MOGUĆNOSTI ULTRAZVUČNE DIJAGNOSTIKE U DIFERENCIJACIJI TUMORA ŠTITNE ŽLIJEZDE

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1 Originalni rad DOI: /PI MOGUĆNOSTI ULTRAZVUČNE DIJAGNOSTIKE U DIFERENCIJACIJI TUMORA ŠTITNE ŽLIJEZDE Sanja Šehović 1, Nina Jurić 1, Amela Begić 2, Lidija Lincender-Cvijetić 1, 3 1 Poliklinika Sunce Agram, Sarajevo, Bosna i Hercegovina, 2 Klinika za nuklearnu medicinu, Univerzitetski klinički centar Sarajevo, Sarajevo, Bosna i Hercegovina, 3 Akademija nauka i umjetnosti Bosne i Hercegovine, Sarajevo, Bosna i Hercegovina Autorica za korespondenciju: Sanja Šehović Trg međunarodnog prijateljstva Sarajevo Bosna i Hercegovina sanja.sehovic@bosna-sunce.ba Prevoditeljica za engleski jezik: Elza Hajduk Lektorica za bosanski jezik: Nudžejma Softić Sažetak Cilj: Cilj ove studije bio je komparirati ultrazvučni nalaz s nalazom ciljane citološke punkcije nodusa u štitnoj žlijezdi. Takođe utvrditi mogućnosti ultrazvučne dijagnostike (UZV) za probir pacijenata s mogućim tumorom štitne žlijezde za citološku punkciju. Materijal i metode: Studijom je obuhvaćeno 133 pacijenata, oba spola, starosne dobi između godina. Pacijentima je urađen standardni ultrazvučni pregled štitne žlijezde i citološka punkcija pod ultrazvučnom kontrolom. Rezultati: Istraživanjem smo pokazali da se nodozne bolesti štitne žlijezde javljaju u oko 2/3 slučajeva kod žena, a u oko 1/3 kod muškaraca. Najveća zastupljenost nodusa je u dobnoj skupini između 40 i 49 godina. Najčešće se javljaju u donjem polu desnog režnja štitne žlijezde. S porastom veličine nodusa povećava se i mogućnost da se radi o malignomu. Takođe smo pokazali da postoji visoko statistički značajna povezanost između ultrazvučnog nalaza i rezultata citološke punkcije. Zaključak: Ultrazvučna dijagnostika je pouzdana dijagnostička metoda za probir pacijenta za citološku punkciju pod ultrazvučnom kontrolom. Ključne riječi: štitna žlijezda, ultrazvučna dijagnostika, citološka punkcija 40 Tumori štitnjače u kliničkoj praksi

