Endocrine Surgery Center Research Articles

High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis.

Objectives: Cytologically indeterminate thyroid nodules (Bethesda class III or IV) carry a 10-40% risk of malignancy. Diagnostic lobectomies are frequently performed but negative surgeries incur unnecessary costs on the healthcare system, potential complications, and negative impacts on quality of life. Molecular tests (MTs) have been developed to reduce unnecessary surgeries. However, well-validated, high-performance MTs are often expensive, and their cost-effectiveness has not been studied in the Asian population. This study evaluates the rate of unnecessary surgery in the setting without MT (our current practice) and the cost-effectiveness of introducing a commercially available MT for the management of cytologically indeterminate thyroid nodules in a modernized city in Asia. Methods: Management decisions and outcomes of consecutive Bethesda III or IV thyroid nodules in a tertiary endocrine surgery center in Hong Kong were evaluated. Costs of health service provided by the public health system, which covers >90% of healthcare service in the city, were retrieved. A decision tree model was developed to compare the cost-effectiveness in avoiding unnecessary surgeries of current practice versus routine MT from a public healthcare provider's perspective. In our current practice, MT was not available, and patients with indeterminate nodules received either upfront lobectomy, repeat fine needle aspiration cytology (FNAC), or active surveillance. Results: Over a 4-year period, 2157 FNACs were performed. After exclusion, 1957 FNACs were analyzed, and 18.6% were Bethesda III or IV. Thirty-six percent of these cytologically indeterminate nodules received upfront surgery, with 28% having malignancy in final pathology, that is, 72% of surgeries were unnecessary. Routine MT could reduce 82 unnecessary surgeries/year, 26% more than current practice. Routine MT resulted in an incremental cost-effectiveness ratio of Hong Kong dollar (HKD) 49,102 (US dollar [USD] 6314) per unnecessary surgery. Sensitivity analysis showed test cost of MT contributed significantly to incremental cost-effectiveness ratio. Lowering the commercial price of MT to below HKD 8044 (USD 1031) would render routine MT cost-saving. Conclusion: Currently, a high rate of unnecessary surgeries is being performed for cytologically indeterminate thyroid nodules. MT was more effective in reducing unnecessary surgeries than current practice, but at a higher cost. MT will become cost-saving if the test cost could be lowered.

One- or Two-Step Total Thyroidectomy for Cancer Indications: A 20-Year Retrospective Study from a Referral Center.

The ATA guidelines suggest lobectomy as an option for select patients with thyroid cancer (TC), but some may need completion thyroidectomy because of unfavorable characteristics on the final pathology. This study aimed to compare postoperative morbidity of patients with TC who underwent total thyroidectomy in two steps (TT2) or one step (TT1). This was a retrospective comparative study in a high-volume endocrine surgery center. All consecutive adult patients who underwent total thyroidectomy in one step (TT1 group) or two steps (TT2 group) for follicular, oncocytic, or papillary TC between 2000 and 2020 were included. Surgical complications were compared between the two groups using propensity score matching, with a 2:1 allocation, according to age, sex, BMI, tumor stage, lymph node dissection, and year of surgery. In total, 5693 patients were enrolled, with 684 with TT2 and 5009 with TT1. Following adjustment, TT2 patients had significantly lower rates of transient hypocalcemia than TT1 patients did (3.2% versus 13.8%, p < 0.001). There was no significant difference in permanent hypocalcemia (2.1% versus 1.3%, p = 0.290), transient or permanent recurrent laryngeal nerve (RLN) injury (2.3% versus 3.5%, p = 0.201; 1.3% versus 1.3%, p = 0.998), hematoma (0.9% versus 1.2%, p = 0.591), or wound infection rates (0% versus 0.7%, p = 0.062). Total thyroidectomy in two steps for thyroid cancer can be performed safely, with short- and long-term complications at least similar to those of total thyroidectomy in one step.

Parathyroid carcinoma and atypical parathyroid tumor: analysis of an Italian database.

