This journal is
indexed in Scopus
Year 2012 Vol. 20 No 5
GENERAL AND SPECIAL SURGERY
G. A. BLUVSHTEIN, V.V. GREKOV
COMPILCATIONS IN MORPHOLOGICAL DIAGNOSTICS OF THE THYROID GLAND DISEASES
State Budgetary Educational Establishment of Higher Professional Education “Saratov State Medical University named after V.I.Rasumovsky”, Saratov,
The Russian Federation
Objectives. To study sensitivity, accuracy and specificity of pre- and intraoperative cytological examination of the nodular goiter, and also the reasons of false positive and false negative results of the cytological examination.
Methods. The results analysis of surgical treatment of 933 patients with different forms of nodular goiter for a 3-year period (2007-2009) was carried out. Data of the fine needle aspiration biopsies and intraoperative cytological examination were compared with the results of histological examination of the operative mate-rial.
Results. Preoperative cytological examination appeared to be informative in 915 cases out of 933 or in 98,1%. The application of the preoperative complex as well as intraoperative cytological examination permitted to determine correctly the character of the thyroid gland lesion, its morphological form and on the basis of these data to choose an adequate volume of the operation in 94,6% of observations. False positive results of the cytological conclusions on the thyroid gland cancer were in 22 patients (2,3%), false negative results were in 29 patients (3,1%).Intraoperative cytologi-cal examination of the touch smears permitted to improve diagnostics results and to verify the malignant tumor in 16 more patients with the thyroid gland cancer. Coincidence of the data of pre- and intraoperative diagnostics with postoperative planned histological examination composed 91,1% at the thyroid gland cancer, 86,8% – at the nodular colloid goiter, 54,2% – at autoimmune thyroiditis.
Conclusions. The performed research certified that up to present one has faced difficulties in the preoperative verification of the nodular growths of the thyroid gland. There are no special techniques permitting to exclude the malignant nodular tumor growth before the operation absolutely certainly.
Complex application of the preoperative fine needle aspiration biopsy with the consequent obligatory intraoperative cytological examination contributed to the improvement of diagnostics quality of the nodular goiter and permitted to choose an optimal type and volume of the operation.
1. Dedov II, Troshina EA, Iushkov PV, Aleksandrova GV. Diagnostika i lechenie uzlovogo zoba [Diagnosis and treatment of nodular goiter]. Petrozavodsk, RF; 2003. 64 p.
2. Vorob'ev SL, Zaitseva IV, Matveeva ZS. Informativnost' kriteriev tsitologicheskoi diagnostiki novoobrazovanii shchitovidnoi zhelezy [The informative value of the criteria of cytological diagnostics of tumors of the thyroid gland]. Vestn Khirurgii im II Grekova. 2007;(2):62–64.
3. Valdina EA. Zabolevaniia shchitovidnoi zhelezy [Thyroid diseases]. Moscow, RF; 1993. 223 p.
4. Cap J, Ryska A, Rehorkova P, Hovorkova E, Kerekes Z, Pohnetalova D. Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clin Endocrinol (Oxf). 1999 Oct;51(4):509–15.
5. Tolstokorov AS, Ershova GI. Punktsionnye metody diagnostiki i lecheniia zabolevanii shchitovidnoi zhelezy [Puncture methods of diagnosis and treatment of thyroid diseases]. Annaly Khirurgii. 2007;(5):18–21.
6. Khmel'nitskii OK. Tsitologicheskaia i gistologicheskaia diagnostika zabolevanii shchitovidnoi zhelezy [Cytological and histological diagnosis of thyroid diseases]. Saint-Petersburg, RF: Sotis; 2002. 287 p.
7. Kononenko SN. Khirurgicheskaia taktika pri dobrokachestvennykh uzlovykh obrazovaniiakh shchitovidnoi zhelezy [Surgical approach for benign thyroid nodules]. Khirurgiia. 2001;(11):24–27.
8. Grineva EN, Malakhova TV, Goriushkina EV. Rol' tonkoigol'noi aspiratsionnoi biopsii v diagnostike uzlovykh obrazovanii shchitovidnoi zhelezy [The role of fine-needle aspiration biopsy in the diagnosis of thyroid nodules]. Problemy Endokrinologii . 2005;51(1):10–15.
9. Ershova GI. Puti uluchsheniia diagnostiki raka shchitovidnoi zhelezy [The method to improve the diagnosis of thyroid cancer]. Khirurgiia Zhurn im NI Pirogova. 2004;(12):47–49.
10. Beloborodov VA, Olifirova OS, Shevchenko SP, Saaia AT, Man'kovskii VA, Eselevich OV, Modin RV. Dooperatsionnaia tsitologicheskaia diagnostika uzlovykh obrazovanii shchitovidnoi zhelezy [Preoperative cytological diagnosis of thyroid nodules]. Annaly Khirurgii. 2007;(3):29–32.
11. Dedov II, Mel'nichenko GA, Fadeev VV, Gerasimov GA, Vetshev PS, Grineva EN, Kuznetsov NS, Vanushko VE, Bel'tsevich DG, Sviridenko NIu, Troshina EA, Petunina NA, Mazurina NV, Garbuzov PI, Rumiantsev PO, Il'in AA, Artemova AM. Klinicheskie rekomendatsii Rossiiskoi assotsiatsii endokrinologov po diagnostike i lecheniiu uzlovogo zoba [Clinical recommendations of Russian Association of Endocrinologists on the diagnosis and treatment of nodular goiter]. Problemy Endokrinologii. 2005;51(5):40–42.
12. Rosari J, Carcangue ML, de Lelis RA. Tumors of the thyroid gland. Washington, US; 1992. 343 p.
13. Kalinin AP, Maistrenko NA, Vetsheva PS, red. Khirurgicheskaia endokrinologiia: ruk [Surgical Endocrinology: A Guide]. Saint-Petersburg: Piter, RF; 2004. 960 p.
14. Korenev SV, Pleshkov VG, Tugai VV. Osobennosti dooperatsionnoi diagnostiki raka shchitovidnoi zhelezy [Features of the pre-operative diagnosis of thyroid cancer]. Ros Med Zhurn. 2005;(3):13–16.
15. Aleksandrov IuK. Punktsionnye metody v diagnostike i lechenii zabolevanii shchitovidnoi zhelezy [Puncture methods in the diagnosis and treatment of thyroid diseases]. Iaroslavl', RF: Diabet, RF; 1996. 108 p.
410012, Rossiyskaya Federatsiya, g. Saratov, ul. Bolshaya Kazachya, d. 112. GBOU VPO «Saratovskiy gosudarstvennyiy meditsinskiy universitet im. V.I. Razumovskogo», kafedra fakultetskoy khirurgii i onkologii,
Grekov Vladimir Vladimirovich
Grekov V.V. Assistant of the Faculty Surgery and Oncology Chair of SBEE HPE “Saratov State Medical University named after V.I.Rasumovsky”.
Bluvshtein G. A. Doctor of Medical Sciences, Professor, Head of the Faculty Surgery and Oncology Chair of SBEE HPE “Saratov State Medical University named after V.I.Rasumovsky”.