2 Uvod Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde Nodozne promjene štitne žlijezde su česte. Javljaju se u oko 4 7% slučajeva u opštoj populaciji. Ovisno o načinu otkrivanja nalaze se u 4 8% slučajeva palpacijom, 10 41% ultrazvučnim pregledom (UZV) i 50% na autopsiji. Prevalenca javljanja ovisi o nizu faktora koji uključuju: godine, spol, jodni deficit, dijetu, izloženost jonizujućem zračenju okoline ili u terapeutske svrhe. Učestalost javljanja nodusa štitne žlijezde povećava se sa godinama i oko 4 puta se javlja češće kod žena nego kod muškaraca. Ekspozicija zračenju (2-5 Gy) u djetinjstvu, povećava rizik od nastanka nodusa za 2% u opštoj populaciji, a incidenca se povećava u periodu između godina. Incidenca nastanka oboljenja štitne žlijezde, nakon izloženosti zračenju kod odraslih osoba povećava se za 16 31% (1). Prema morfološkom kriteriju se mogu podijeliti na polinodozne promjene štitne žlijezde i solitarne noduse, a po karakteru mogu biti benigni i maligni. Prema podacima iz literature 5-20% su maligne lezije, a preostalo su benigne hiperplastične lezije (2, 3). U SAD se svake godine dijagnosticira oko novih slučajeva kancera, i od njih oko umire od te bolesti. Maligni nodusi su mnogo češći kod pacijenata < 20 godina, i >60 godina, nego kod pacijenata između godina. U 75 80% slučajeva se radi o papilarnom tumoru, o folikularnom u 10-20%, o medularnom 3 5%, i anaplastičnom 1 2% slučajeva (1). Ultrazvučne karakteristike nodusa Tireoidni nodusi se definišu kao fokalna, bilo koja vrsta poremaćaja arhitektonike tkiva koja se razlikuje od okolnog parenhima. Za svaki evidentiran nodus korisi se siva skala i color Doppler US da se definišu ultrazvučne karakteristike, koje uključuju: oblik, veličinu, ehogenost, sastavu ehogenosti kao i prisustvo sitnih kalcifikata, haloa, iregularnih margina, internog protoka. Ehogenost nodusa se smatra važnom karakteristikom istog, tako da govorimo o hipoehogenim, hiperehogenim i izoehogenim nodusima, a prema sastavu o solidnim, miješanim i predominantno cističnim nodusima. Solidni i predominantno solidni nodusi imaju visok nivo rizika za malignitet (Slika 5, Slika 6.), u odnosu na mješane i predominantno cistične lezije. Cistični ili prevashodno cistični nodusi imaju vrlo malu mogućnost maligne prirode istih (Slika 1, Slika 2.). U toj kategoriji izdvajamo cistične noduse sa intracističnom proliferacijom (Slika 3, Slika 4.). Veličina nodusa može varirati od 1cm pa do zahvatanja kompletnog režnja. Prisustvo sitnih kalcifikata, bez repa komete su visoko sugestivni za malignitet (Slika 8.). Iste treba razlikovati od benignih kalcifikata, sa sjenom tipa repa komete, koji su česti u benignim lezijama (Slika 2.). Također se kao značajni parametri analiziraju i nedostatak halo znaka i iregularne konture. Color doplerom i power doplerom određujemo tip vaskularizacije nodusa: Tumori štitnjače u kliničkoj praksi 41

3 Posebna izdanja ANUBiH CLXVII, OMN 48, str Type I- nedostatak protoka, Type II-perinodularni protok, Type III- intranodularni protok (Slika 4., Slika 7.) Udruženje radiologa ultrasoničara Amerike je u decembru godine donijelo koncensus o menadžmentu tiroidnih nodusa uočenih na UZV-u s akcentom na noduse koji trebaju biti podvrgnuti FNAB (fine neddle aspiration biopsy) pod UZV kontrolom i one koje nije potrebno punktirati Solitarni nodusi: a) obavezna citološka punkcija za noduse 1 cm i veće ukoliko sadrže mikrokalcifikate i b) nodusi 1, 5 cm i veće ukoliko su solidni ili prevashodno solidni ili sadrže kalcifikate. Nodusi od 2 cm i veći ukoliko a) su mješano solidni i cistični ili su većinom cistični sa solidnom komponentom ili b) pokazuju ubrzan rast u komparaciji s ranijim UZV nalazom. FNAB nije neophodna ukoliko su nodusi prevashodno cistični i ne sadrže neke od predhodno navedenih osobina. Multipli nodusi FNAB nije potrebna kod difuzno uvećane žlijezde sa multiplim nodusima sličnih UZV karakteristika bez normalnog parenhima (2). Slika 1. Cistično degenerisan nodus 42 Tumori štitnjače u kliničkoj praksi

4 Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde Slika 2. Cistično degenerisan nodus s kalcifikatima tipa repa komete Slika 3. Cista s intracističnom proliferacijom Tumori štitnjače u kliničkoj praksi 43