Atypical parathyroid tumor (aPT) and parathyroid carcinoma (PC) are extremely rare parathyroid neoplasms, accounting together for <2% of all parathyroid tumors. They often present an overlapping clinical phenotype, sharing clinical, biochemical, and some histological features. They are distinguished only by the presence of local invasion, and lymph nodes or distant metastasis, which are all absent in aPTs. To date, only few studies have compared clinical presentation and features between aPTs and PCs. Our purpose was to conduct a retrospective study on a multicenter Italian database of aPT and PC patients. We comparatively analyzed main features of aPT (n = 57) and PC (n = 74) patients collected at 15 major endocrinology and endocrine surgery centers in Italy. Atypical parathyroid tumors and PCs showed no significant differences in many clinical features and presented similar values of elevated parathyroid hormone and total serum calcium. Renal complications, namely nephrolithiasis and nephrocalcinosis, appeared to be more common in PC, with a significantly higher rate of renal colic, regardless of total serum calcium levels and 24-h calciuria. Parathyroid carcinomas showed significantly higher postoperative disease persistence and recurrence rates, presumably due to an uncomplete resection of the primary tumor in 23.5% of cases and/or presence of unremoved active metastasis, but they had similar disease-free mean time after surgery than aPT. To deepen the study of malignant parathyroid tumors, the institution of a novel Italian retro-prospective multicenter registry of aPTs and PCs is currently ongoing, and a dedicated PC European registry has been recently activated.

Role of thymectomy in surgical treatment of renal hyperparathyroidism

IntroductionThe role for routine thymectomy in patients with secondary or tertiary hyperparathyroidism (SHPT, THPT) is unclear. We aim to compare rates of recurrence and complications in patients who underwent subtotal parathyroidectomy with and without thymectomy. MethodsPatients who underwent surgery for renal HPT at a tertiary endocrine surgery center between 2010 and 2022 were reviewed. Presence of parathyroid tissue in resected tissue was identified through pathology reports. A multivariate logistic regression was used to compare baseline characteristics, recurrence rates and complications between those who did and did not undergo thymectomy. ResultsOf 107 patients who underwent subtotal parathyroidectomy, 29 (27.1 ​%) underwent concomitant thymectomy. Recurrence occurred in 15 patients (14 ​%). Thymectomy did not affect recurrence (OR: 0.33, 95%CI: 0.06–1.28, p ​= ​0.14), but was associated with permanent hypoparathyroidism (OR: 4.62, 95%CI: 1.67–13.18, p ​= ​0.003). Fewer parathyroid specimens increased the odds of thymectomy (p ​= ​0.04). Parathyroid glands were found in 6 thymectomy samples (20.7 ​%). ConclusionThymectomy at the time of subtotal parathyroidectomy for renal HPT was not associated with disease recurrence, but increased likelihood of permanent hypoparathyroidism.

The Incidence of Thyroid Cancer in Bethesda III Thyroid Nodules: A Retrospective Analysis at a Single Endocrine Surgery Center.

Fine-needle aspiration cytology (FNAC) is widely used to diagnose and monitor thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the standard for interpreting FNAC specimens. The risk of malignancy in Bethesda III nodules, also known as Atypia of Undetermined Significance (AUS), varies significantly throughout several studies published worldwide. This retrospective study examines the risk of cancer in thyroid FNAC categorized as Bethesda III as identified in the final histopathology of thyroidectomy specimens at a single endocrine surgery center. This retrospective cohort analysis included 1038 consecutive patients who underwent elective thyroid surgery with complete follow-up data between January 2020 and March 2024. Preoperative data on clinical and pathological characteristics have been collected. The final histopathology report from the thyroidectomy specimen was compared to the results of the preoperative FNAC on nodules that were judged to be Bethesda category III. Statistical methods were performed using SPSS version 29. A total of 670 ultrasound-guided FNACs (64.5%) performed during the study period were included in the final analysis. The study population was predominantly female, represented by 79.6% of patients with a mean age of 42.5 (SD 12.1), while 20.4% were male and significantly older with mean age of 45.13 years (p = 0.02). The FNAC inadequacy rate was 5.1%, which was associated with a high risk of malignancy (6 out of 34; 17.6%). Out of the total sample size of 170 patients classified as group III, 57 were found to have malignancies in final surgical histopathology, representing 33.5% of the cases within this category. The secondary gender-related outcome analysis showed that female patients classified under the Bethesda II category had a significantly higher risk of malignancy, with a rate of 21.2%, compared to males who had a malignancy rate of 3.4% in the same Bethesda category (p = 0.001, chi-square test). However, the female patients exhibited prognostically superior non-invasive tumors compared to male individuals (p = 0.02, chi-square test). This study's results indicate that Bethesda categories II and III are associated with a higher risk of malignancy in comparison to the reports of the first and third editions of the TBSRTC, particularly for female patients classified under category II.

