Cytological diagnosis of thyroid disease

Abstract

Cytological diagnosis of various human diseases is widely used in modern medicine, especially for early preoperative diagnosis of tumors of different organs and tissues. A fine-needle aspiration puncture biopsy followed by microscopic examination of its cytogram is one of the integral parts of diagnostic cytology, including the diagnosis of thyroid diseases (thyroid gland). The methods used to verify various thyroid pathology options (palpation, ultrasound - ultrasound, scintigraphy, biochemical and immunological tests, etc.) do not always allow us to clarify the nature of pathological changes in the thyroid gland. For example, cold nodes (according to the scan) only in some cases turn out to be malignant neoplasms of the thyroid gland, like the bulk of nodular goiter in patients from regions endemic to goiter; in most cases there is no need for their prompt removal. And only a microscopic examination of thyroid puncture points, especially its nodular formations, allows you to clarify the diagnosis and make an adequate decision on the nature of the treatment measures. Thin-needle aspiration puncture biopsy of the thyroid gland is a non-invasive morphological diagnostic tool that allows you to make a correct diagnosis with almost 100% probability. At the same time, since the thyroid gland is an epithelial organ, in the structures of which the cells are closely “fused” with each other, cellular connections are broken with difficulty, which makes it extremely difficult to obtain informative material for subsequent microscopic examination. To facilitate the process of obtaining material on the needle, which is performed by puncture biopsy, in the Endocrinology Research Center of the Russian Academy of Medical Sciences, notches were started at a distance of about 0.5-0.7 cm from the sharp end of the needle (Candidate of Medical Sciences A.V. Antonov), which allows you to take material like a harpoon, without aspiration and receive a plentiful punctate. With ischemia of the punctured area of the gland, it is possible to obtain abundant punctate with virtually no impurity of peripheral blood (Ph.D. I.V. Panteleev). The material thus obtained is applied to a fat-free glass slide and a smear is obtained using a polished glass slide (similar to a blood smear). Air-dried strokes are stained according to May — Grunwald — Giemsa. Every year we examine from 1.5 to 2.5 thousand puncture biopsies from patients with various pathologies. The information content of the obtained material largely depends on the experience and skill of the surgeon. Scanty punctate, as a rule, is uninformative and can only describe the punctate without an opinion on the nature of pathological changes in the thyroid gland. Abundant cellular punctate from different points of the gland, especially if there is a suspicion of diffuse and / or combined pathology, makes it possible to make a final diagnosis.