5 Posebna izdanja ANUBiH CLXVII, OMN 48, str Slika 4. Cista s intracističnom proliferacijom, bez vaskularizacije u solidom dijelu, benigne naravi Slika 5. Solidni nodus s anehogenim rubom (folikularni tumor) 44 Tumori štitnjače u kliničkoj praksi

6 Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde Slika 6. Solidni hipoehogeni nodus s anehogenim rubom, Ca Slika 7. Opsežna vaskularizacija kod Tu procesa Tumori štitnjače u kliničkoj praksi 45

7 Posebna izdanja ANUBiH CLXVII, OMN 48, str Slika 8. Papilarni Ca štitne žlijezde (maligni mikrokalcifikati) Slika 9. Metastatski limfonod kod papilarnog Ca 46 Tumori štitnjače u kliničkoj praksi

8 Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde Slika 10. Metastatski limfonod kod Ca štitne žlijezde Pacijenti i metode Sprovedena je klinička, retrospektivno-prospektivna studija i obuhvata period godine. Ispitanici su pacijenti s nodoznim promjenama štitne žlijezde koji su dijagnostički obrađivani na Poliklinici Sunce Agram (ultrazvuk i citološka punkcija). Studijom je obuhvaćeno 133 pacijenata, oba spola, starosne dobi između godina. Pacijentima je urađen standardni ultrazvučni pregled štitne žlijezde na aparatu Simens, Acuson X500, sonda 7, 5 MHZ u tipičnoj poziciji. Citološka punkcija pod ultrazvučnom kontrolom je rađena na Poliklinici Sunce uz učešće citologa i radiologa u izvođenju same procedure. Procedura je rađena na ultrazvučnom aparatu Simens, Acusonn X500, uz korištenje sonde od 7, 5 MHZ. Korišten je držač brizgalice Cameco i tanke igle 21 gauge. Rezultati Od ukupnog broja ispitanika (n=133), ženskog spola bilo je 114 (85, 7%), a muškog spola bilo je 19 (14, 3%). Od ukupnog broja ispitanika (n=133), četvrtina (24, 8%) ispitanika je imala između godina, zatim 28 (21, 1%) ispitanika bilo je između godina, 25 (18, 8%) ispitanika imalo je godina, te 24 (18, 0%) ispitanika je imalo godina. Manje od 30 godina imalo je 13 (9, 18%) ispitanika, dok je 70 godina imalo 10 (7, 6%) ispitanika. Tumori štitnjače u kliničkoj praksi 47