Papillary Thyroid Cancer Trends in the Wake of the COVID-19 Pandemic: Is There a Shift toward a More Aggressive Entity?

Globally, the incidence of papillary thyroid cancer (PTC) has been increasing over the last few decades and it has become the second most common cancer in women in the UAE. There is some evidence to suggest that COVID-19 infection might be directly linked to the development of aggressive variants of PTC. The primary goal of this study was to compare the clinical and pathologic characteristics of thyroid cancer patients treated at the largest endocrine surgery center in Abu Dhabi before and after the COVID-19 pandemic outbreak. This retrospective cohort analysis included patients who underwent elective thyroid surgery at Burjeel Hospital between January 2018 and December 2022. Patients were divided into two groups based on when the COVID-19 outbreak started: group one, comprising patients who had surgery between January 2018 and December 2019 (the "pre-pandemic group"), and group two, comprising patients who had surgery between January 2021 and December 2022 (the "post-pandemic group"). In addition to demographic data, clinicopathological factors, such as aggressive cell type, multifocality, tumor size and location, laterality, lympho-vascular invasion, and extrathyroidal extension, were assessed. We utilized the t-paired test for parametric variables and the Chi-square test for the cross-table analysis. During the study, 1141 people had thyroid surgery, with an annual average of 285 procedures. PTC cases recorded in the final histopathological samples rose from 111 in the pre-pandemic era to 182 in the post-pandemic era. Neither the female-to-male gender ratio, which was 90:21 in the pre-pandemic group and 142:40 in the post-pandemic group (p = 0.532), nor the median age, which was 39.1 and 40.1 years, respectively, varied significantly between the two groups. However, there was a significant increase between pre-pandemic and post-pandemic in the aggressive PTC variants (3% vs. 11.5%, p = 0.001), increased poor prognostic factors such as bilateral multifocality (10.8% vs. 32.4%, p = 0.000), as well as increased capsule-vascular tumor invasion (19.8% vs. 27%); on the other hand, the size of the single foci was 17 mm in the pre-pandemic group compared to 13 mm in the post-pandemic group (p = 0.001). A significant rise in unfavorable prognostic markers and aggressive subtypes of PTC was seen post-pandemic in thyroidectomy patients operated on at a leading endocrine surgery center in the United Arab Emirates.

Metastases to lymph nodes from monofocal and multifocal papillary thyroid malignant tumors in patients with autoimmune thyroiditis

The aim of this work was to study the risk factors for metastasis to the central and lateral neck lymph nodes in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), especially in patients with Hashimoto’s thyroiditis (TH).Methods: A retrospective analysis of 763 patients after thyroidectomy with bilateral central lymphadenectomy (CLE) was performed at the interterritorial Center for Endocrine Surgery in Krasnodar during the period from October 2011 to October 2021. All patients had official histological diagnoses of TH. To identify risk factors for metastasis (Mts) to the lymph nodes of the neck, a multifactorial logistic regression analysis was performed.Results: In our study, 277 patients with SCLC and TC showed relatively low rates of Mts to the central lymph nodes (CLU) compared with patients with SCLC without TC (37.2 % vs. 54.7 %, P 140 IU / ml was established as the most sensitive and specific level for predicting MPCT based on the study. Antibodies to AT-TPO, age, tumor size, and multifocal tumor shape demonstrated the ability to predict Mts in the central nervous system in patients with PCT on the background of TC with a probability of 81.1 % based on a multidimensional model. TH was associated with an increased prevalence of multifocal tumor with invasion of the gland capsule.Conclusions: TH detection demonstrated the reduced risk of metastases to the CLN in patients with PCT and MPCT and indicated a potential protective effect. We found that the prognostic model is applicable for predicting a multifocal tumor and metastasis to the central nervous system in patients with PCT and TH.

