4.1 (R Core Team, 2024). Mixed effects models were used to analyze numerical variables. A p-value of <0.05 was considered statistically significant. Receiver Operating Characteristic (ROC) curves were used to evaluate the numbers of MN and BN in distinguishing between malignant and benign thyroid lesions. Results: In the preoperative fine-needle aspiration biopsy (FNAB) evaluation, 3 out of 39 patients were classified as Bethesda 1, 10 as Bethesda 2, 8 as Bethesda 3, 1 as Bethesda 4, 4 as Bethesda 5, and 13 as Bethesda 6. In the surgical pathology assessment, 16 of the 39 patients were diagnosed as benign, 19 as papillary thyroid carcinoma (PTC), and 4 as follicular thyroid carcinoma (FTC). The number of MN in normal thyroid tissue was (n=0.08±0.35), while the number of BN was (n=0.10±0.38). In nodular thyroid tissue, the number of MN was (n=4.23±2.99), and the number of BN was (n=3.28±3.05). A statistically significant difference was found between normal thyroid tissue and nodular thyroid tissue in terms of MN and BN counts, except for the comparison in the nondiagnostic and benign groups (p<0.05). In the surgical pathology group, patients were categorized into three groups: benign papillary carcinoma and follicular carcinoma. In nodules diagnosed as benign, the MN count was (n=1.87±1.62), and the BN count was (n=1.12±1.58). In nodules diagnosed with papillary thyroid carcinoma, the MN count was (n=6.21±2.65), and the BN count was (n=5.05±2.83). In nodules diagnosed with follicular thyroid carcinoma, the MN count was (n=4.25±1.70), and the BN count was (n=3.50±3.51). When these groups were compared among themselves, the MN and BN counts in malignant (papillary and follicular) groups were significantly higher than in the benign group (p<0.05). However, no statistically significant difference was found between the follicular carcinoma and papillary carcinoma groups in terms of MN and BN counts (p>0.05). According to the Bethesda classification, the MN count was (n=2±1.79) and the BN count was (n=1.42±2.06) in nodule biopsies classified as category 1 (Nondiagnostic) and category 2 (Benign). In category 3 (Atypia of undetermined significance/Follicular lesion of undetermined significance), the MN count was (n=4.71±3.77) and the BN count was (n=4.71±5.05). In biopsies classified as category 4 (Follicular neoplasm or suspicion of follicular neoplasm), category 5 (Suspicious for malignancy), and category 6 (Malignant), the MN count was (n=6±2.33) and the BN count was (n=4.31±1.95). A statistically significant increase in the number of MN and BN was detected in other groups compared to the group consisting of the Non-diagnostic and Benign categories in the Bethesda classification (p<0.05). However, no statistically significant difference was found in MN and BN counts in normal thyroid tissue across different pathology categories (p>0.05). Conclusion: In patients followed up for thyroid nodules, it was concluded that the preoperative evaluation of MN and BN counts could be useful in distinguishing malignant from benign nodules. In both the Bethesda classification-based groups and the surgical pathology groups, MN and BN counts were found to be higher in malignant cases compared to benign ones, contributing to differential diagnosis.It was considered that, in addition to preoperative pathological evaluation, the assessment of micronucleus (MN) and binucleus (BN) counts could aid in diagnosis in suspicious cases. Further studies with larger patient series are needed to evaluate MN and BN counts in FNAB.
Açıklama
Anahtar Kelimeler
Mikronükleus testi, Binükleus, Tiroit Lezyonları, Micronucleus, İğne aspirasyon biyopsisi, Önemi belirsiz atipi veya önemi belirlenemeyen foliküler lezyon(ÖBA/ÖBFL), Micronucleus Test, Binucleus, Thyroid Lesions, Mikronükleus, Fine- Needle Aspiration Biopsy, Atypia of Undetermined Significance (AUS) or Follicular Lesion of Undetermined Significance (FLUS)
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Alper, H. (2025). Tiroit kanserinde mikronükleus testi ile malignite ilişkisinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kulak Burun Boğaz Anabilim Dalı, Konya.