9 Posebna izdanja ANUBiH CLXVII, OMN 48, str UVZ Tabela 1. Rezultati ultrazvučnog nalaza prema spolu Ženski Muški Ukupno n % n % n % izoehogeni nodus 9 7, 9% 5 26, 3% 14 10, 5% izoehogeni nodus sa cistično degeneracijom 66 57, 9% 7 36, 8% 73 54, 9% anehogena formacija debljeg zida 17 14, 9% 2 10, 5% 19 14, 3% hipoehogeni nodus 20 17, 5% 4 21, 1% 24 18, 0% nejasno ograničen hipoehogeni nodus sa kalcifikatima 2 1, 8% 1 5, 3% 3 2, 3% Ukupno , 0% , 0% , 0% Od ukupnog broj ispitanika (n=133), kod više od polovine ispitanika, njih 73 (54, 9%), je ultrazvučnim pregledom (UZ) uočen izoehogeni nodus sa cističnom degeneracijom. Zatim, kod 24 (18, 0%) ispitanika je uočen hipoehogeni nodus, kod 19 (14, 3%) ispitanika je uočena anehogena formacija debljeg zida, kod 14 (10, 5%) ispitanika bio je izoehogeni nodus. Kod tri ispitanika nađen je hipoehogeni nodus, iregularnih kontura sa kalcifikatima (2, 3%) (Tabela1): Tabela 2. Citološki nalaz Citološki nalaz Broj ispitanika Relativna frekvencija proliferacija tireocita u miješanoj strumi , 2% adenom 24 18, 0% cistično promijenjena štitna žlijezda 5 3, 8% Karcinom 4 3, 0% Ukupno , 0% Od ukupnog broj ispitanika (n=133), kod najvećeg broja, njih 100 (75, 2%), ispitanika je citološki nalaz pokazao proliferaciju tireocita u miješanoj strumi. Od toga je kod 61 (46, 2%) ispitanika citološki nalaz pokazao osrednju proliferaciju, zatim kod 26 (19, 7%) ispitanika citološki nalaz je bila lagana proliferacija, te kod 13 (9, 8%) ispitanika bila je jaka proliferacija stanica. Od ukupnog broj ispitanika (n=133), citološki je nađen adenom kod 24 (18, 0%) ispitanika, dok je karcinom dokazan citološkim nalazom kod četiri ispitanika. (3, 0%) (Tabela 2). Izoehogeni nodus na ultrazvučnom pregledu imalo je 14 ispitanika, kod svih ispitanika je citološkim pregledom utvrđena proliferacija tireocita u miješanoj strumi. Izoehogeni nodus sa cističnom degeneracijom nađen je na ultrazvučnom pregledu kod ukupno 73 ispitanika. Citološkim pregledom kod 72 ispitanika (98, 6%) ispitanika je utvrđena proliferacija tireocita u miješanoj strumi, dok je kod jednog ispitanika (1, 4%) otkriven adenom. Anehogena struktura debljeg zida na ultrazvučnom pregledu bila je kod ukupno 19 ispitanika. Citološki nalaz kod 14 ispitanika (73, 7%) je 48 Tumori štitnjače u kliničkoj praksi

10 Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde proliferacija tireocita u miješanoj strumi, dok je kod pet ispitanika (26, 3%) utvrđeno cistično promijenjena štitna žlijezda. Hipoehogeni nodus na ultrazvučnom pregledu imalo je ukupno 24 ispitanika. Kod 23 ispitanika (95, 8%) citološkim pregledom utvđen je adenom, dok je kod jednog ispitanika (4, 2%) otkriven karcinom. Nejasno ograničeni hipoehogeni nodus s kalcifikatima, nađen je na ultrazvučnom pregledu kod ukupno tri ispitanika. Kod sva tri ispitanika je citološkim pregledom utvrđen nalaz karcinoma (Grafikon1). Grafikon 1. Rezultati ultrazvučnog nalaza upareni sa rezultatima citološkog pregleda Statistički je utvrđena visoko značajna povezanost između ultrazvučnog nalaza i rezultata citološkog pregleda [χ2 (12) = 252, 147; p<0, 001; Cramer s V = 0, 795; p<0, 001]. Diskusija Nodozne bolesti štitne žlijezde su česte. Javljaju se u oko 4 7% slučajeva u opštoj populaciji. Od ukupnog broja nodoznih promjena samo 5 20% otpada na karcinom (4). Osnovni cilj u evaluaciji nodusa štitne žlijezde je utvrditi da li se radi o benignom ili malignom nodusu, da bi pacijenti s karcinomom dobili blagovremenu dijagnozu i bili podvrgnuti odgovorajućem tretmanu u što ranijem stadijumu.time bi se reducirao morbiditet i mortalitet uzrokovan ovom bolešću. Izbjegle bi se nepotrebne procedure, kao i nepotrebni hirurški zahvati kod benignih promjena (1, 3). Zna se da FNAB pod UZV kontrolom zahvaljujući svojoj visokoj senzitivnosti i specifičnosti je najbolja pojedinačna dijagnostička procedura za dijagnosticiranje malignih nodusa. Obzirom na visok procenat pojavljivanja nodusa štitne žlijezde potrebno je izvršiti užu selekciju nodusa koji će biti podvrgnuti toj metodi. Zbog toga je i cilj ovog rada bio procijenti i definisati ulogu UZV u selekciji pacijenta za tu metodu. Tumori štitnjače u kliničkoj praksi 49