Problems of follicular thyroid carcinoma diagnostics

Introduction. Follicular thyroid cancer is much less common than papillary cancer. Nevertheless, the main difficulties in preoperative diagnosis are associated with this morphological type. A fine needle aspiration biopsy is not able to distinguish a benign follicular adenoma from a follicular carcinoma, which forces surgeons to perform diagnostic resection of the thyroid gland in all patients with a cytological conclusion «follicular tumor».Aim. To search for microRNAs specific to follicular cancer by sequencing a new generation.Materials and methods. The data of patients with a preoperative cytological conclusion «follicular tumor» operated at the Chelyabinsk Center for Endocrine Surgery from 2021 to 2022 were analyzed. Histological preparations were reviewed twice by pathologists. Genome sequencing was performed in 8 histological samples of follicular cancer and 8 samples of follicular adenoma. The expression levels of the selected microRNAs were compared with 198 archived cytological samples of various types of thyroid tumors.Results. The risk of malignancy at the cytological conclusion «follicular tumor» was 25.4 % (error 74.6 %). Follicular cancer was first detected in 36 patients, the incidence was 0.68 new cases per 100 thousand population per year. The diagnosis of «follicular cancer» was confirmed by 3 morphologists in 8 (36.4 %) cases. Sequencing revealed the 5 most distinct microRNAs between follicular cancer and follicular adenoma: miR-625, miR-323a, let-7a, let-7c and miR-574. The level of errors in the differentiation of follicular adenoma and follicular cancer using the microRNAs we selected was 21 % (35 % with cross-validation).Conclusion. Molecular genetic research at the preoperative stage, aimed at differentiating follicular cancer and follicular adenoma, in comparison with cytological research has a greater, but insufficient accuracy for making a final clinical decision.

The clinical and histopathological characteristics of thyroid gland diseases in adolescents requiring surgical treatment: a ten-year follow-up study.

The present research aimed to determine the clinical and pathohistological characteristics of thyroid gland diseases in adolescents who were previously surgically treated at the Endocrine Surgery Center of the University Medical Center of Serbia from 01/01/2001 to 01/01/2011. The study covered 170 patients of both sexes from the population of adolescents (aged 16 to 20 years) with various malignant and benign thyroid gland diseases. The data for this study were extracted from the medical histories of patients and the electronic database of the Center for Endocrine Surgery. Detailed data analysis included diagnosis, symptomatology, surgical intervention type, and disease stage. The following thyroid status parameters were analyzed from preoperative data: thyroxine (T4), thyroxine free fraction (FT4), triiodothyronine (T3), triiodothyronine free fraction (FT3), and thyroid stimulating hormone (TSH). In addition, the pathohistological features of diagnosed thyroid diseases were also determined, with a special focus on the presence of well-differentiated cancers. Papillary carcinomas were the most common of well-differentiated cancers in adolescents over the ten-year follow-up period. Based on the assessed data, total thyroidectomy was the most commonly used type of surgical intervention in these patients. The conducted research provides essential information related to both the biological characteristics and diagnostics of these cancers and their surgical treatment in such a sensitive population. Moreover, research showed that the clinical presentation of thyroid cancer in adolescents is almost identical to that in adults.

Modern diagnosis and treatment of papillary thyroid cancer

thyroid cancer is the most common malignant tumor of the endocrine glands, accounting for 1% of all cases of malignant neoplasms. According to the National Cancer Registry, 24,626 patients with thyroid cancer were identified in Ukraine for the period from 2014 to 2021, of which 4,556 were men (18.5%) and 20,070 were women (81.5%). Treatment of papillary thyroid cancer combines three methods: surgery, the use of radioiodine therapy, and hormone replacement therapy with levothyroxine drugs. The aim of this work, based on the example of a clinical case, was to analyze the patient's route, methods of diagnosis, and treatment of a thyroid neoplasm in accordance with current guidelines and recommendations. This clinical case highlights the importance of early diagnosis of TG diseases, namely papillary thyroid cancer. The patient turned to the clinic of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of MoH of Ukraine with complaints of an increase in the front surface of the neck and deterioration of the general condition for a long time. After analyzing the complaints, the patient was sent for a comprehensive examination, where an ultrasound of the TG revealed a mass, cytological examination confirmed a thyroid papillary cancer, grade 6. After undergoing preparation, the patient was referred for surgical intervention, namely extrafascial thyroidectomy. Combined treatment was carried out (operative intervention and treatment with the drug I131), and a suppressive dose of levothyroxine was prescribed, followed by dose correction and dynamic supervision by an endocrinologist. The described clinical case testifies to the high quality of diagnosis and treatment of a patient with thyroid papillary cancer in the conditions of a highly specialized endocrinological center. This approach fully meets the international requirements for the treatment of thyroid cancer. Despite the difficult epidemiological situation in Ukraine and the state of war, the patient was promptly referred to the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues, where she received the necessary assistance in full.

