FEATURES OF THE DIAGNOSIS AND TREATMENT OF PATIENTS WITH SMALL TUMORS OF THE THYROID GLAND
P.I. Gordiichuk1,2, O.V. Pogorelov1,2, M.P. Gordiichuk1, A.A. Samusieva1
1 Shupyk National University of Healthcare of Ukraine,
2 Kyiv City Clinical Endocrinology Center, Kyiv, Ukraine
DOI: https://doi.org/10.15407/oncology.2024.02.146
Summary. Aim: to identify the causes of diagnostic errors at the preoperative stage in patients with thyroid nodules measuring < 1.0 cm. Object and methods: the study consists of retrospective and prospective research based on the analysis of examination results of 4509 patients with focal lesions of the thyroid gland. All patients underwent a comprehensive examination (ultrasound, fineneedle aspiration biopsy + cytological examination) in 872 patients with nodules of the thyroid gland measuring < 1.0 cm. The data of histopathological, cytological, and ultrasound findings were compared, and the accuracy, sensitivity, and specificity of ultrasound (US) and fineneedle aspiration biopsy (FNAB) under US control in the diagnosis of thyroid nodules with a diameter < 1.0 cm, including microcarcinoma, were evaluated. Results: out of 1003 cases of thyroid nodules, a correct preoperative US conclusion was formulated in 838 cases (83.6%) relative to postoperative histological examination, incorrect interpretation of the ultrasound image was noted in 165 cases (16.5%), with false-positive results in 85 cases (8.5%) and false-negative results in 80 (8.0%). The sensitivity of US for thyroid nodules measuring < 1 cm was 73.9%, and specificity was 82%. In 159 cases (94.6%) out of 168 patients with verified thyroid nodules, cytological examination data (papillary, follicular, or medullary thyroid carcinoma) corresponded to histological findings. The sensitivity of FNAB for thyroid nodules in less than centimeter sizes was 89.7%, and the specificity for benign less than centimeter thyroid nodules was 83.4%. Conclusions: ultrasound remains the standard for visualizing thyroid nodules, so clear criteria for their assessment will significantly reduce the number of nodules requiring biopsy and help clinicians improve the accuracy of treatment recommendations.
References
- Alexander EK, Doherty GM, Barletta JA. Management of thyroid Lancet Diabetes Endocrinol 2022; 10 (7): 540–8. doi: 10.1016/S2213-8587(22)00139-5.
- Barbosa TLM, Junior COM, Graf H, et al. ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology. BMC Endocr Disord 2019; 19 (1): 112. doi: 10.1186/s12902-019-0429-5.
- Griffi AS, Mitsky J, Rawal U, et al. Improved quality of thyroid ultrasound reports after implementation of the ACR thyroid imaging reporting and data system nodule lexicon and risk stratifi ation J Am Coll Radiol 2018; 15 (5): 743–8. doi: 10.1016/j.jacr.2018.01.024.
- Grani G, Brenta G, Trimboli P, et al. Sonographic risk stratification systems for thyroid nodules as rule-out tests in older Cancers (Basel) 2020; 12 (9): 2458. doi: 10.3390/ cancers12092458.
- Al Dawish MA, Alwin Robert A, Thabet MA, Braham R. Thyroid nodule management: thyroid-stimulating hormone, ultrasound, and cytological classification system for predicting malignancy. Cancer Inform 2018; 17: 1176935118765132. doi: 11177/1176935118765132.
- Hoang JK, Middleton WD, Farjat AE, et al. Reduction in thyroid nodule biopsies and improved accuracy with american college of radiology thyroid imaging reporting and data sys- Radiology 2018; 287 (1): 185–93. doi: 10.1148/radiol. 2018172572.
- Savelonas M, Maroulis D, Sangriotis A computer-aided system for malignancy risk assessment of nodules in thyroid US images based on boundary features. Comput Methods Programs Biomed 2009; 96 (1): 25–32. doi: 10.1016/j.cmpb. 2009.04.001.
- Cancer in Ukraine 2021–2022. Incidence, mortality, prevalence and other relevant statistic Bulletin of the National Cancer Registry of Ukraine 2023; 24. [Electronic resource]. http://www.ncru.inf.ua/publications/BULL_24/index_e.htm (accessed: 16.04.2024).
- Cancer Today [Electronic resource]. https://gco.iarc.wh int/today/ (accessed: 16.04.2024).
- Renshaw AA, Gould EW, Russ G, Poller Thyroid FNA: Is cytopathologist review of ultrasound features useful? Cancer Cytopathol 2020; 128 (8): 523–7. doi: 10.1002/ cncy.22262.
- Roman BR, Morris LG, Davies The thyroid cancer epidemic, 2017 perspective. Curr Opin Endocrinol Diabetes Obes 2017; 24 (5): 332–6. doi: 10.1097/MED.0000000000 000359.
- Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and diff rentiated thyroid can-Thyroid 2016; 26 (1): 1–133. doi: 10.1089/thy.2015. 0020.
- Cibas ES, Ali The Bethesda system for reporting thyroid cytopathology. thyroid, 2009; 19 (11): 1159–65. doi: 10. 1089/thy.2009.0274.
No comments » Add comment