11 Posebna izdanja ANUBiH CLXVII, OMN 48, str Prema rezultatima izvršenog ispitivanja fokalnih promjena u štitnoj žlijezdi najveći broj nodusa je izoehogene strukture s cističnom degeneracijom, kod 54, 9%, odnosno 73 ispitanika od ukupno 133 ispitanika. Izoehogeni nodus s homogenom strukturom nađeni su kod 10, 5%, odnosno 19 ispitanika. Kod svih izoehogenih nodusa citološkom analizom je utvđena proliferacija tireocita u miješanoj strumi, osim u jednom slučaju izoehogenog nodusa s cističnom degeneracijom kod jednog (1, 4%) nađen je adenom. Nodusi hipoehogene homogene strukture zastupljeni su u 18, 0% (24) ispitanika i hipoehogene strukture s neravnom konturom i s kalcifikatima kod 2, 3%, odnosno 3 ispitanika. Kod 95, 8% hipoehogenih nodusa, odnosno 23 ispitanika, citološkim pregledom utvrđen je adenom, dok je kod jednog ispitanka (4, 2%) otkriven nalaz karcinom. Međutim kod tri ispitanika s ultrazvučnim nalazom hipoehogenog nodusa s neravnom konturom i kalcifikatima citološkim pregledom je utvđen karcinom kod sva tri ispitanika. Anehogene strukture debljeg zida nađene su kod 14, 3% svih ispitanih, odnosno kod 19 ispitanika. Kod pet ispitanika, odnosno 26, 3%, utvđen je nalaz cistično promijenjene štitne žlijezde. Ostalih 73, 7%, odnosno 14 ispitanika je citološki nađena proliferacija tireocita u miješanoj strumi. Dobijeni rezultati su u skladu s podacima iz literature. Papini i sar godine su pokazali da hipoehogenost nodusa s nepravilnim rubom (iregularne margine) i/ili mikrokalcifikatima, u 87% slučajeva su s FNAB potvrdili karcinom (5). Cappelli et al su naveli da određene UZV karakteristike (mikrokalcifikati, solidne hipoehogene lezije, neravne margine), Dopler protok tip 2 su signifikantno češće kod malignih nego benignih lezija (4). Lee i sar. su u istraživanju cističnih nodusa dobili su da ekscentričan položaj solidnog dijela i prisustvo mikrokalcifikata su signifikantno povezani s malignitetom (6). Frederico FR Maia i sar godine su u svojoj studiji objavili da se UZV pokazao kao vrlo efikasno oružje u diferencijaciji malignih nodusa na osnovu njihovih UZV karakteristika iregularne margine, hipoehogenost, prisustvo mikroklacifikata u 82% slučajeva (7). Italijanski autori Rago i sar. su pokazali da nedostatak halo znaka i mikrokalcifikati su najspecifičnija kombinacija ultrazvučnih nalaza za dijagnozu karcinoma štitne žlijezde p < 0, 005, specifičnost 93, 2%, senzitivnost 26, 6% (8). Britanski naučnici Jones i saradnici su u svom istraživanju dobili sljedeće vrijednosti za pojedine dijagnostičke modalitete za tireoidni karcinom-senzitivnost FNAB 92%, scintigrafija 82%, UZV 75%, specifičnost FNAB 85%, scintigrafija 34%, UZV 61%, pozitivna prediktivna vrijednost :FNAB 41%, scintigrafija 11%, UZV 19%, (9). Godine 2003., portugalski autori Peccins i sar. navode da je senzitivnost i specifičnost FNAB 87% i 62%, a UZV 81% i 70%, dok je u kombinaciji ove dvije metode 69% i 91% (10). Seong i sar godine navode da je mogućnost karcinoma veća kod solidnih u odnosu na cistične ili miješane lezije (26% vs.7%), hipoehogenih u odnosu na izo ili hiperehogene noduse (27% vs.14%), noduse s punktiformnim kalcifikatima u odnosu na one bez kalcifikata (39% vs.16%), one sa slabo definiranim 50 Tumori štitnjače u kliničkoj praksi