Bilateral adrenal pathology: Conn syndrome and autonomous cortisol secretion

this case report presents the route of a patient with bilateral adrenal pathology and severe complaints, who where admitted to the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of MoH of Ukraine as scheduled. The selective blood sampling from adrenal veins, which was performed at the Center, in patient with bilateral adrenal pathology, is analyzed. This method is the gold standard of diagnosis, which allows to choose the optimal method of treatment for such patients.

Incidental parathyroidectomy during total thyroidectomy and functional parathyroid preservation: a retrospective cohort study

BackgroundThe published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP.MethodsThis retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups.ResultsAvoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16–2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29–6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71–8.86, p < 0.001 and OR 1.72, 95% CI 1.02–2.82, p = 0.038).ConclusionsPatients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND.

Diagnostic effectiveness of intraoperative express histological examination as a tool to take decisions on the extent of surgery for papillary thyroid cancer

Background. In case of the screening use of high-resolution ultrasound, the level of detecting thyroid neoplasms is about 25 % in the population. Ultrasound criteria are not enough to detect carcinoma. The following methods are used for the differential diagnosis of malignant thyroid neoplasms: ultrasound scans, computed tomography, fine-needle aspiration (FNA) biopsy, intraoperative express histological and histopathological examination. Some authors consider FNA to be the standard method for primary morphological diagnosis of thyroid nodes. It is not always possible to conduct FNA safely. Also, FNA cannot be a method of 100% morphological identification of a primary tumor. In such cases, the extent of the surgery will depend on the data obtained from the intraoperative express histological examination. Analysis of the diagnostic effectiveness of the express histological examination will help to take a decision on the need for it when choosing the extent of a surgery on the thyroid gland. Aim of the study: to evaluate the diagnostic efficiency of the intraoperative express histological method in the detection of papillary thyroid cancer on solitary nodes (Bethesda IV, V) and metastases of papillary thyroid cancer during surgery. Materials and methods. The results of intraoperative express histological and pathohistological examinations performed at the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues from 2018 to 2021 were analyzed. The sample included materials of surgeries on the thyroid gland in case of papillary cancer T1ab-2N0–1 and solitary nodes (Bethesda IV and Bethesda V) according to data obtained using FNA. The sample size in the study of regional metastasis included 220 examinations, 845 examinations in the “gray zone” (Bethesda IV — 465, Bethesda V — 380). Cases of discrepancy between the results of intraoperative express histological and final histopathological examinations were considered. The data was processed using the EZR v. 3.4.1 statistical analysis program. Results. The sensitivity of the express histological examination in case of detecting metastases of thyroid cancer is 72.2 % with the method specificity of 99.9 %. The diagnostic efficiency in detecting metastases of thyroid cancer is 89.1 %. When the express histological examination is used for Bethesda IV nodes, the sensitivity of the method is 8 % with a specificity of almost 100 %. The diagnostic efficiency of the express histological examination is even higher in case of Bethesda V: sensitivity of 47 % with the method specificity of almost 100 %. The values obtained correlate with international data. This testifies to the need for further improvement of the of intraoperative diagnosis method. Conclusions. The diagnostic efficiency of the intraoperative express histological examination for detecting metastases of papillary thyroid cancer in the selected group is 89.1 % with sensitivity of 72.2 % and specificity of 99.9 %. The diagnostic efficiency of intraoperative express histological examination for verification of thyroid cancer in case of Bethesda IV nodes is 63.9 % with sensitivity of 8.2 % and specificity of 99.6 %. The diagnostic efficiency of intraoperative express histological examination for verification of thyroid cancer in Bethesda V nodes is 63.4 % with sensitivity of 47.3 % and specificity of 99.2 %. The intraoperative express histological examination method makes it possible to take decisions on surgical tactics during surgery within the determined limits, so we believe it reasonable to further use and improve it.

Clinico-pathological initial outcome of a newly adopted novel surgical technique for nodal metastatic thyroid cancer at a large-volume centre in a high-income developing country.

