PROBLEMS OF THE PREOPERATIVE DIAGNOSTICS OF THE THYROID CANCER IN GRAVES DISEASE
Keywords:thyroid cancer, Graves’ disease, cytological studies
The Preoperative Diagnostics of the Thyroid Cancer in Graves Disease is relevant problem as the number of reports of the association of thyroid cancer with Graves’ disease (CG) has increased. Tne reports are quite controversial regarding the prevalence of thyroid cancer and its biological behavior and there is no clear diagnostic algorithm. The aim of the study was to identify the clinical, ultrasound, cytological and morphological characteristics of the thyroid cancer (TC) in Graves’ Disease (GD). Materials and methods. A retrospective analysis of the medical documentation of patients with thyroid cancers GD were treated in the surgical department of the Institute of Endocrinology and Metabolism named for V.P. Komissarenko from 2008 to 2019. We analyzed the age of the patients, the results of an ultrasound examination (ultrasound) of the thyroid, a fine-needle aspiration puncture biopsy (FNAB) with cytological and immunocytochemical studies, and the results of a histological examination. Statistical analysis was carried out in the Statistica 10.0 program according to the ӽ2 criterion with Yates correction for continuity. Results. From 1854 patients with GD went under knife in the clinic of the «Institute of Endocrinology and Metabolism named for VP Komisarenko», thyroid cancer according to histological examination was detected for 195 patients (women — 164, men — 31). The studies found that although the prevalence of thyroid cancer in GD is 10.52 %, preoperative diagnosis made it possible to clearly establish the diagnosis in only 28 (14.36 %) of 195 patients. According to the results of thyroid ultrasound examination, out of 195 patients, only 42.05 % had indications for FNAB, since in 26.67 % of cases nodules were not found in patients. In 31.28 % of patients the nodules did not show signs of malignancy. A cytological study confirmed the presence of carcinoma in only 28 of 82 patients (34.15 % of the total number of FNAB’ performed). Conclusion. Morbidity of TC was 10.52%. According to data of the histological study papillary carcinoma was detected for 92.82 % of patients, follicular carcinoma — for 4.61 %, and medullary carcinoma — for 2.56 %. The complexity of ultrasound verification of thyroid malignancies in patients with hypertension is due to the fact that 26.67 % of patients had no nodules, and in 31.28 % they did not show signs of malignancy. Cytological studies revealed atypia of unclear genesis and follicular neoplasia in 14.63% of cases (BSRTC III і IV), suspicion of malignancy or carcinoma in 50 % of cases (BSRTC V і VI). False negative results were obtained in 34.15 % of cases (BSRTC II). The presence of GD significantly complicates the cytological diagnosis of thyroid carcinomas, significantly increasing the number of false-negative results by 5 times, and decreasing the effectiveness of detection of carcinomas by 1.7 times.
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