12 Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde rubovima u odnosu na jasno ograničene (31% vs.16%) i za noduse s intranodalnom vaskularizacijom u odnosu na perifernu vaskularizaciju (43% vs.17%) (11). Autori iz USA, Iannuccilli i sar. navode u svom radu da komparacija ultrazvučnih karakteristika izmedu benignih i malignih nodusa je rezultirala u utvđivanju mikrokalcifikacija kao jedinog statistički značajnog indikatora maligniteta (35, 3% senzitivnost, 94, 4%, p < 0, 005) (12). Istraživanja Korejskih autora iz godine pokazuju datri ultrazvučne karakteristike nodusa štitne zlijezde mikrokalcifikati, hipoehogenost isferični oblik su tri osnovne karakteristike aligniteta (13). Gul i sar. iz Turske navode da ultrazvučne krakteristike hipoehogenost, mikrokalcifikati i iregularne konture su najvažniji u određivanju maligniteta (14). Portugalski autori iz 2011 godine su utvrdili da ne postoji statistički značaj u prevalenci karcinoma vezano za broj, veličinu i nivo hormona osobito TSH. Hipoehogenost i mikrokalcifikati su ultrazvučni riziko faktori (15). Kim i sar. navode da rezultati ultrazvučnog ispitivanja karcinoma štitne žlijezde iznose senzitivnost 93%, specificnost 66%, pozitivna prediktivna vrijednost 56%, negativna prediktivna vrijednost 95, 9% (16). Tramalloni i sar. navode značaj ultrazvuka u procjeni zahvaćenosti regionalnih limfonoda na osnovu ultrazvučnih karakteristika maligniteta, a to su okrugli limfonodi, gubitak normalne ehogenosti hilusa, gubitak normalne hilarne vaskularizacije, mikrokalcifikati, cistična komponenta i hiperehogenost limfonoda (17). Zaključak Nodozne bolesti štitne žlijezde se javljaju u oko 2/3 slučajeva kod žena, a u oko 1/3 kod muškaraca. Sa porastom veličine nodusa povećava se i mogućnost da se radi o malignomu. Kod svih ispitanika sa izoehogenim nodusima kao i sa izoehogenim nodusima sa cističnom degeneracijom je potvrđena dijagnoza benigne promjene, kod hipoehogenih nodusa većinom se radilo o adenomu, dok se samo u jednom slučaju radilo o karcinomu. Svi citološki potvrđeni karcinomi su bili ultrazvučno hipoehogeni nejasno ograničeni nodusi iregularnih kontura sa kalcifikatima ili hipoehogeni nodusi. Rezultati našeg istraživanja pokazuju da postoji visoko statistički značajna povezanost između ultrazvučnog nalaza i rezultata citološkog pregleda. Stoga se ultrazvučna dijagnostika može preporučiti kao pouzdana dijagnostička metoda za probir pacijenata za punkciju pod UZV kontrolom i citološku analizu, a etiološka dijagnoza tumora pridonosi bržoj i adekvatnoj terapiji. Tumori štitnjače u kliničkoj praksi 51