Thyroid cancer is the most common tumour in the endocrine system. In the past decade, the incidence of lymph node metastasis has increased, and so has the patient demand for a smaller scar. This research reports the surgical and patho-oncological short-term outcomes of a novel, minimally invasive neck dissection approach for thyroid carcinoma with lymph node metastases at the UAE's leading endocrine surgery centre. This study employed a prospectively maintained surgical database to retrospectively analyse relevant parameters such as surgical complications, including bleeding, hypocalcaemia nerve injury and lymphatic fistula, as well as oncological metrics such as the type of tumour and the ratio of lymph node metastasis to the number of harvested lymph nodes in 100 patients that underwent open minimally invasive selective neck dissection. The study comprised 50 patients with thyroidectomy, with bilateral central compartment neck dissection (BCCND; 50%); 34 with thyroidectomy, BCCND and selective bilateral lateral compartment neck dissection (BLCND; 34%); and 16 patients with selective unilateral central and lateral compartment neck dissection by recurrent nodal disease (ULCND; 16%). The female-to-male gender ratio was 78:22, with median ages of 36 and 42 years, respectively. Histopathology findings revealed that 92% of patients had papillary thyroid cancer (PTC) and 8% had medullary thyroid cancer. The mean total number of lymph nodes removed was 22 in the BLCND group, 17 in the ULCND group and 8 in the BCCND group (p = 0.001). Furthermore, the average lymph node metastasis was significantly higher in the BLCND group (p = 0.002). The percentage of temporary hypoparathyroidism was 29.8% and it persisted for 1.3%. The lateral compartment dissection morbidity was as follows: Four male patients with tall cell infiltrative PTC presented with pre-existing vocal cord paresis, necessitating nerve resection and anastomosis, and two more developed it after surgery (1.1% of the nerve at risk). Lymphatic fistulas occurred in four patients (4%) who were treated conservatively. Two patients were readmitted due to symptomatic neck collection. Horner syndrome was discovered in just one female patient. Male gender, aggressive histology and lateral compartment dissection independently increased surgical morbidity. In a high-volume endocrine centre, the adoption of minimally invasive selective neck dissections to treat nodal metastatic thyroid cancer did not increase specific cervical surgery complications.

A-287 UTILITY OF CORRELATION BETWEEN TI-RADS AND BETHESDA CLASSIFICATION TO ESTIMATE RISK OF MALIGNANCY FOR CYTOLOGICALLY INDETERMINATE THYROID NODULES

Abstract Background Currently, we are directing therapeutic strategy based on the results of fine-needle aspiration biopsy defined by the Bethesda classification. The TI-RADS classification of ultrasound features can help surgeons to estimate the risk of malignancy (ROM). The aim of this study was to explore the correlation between the two classifications. Methods All patients who underwent a total or hemithyroidectomy from January 2021 to June 2022 in a high-volume endocrine surgery center were included in this study. The results of TI-RADS classification and Bethesda classification were collected, as well as the pathologic results. Multivariable logistic regression analysis was performed to determine whether malignancy correlated with the Bethesda diagnosis and TI-RADS score. Results During the study period, 1903 patients had thyroid surgery including 848 (44.6%) who had a final pathologically verified thyroid cancer. Bethesda group III was associated with a ROM of 25.4%; in association with a TI-RADS 5 the ROM increased to 48.6%. Bethesda IV was associated with a ROM of 33.5% but, when combined with TI-RADS 3 or 5, the ROM ranged between 33.3 and 44.8% respectively. Bethesda 5 group was associated with a ROM of 81.8% and in combination with TI-RADS 5 score the ROM increased to 90.2%. Our model used the TI-RADS score to stratify the ROM for each Bethesda diagnostic group. We found that the model was more accurate than using the Bethesda diagnosis alone especially for estimation of ROM for Bethesda III thyroid nodules classified as Bethesda III. Conclusion Use of TI-RADS scores for each Bethesda diagnostic group allow a more accurate assessment of ROM for indeterminate thyroid nodules.

Papillary thyroid cancer in children. Clinical cases

Thyroid cancer (TC) is the most common endocrine tumor in pediatric patients. Papillary carcinoma accounts for the highest rate among differentiated TCs (80—90%). Papillary thyroid cancer in children is clinically different from this pathology in adults. In comparison with adults, papillary thyroid cancer in children is diagnosed at later stages and is associated with a more aggressive course of the disease. Despite the high frequency of metastases and recurrences of papillary thyroid cancer in children, the prognosis remains favorable. In Ukraine, 10 years after the accident at the Chernobyl nuclear power plant, the average incidence rates of papillary thyroid cancer among children of all ages gradually decreased, but since 2010—2011, a negative trend towards an increase in the number of new cases of pathology, especially children under 14 years of age, has been restored. Several studies suggest that the increase in the incidence of papillary thyroid cancer is only partially explained by the increase in the number of preventive examinations performed, as there is also an increase in the detection of large tumors and the diagnosis of advanced stages of the disease.Over the past 14 years, 759 children aged 3 to 18 from all regions of Ukraine were operated in the clinic of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine (Center). From them, based on the results of histopathological examinations, papillary thyroid cancer was diagnosed in 290 (38.2%) children (including 73.45% girls and 26.55% boys). In most cases, the disease was diagnosed during adolescence, except for isolated cases among children of primary school and preschool age. The paper presents two clinical cases.Annual preventive thyroid ultrasound investigation is required for early diagnosis of nodular goiter, including malignant thyroid tumors, especially in children with a burdened family history of these tumors. Any nodular goiter in children should be considered potentially malignant until its benign nature is proven by appropriate qualified investigations. To ensure proper and timely verification of malignant thyroid tumors in pediatric patients, to avoid unjustified (insufficient or excessive) surgical treatment of children with thyroid tumors, such patients should be referred to medical institutions with modern diagnostic capabilities and expert‑level surgical experience in the treatment of children with nodular goiter and malignant thyroid tumors.

