MODERN THERAPY FOR NODULAR GOITER
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 2, Pages 933-939
AbstractIntroduction: To date, thyroid surgery has undergone major changes in terms of preoperative assessment of thyroid nodules. Various systems are used to evaluate thyroid nodes using ultrasound, one of which is the ACR TIRADS system, proposed by the American College of Radiology (American College of Radiology). A special system of cytological evaluation of these nodes according to the updated Bethesda classification adopted in 2017 is also used. This article presents data on the use of ACR TIRADS and Bethesda systems in patients who underwent surgery on the thyroid gland in the VITAMED clinic in Tashkent in the period from 01/08/2019 to 03/12/2020.
Objective: To show and evaluate the experience of using ACR TIRADS and Bethesda systems in the practice of thyroid surgery. To evaluate the correlation between the results of a preoperative assessment using these systems and the results of a histopathological study.
Materials and methods: 1378 patients were examined. Of these, 158 patients were operated on in 2019 for nodular (n = 70) or mixed non-toxic (n = 31), diffuse toxic (n = 22), mixed toxic (n = 6), toxic nodular goiter (n = 15), as well as patients with autoimmune thyroiditis (AT) (n = 7) and patients with primary hyperparathyroidism simultaneously with the presence of thyroid nodules or with diffuse toxic goiter (n = 7). Ultrasound diagnostics using the ACR TIRADS system and a fine-needle aspiration biopsy (FNA) followed by a cytological evaluation using the Bethesda system were used for their preoperative evaluation. During the operation, express diagnostics of the remoted nodes was performed. Subsequently, after the final histology, the data of cytology and express diagnostics and preoperative node evaluation were compared according to the results of ultrasound using the ACR TIRADS system.
Results: Data obtained from the use of ACR TIRADS and Bethesda systems have been shown to be effective in detecting thyroid cancer. 90.5% of the thyroid cancer revealed by the final histology , were rated before the operation by ACR TIRADS classification in categories TIRADS -3, TIRADS-4, TIRADS -5, in 19%, 34%, 37.5% of cases, respectively. According to the results of the FNA, 69% of thyroid cancer was preoperatively assigned to the three Bethesda classification categories, as B-IV - 41%, B-V - 22%, B-VI -6%, respectively. The indications for the operation were cases of confirmed thyroid cancer (n = 3), suspected thyroid cancer (n = 81), toxic goiter (n = 43), primary hyperparathyroidism and the simultaneous presence of thyroid nodes or diffuse toxic goiter (n = 7) and the presence of symptoms compression and / or substernal growth of thyroid nodes (n = 24). 101 total and near-total thyroidectomies, 15 subtotal thyroidectomies, 25 hemistromectomies, 17 extended or economical thyroid lobe resections were performed. During express histological diagnosis, all 100% of thyroid cancer cases were assigned to categories B-IV, B-V, B-VI in 28%, 58% and 16% of cases, respectively. According to the results of the final histology, 32 cases of thyroid cancer were identified (13 papillary
carcinomas (41%), 8 (25%) follicular carcinomas, 10 (31%) follicular variant of papillary carcinomas, 1 (3%) undifferentiated carcinomas.
Conclusions: The use of ACR TIRADS and Bethesda systems in the preoperative assessment of thyroid nodules is effective in detecting malignant tumors. The use of the Bethesda system for the cytological evaluation of smear materials on glass from thyroid nodules after their resection during surgery is effective in detecting thyroid cancer and adjusting the volume of surgical intervention.
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