13 Posebna izdanja ANUBiH CLXVII, OMN 48, str Literatura 1. Mazzaferri E. Manegment of a solitary Thyroid Nodule. The New England Journal of Medicine 1993;329: Mery C. Frates, Carol B. Management of Thyroid Nodules Detekted at US. Society of Radiologists in ultrasound Consensus Conference Statmen. Radiology 2008;34: Hegedus L.The Thyroid Nodule. N Engl J Med 2004;351: Cappelli C, Castellano M, Pirola I. The predictive value of ultrasound findings in the managment of thyroid nodules.qsm.2007;100: Papiri E, Guglielmi R, Bianchini A. Risk of malignancy in non palpabile thyroid nodules:predictive volue of ultrasound and color dopler features. J.Clin Endocrinology Metab May;87(5): Lee MJ, Kim EK, Partially cystic thyroid nodules on ultrasound probability of malignancy and sonographic differentiation. Thyroid. 2009;19(4): Frederico FR Maia, Patricia S Matos. Role of ultrasound, clinical and scintigraphy parameters to predict malignancy in thyroid nodule. Head Neck Oncology, 2011;3: T. Rago, P Vitti, L Chiovato, S Mazzeo. Role of conventional ultrasonography and color flow-dopler sonografy in predicting malignancy in cold thyroid nodules. Europien Journal of Endocrinology 1998;138:41-46o. 9. Jones AJ, Aitman CJ.Edmonds C.J.Comparision of fine needle aspiation cytology, radioisotopic and ultrasound scanning in the management of thyroid nodules.postgrad med. J 1990;66: Peccin S.Furlanetto TW. Cancer in thyroid nodules:evaluation of ultrasoud and fine- needle aspiration biopsy. Rey Assoc Med Bras.2003 Apr-Jun;49(2): Seong N, Ha Y, Gyungyub G.Ultrasonography-Guided Fine Needle Aspiration o Thyroid Incidentaloma:Correlatio With Pathological Finding.Clin Endocrinology 2004;60 (1). 12. Iannuccilli JD, Cronan JJ. Risk for malignancy of thyroid nidules as assessed by sonographic criteria:the need for biopsy. J Ultrasound Med Nov;23(11): Hong Y, Son EJ. Positive predictive values of sonographic features of solid thyorid nodule.clin Imaging 2010 Mar-Apr;34(2): Gul K, Erspy R. Ultrasonographic evaluation of thyroid nodules: comparision of ultrasonographic, cytological, and histopathological findings. Endocrine Dec;36(3): Habor RS. Role of ultrasonography in the diagnosnosis and menagment of thyroid cancer. Endocr. Pract, 2000 Sep-Oct 6(5): Amino N. Ultrasonographic evaluation of thyroid nodules in 900 patients:comparation among ultrasonographic, cytological and histological findings. Thyroid 2007 Dec;17(12): Kim EK.Park CS. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol.2002 Mar, 178(3): Tramalloni J.Monpeyssen. Thyroid nodule menagment:ultrasonography, fine-needle cytology. J Radiol.2009 Mar;90(3): Tumori štitnjače u kliničkoj praksi

14 Sanja Šehović et al.: UZV dijagnostika tumora štitne žlijezde THE BENEFITS OF ULTRASONOGRAPHY IN THE DIFFERENTIATION OF THYROID TUMOR Abstract Purpose: The purpose of this study was to compare ultrasonography (US) results with results of targeted cytological puncture of a nodule of the thyroid, as well as to assess the capabilities of ultrasonography in screening patients with potentially present tumor for cytological puncture. Material and method: The study analyzed results of 133 patients, men and women, between the age of 16 and 75. The patients had a standard ultrasound exam of the thyroid and ultrasound guided cytological puncture. Results: The research showed that nodular diseases of the thyroid were presented in 2/3 of women patients, and in 1/3 of men patients. The largest presence of nodules was among the group of years of age. Nodules are the most common in the lower right lobe of the thyroid. The size increase of nodules also increases probability to be malignant. Furthermore, this research has shown that there is a statistically significant connection between ultrasonography results and the cytological puncture test results. Conclusion: Ultrasonography is a reliable method of diagnosis for selecting patients to have a cytological puncture. Key words: thyroid gland, ultrasonography, cytological puncture Tumori štitnjače u kliničkoj praksi 53

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