Level of parathyroid hormone in the early postoperative period as a prognostic factor for persistent manifestations of clinical hypocalcemia

Objective — to determine the level of parathyroid hormone (PTH) in the early postoperative period in patients after the thyroid gland surgery, which enables to define the risk of persistent postoperative hypoparathyroidism with clinical manifestations of hypocalcemia.&#x0D; Materials and methods. The study involved 303 patients who were operated in the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organ and Tissue due to various thyroid pathologies in the period of January, 2020 through June, 2021. The scope of the operation was thyroidectomy with/without lymph node dissection. The PTH level in blood serum was determined for all patients in the morning after the surgery (16 — 22 hours later). Clinical signs of hypocalcemia due to hypoparathyroidism (PTH level &lt; 15 pg/ml) were revealed in 147 (48.5 %) subjects. Moving forward, such patients were examined for blood serum PTH levels after 3 months (first stage of examinations) and 6 months (second stage of examinations).&#x0D; Results. After 3 months, normalization of PTH levels and no clinical hypocalcemia manifestations were defined in 126 patients (85.7 %); 21 patients (14.3 %) had low PTH levels (&lt; 15 pg/ml) with clinical manifestations of hypocalcemia. The use of ROC‑analysis to predict the normalization of PTH levels after 3 months revealed the cut‑off threshold 2.8 pg/ ml. After 6 months, normalization of PTH levels and no clinical hypocalcemia manifestations were defined in 136 (92.5 %) patients, whereas 11 (7.4 %) subjects demonstrated the reduced PTH levels and clinical manifestations of hypocalcemia. Results of ROC‑analysis prediction of the normalization of PTH levels after 6 months post‑surgery, the cut‑off threshold 1.6 pg/ml.&#x0D; Conclusions. Postoperative PTH levels &gt; 2.8 pg/ml after 3 months after surgery and &gt; 1.6 pg/ml after 6 months established to be a predictor of normalization serum PTH levels. A PTH level &lt; 1.6 pg/ml can be considered a predictor of persistent hypoparathyroidism, and allows the physician to recognize patients with possible long‑term specific treatment.

Injury of the external branch of the superior laryngeal nerve in thyroid surgery

Injury of the external branch of the superior laryngeal nerve is one of the complications in thyroid surgery, the frequency of which varies within very wide limits due to the difficulties in diagnosis. The complaints relate to a change in voice tone, which significantly impairs the quality of life of patients, especially those with voice profession. The most accurate specific method for diagnosis is electroneuromyography but this technique is very difficult to perform and not used in routine practice. To diagnose the lesion of the external branch of superior laryngeal nerve the authors used laryngoscopy, laryngostroboscopy and spectral analysis of the voice, which revealed the frequency of nerve injury and dynamic monitoring of voice recovery in the patient.&#x0D; Objective — to examine the frequency of lesions of the external branch of superior laryngeal nerve in thyroid surgery on the basis of changes in the laryngoscopic picture, spectral analysis of the voice and dynamic monitoring of their recovery during treatment&#x0D; Materials and methods. The study was conducted in the surgical department of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues MOH of Ukraine with involvement of 241 operated patients. Examination of the larynx and voice examination were performed before surgery, on the 2 — 3 days and 6 and 12 months after surgery. Diagnosis was performed using methods: videolaryngoscopy, videolaryngostroboscopy, spectral analysis of the voice.&#x0D; Results. Clinical signs of trauma to the external branch of the superior laryngeal nerve were found in 8 (3.3 %) patients out of 241 operated. Patients received a course of phonopedia and stimulation therapy in the absence of contraindications. Voice recovery over time was recorded in 7 (87.5 %) patients, no voice recovery in 1 (0.4 %).&#x0D; Conclusions. Injury of the external branch of superior laryngeal nerve after surgery on the thyroid gland is a complication after thyroid surgery which does not happen often (3.3 %). This complication is very difficult to detect, considering inconspicuous symptoms, the lack of specificity of the laryngoscopic picture and the peculiarities of diagnostic methods. It is not always possible to fully restore the voice when the external branch of the superior laryngeal nerve is damaged (permanent injury accounts for 0.4 % of the total number of operations on the thyroid gland and 85.0 % of the total number of patients with damage to the external branch of the superior laryngeal nerve), which requires dynamic monitoring of patients and timely treatment administration.&#x0D;

