Surgical treatment of the thyroid nodes of uncertain cytological structure

Abstract

Objective. To determine the clinical factors of the enhanced risk of malignancy in patients, having categories of cytological conclusions III (AUS/FLUS) and IV (FN/SFN).
 Маterials and methods. There were 11 621 patients examined with cytological investigation of thyroidal nodes under ultrasonographic control. Cytological conclusions of category ІІІ (AUS/FLUS) have characterized 621 nodes, while conclusions of category IV (FN/SFN) - 1215 nodes. There were operated 150 patients, owing cytological conclusions of category III, 436 patients - with cytological conclusions of category IV, and 11 patients, having categories of cytological conclusions III and IV.
 Results. Papillary and follicular carcinomas were revealed in 36% patients, suffering thyroidal nodes of the Bethesda III category, what is trustworthily more frequently (р < 0.01), than in the patients, suffering thyroidal nodes of the Bethesda category IV (25.1%).
 There were revealed such factors of risk for malignant properties in patients, suffering thyroidal nodes with the Bethesda category III, as: the node size 2 сm and less, its hypoechogeneicity, uneven borders, irregular form, and presence of hyperechogenic foci (р < 0.01). Cystic degeneration of a node constitutes the sign of its benign origin (р < 0.01).
 Conclusion. High risk of malignant changes (36%) in thyroidal nodes, in accordance to cytological conclusion of the Bethesda category III revealed, trusts the need for enhanced oncological suspicion and conduction of surgical treatment. Тhe additional factors of malignant changes must be taking into account as well, such as the node size 2 сm and less, its hypoechogeneicity, uneven borders, irregular form, and presence of hyperechogenic foci.