OPTIMIZATION OF THE ALGORITHM FOR PREOPERATIVE DIAGNOSTICS OF NODAL FORMATIONS IN GRAVES' DISEASE

Abstract

The purpose of the study: to investigate the morphological features of thyroid nodules in Graves' disease (GD) based on ultrasound, cytological and morphological methods of examination.

Materials and methods: the results of ultrasound, cytological and pathomorphological studies of nodular formations in 604 patients with GD were analyzed. Cytological examination results were evaluated according to Вethesda Thyroid Cytopathology System (BSRTC). For conducting immunocytochemical studies, an indirect immunoperoxidase method using mouse monoclonal antibodies against thyroid peroxidase (TPO) (TPO-47) and thyroglobulin (TG) (DakoCytomation, Denmark) was used Antibodies against mouse g-globulins labeled with horseradish peroxidase (DakoCytomation) were used as secondary antibodies.

An analysis of the histological structure of benign and malignant nodules was carried out: all pathological documentation (macrodescription of biopsies, microdescription of preparations) was checked, and archived histological preparations (stained with hematoxylin-eosin) were additionally reviewed and analyzed in accordance with the recommendations of the latest editions of the WHO Histological Classification of Thyroid Tumors. Statistical processing of the data was done according to the Student's criterion. Calculations were performed in the Statistica 10.0 program.

Results. When studying the structure of the thyroid gland by ultrasound in 1854 patients with GD, it was established that diffuse goiter occurred in 53.07% of patients, multinodular goiter in 25.62% of patients, solitary (single) nodes were observed in 16.07% of patients, and absence of goiter - in 5.20% of cases. According to the results of the pathomorphological examination, benign neoplasms of the thyroid gland were confirmed in 409 (363 women and 46 men) patients from the total number of operated patients with GD. Cases of nodular hyperplasia and adenomatous goiter predominated among the morphologically confirmed benign neoplasms. According to histological examination, thyroid cancer was detected in 195 patients (women – 164; men – 31), which was 10.54%. Among all patients with thyroid cancer, papillary carcinoma was detected in 178 (91.28%), follicular carcinoma in 12 (6.15%), and medullary carcinoma in 5 (2.56%).

A comparison of the effectiveness of cytological diagnosis of thyroid malignancies in patients with GD with a group of patients without GD showed that in the latter group, carcinomas were detected statistically more often than in its presence.

Conclusions. The study of the structure of the thyroid gland according to ultrasound data in 1854 patients with GD allowed to establish that diffuse goiter occurred in 53.33% of patients, multinodular goiter - in 25.48% of patients, solitary (single) nodes - in 15.99% of patients, and absence of goiter - in 5.20% of cases. According to the data of histological examination, the prevalence of thyroid cancer in GD was 10.52%. Papillary carcinoma was detected in 91.28% of patients with GD, follicular carcinoma in 6.15%, medullary carcinoma in 2.56%. The difficulty of ultrasound verification of malignant formations of the thyroid gland during GD is due to the fact that 26.67% of patients do not have focal formations, and 31.28% do not have ultrasound signs of malignancy. Cytological studies revealed atypia of unclear origin and follicular neoplasia in 14.63% of cases, suspicion of malignancy or carcinoma in 50% of cases. False-negative results were obtained in 34.15% of cases.