DIFFERENTIATED APPROACH TO MANAGEMENT TACTICS OF PATIENTS WITH NODULAR CHANGES IN THE THYROID
Keywords:
thyroid palpable abnormalities,TIRADS classification, fine needle aspiration needle biopsy, thyroid cancer, ,surgery,ultrasound diagnosticsAbstract
TARGET. To develop a differentiated approach to the dynamic monitoring of patients with nodules in the thyroid gland, depending on the classification of TIRADS. MATERIALS AND METHODS. 535 patients were observed and operated about benign thyroid nodular pathology in the clinic of faculty surgery of the Clinics of Samara State Medical University during the period from 2014 to 2019. Divided into 2 groups. 1st group (254 people): who were operated on from 2014 to 2016. During this period, for patients with no signs of tumor changes, compression syndrome, and functional autonomy, repeated ultrasound and fine needle aspiration biopsy were performed after 12-24 months, regardless of the classification of nodes according to TIRADS. 2nd group (281 people): these are patients who were operated on from 2017 to 2019. During this period, for patients with TIRADS III (T III) and TIRADS IV (T IV) nodes who did not have primary signs of tumor pathology, compression syndrome, and functional autonomy, repeated ultrasound and fine needle aspiration biopsy were performed earlier - after 3-6 months.
RESULTS. According to the results of the preoperative diagnosis, the groups were absolutely comparable. The number of confirmed follicular neoplasias as a result of a planned postoperative histological examination increased from 50% (in group I) to 76.4% (in group II). The difference was statistically significant. A significant decrease in the number of patients with signs of thyroid cancer was also noted according to the results of postoperative histological examination. This indicator decreased from 4.7% (in group I) to 2.8% (in group II). Moreover, among patients with preoperatively verified follicular neoplasia, the number of malignant processes detected intraoperatively changed from 3.6% (in group I) to 0.7% (in group II ) (p<0,05).
CONCLUSION. It is advisable for patients with TIRADS III, TIRADS IV nodes to conduct dynamic monitoring in the form of repeated cytological examination in the period of 3-6 months. This approach contributes to the timely identification and elimination of the tumor-left process before the development of malignancy.
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