Effect of skip metastasis to lateral neck lymph nodes on outcome of patients with papillary thyroid carcinoma.

Lymph node metastasis (N1) is a prognostic factor for disease recurrence in papillary thyroid carcinoma (PTC) patients. Skip metastasis is defined as only lateral N1 with negative central lymph nodes (LNs). The aim of this study was to explore the outcome of PTC patients with skip N1. All patients who underwent a total thyroidectomy with ipsilateral central and lateral LN dissection for PTC from 1999 to 2019 in a high-volume endocrine surgery centre were included in this study. Demographic and outcomes-recurrence and disease-specific survival (DSS)-were compared between three groups: N1a (central N1 only), N1b-CL (central and lateral N1), and N1b-Skip (lateral N1 without central LN involvement). During the study period, 3046 patients had surgery for PTC, including 1138 with N1 (37%, 860 women, mean age: 44.8years) comprising 474 N1a (42%), 513 N1b-CL (45%), and 151 N1b-Skip (13%). The median follow-up was 74months (range 12-216months). The recurrence rate in the N1b-Skip group was 13% (20/151) and 10% (47/474) in the N1a group. This was significantly lower than that in the N1b-CL group (27%, 140/513) (p < 0.0001). DSS at 10years was 99% for group N1a, 98% for the N1b-CL, and 99% in the N1b-Skip group. The recurrence rate of N1b-Skip patients was lower than that of N1b-CL patients and similar to that of N1a patients. This result could be used as an indication for the modality of radioiodine therapy, and for the pattern of follow-up procedures.

Predictive value of CD138, CD68, CD163 expression in the pathogenesis of the development of thyroid cancer against the background of metabolic disorders

Objective — to investigate the expression of CD138, CD68, CD163, involved in the pathogenesis of papillary thyroid cancer (PTC) against the background of metabolic disorders. Materials and methods. The analysis was performed on 36 selected medical histories of patients who were operated for PTC in the Surgical Department of the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the MoH of Ukraine. Patients’ aged ranged 18 to 76 years, the mean age was 41.4 ± 13.8 years; women prevailed among patients — 32. According to the body mass index (BMI) patients were divided into two groups: group 1 (n = 14) with normal weight (BMI &lt; 25 kg/m2), group 2 consisted of 22 overweight patients (BMI ≥ 25 kg/m2). All patients had autoimmune thyroiditis confirmed by laboratory and histological examination. Molecular genetic mutation BRAFV600E was detected in 20 (55.6 %). Immunohistochemical study of markers CD138, CD68, CD163 was performed according to the standard methods on histological material of tumors. Results. Among the studied immunohistochemical markers, CD68 was the most common — 72.2 % of cases, while CD138 and CD138 were found in 50 % and 55.6 %, respectively. In both studied groups, no statistically significant association was found between BMI and the presence of BRAFV600E (p &gt; 0.05). In the immunohistochemical study of markers CD138, CD68 and CD163 no significant relationship between their expression and BMI was found (p &gt; 0.05). Instead, we found a significant difference in the detection of the CD68 marker in patients of both groups (p &lt; 0.01), while CD138 and CD163 did not show significant difference. The aggressiveness of the tumor process occurred in 25 % of patients. Patients in group 1 (with normal BMI) did not have significant differences in the aggressiveness in contrast to patients of the group 2 (21.4 % and 27.3 %, respectively). Conclusions. No increase of the expression of immunohistochemical markers CD138, CD68, CD163, involved in the pathogenesis of PTC, was established in overweight patients; there was no significant correlation between BMI and the presence of BRAFV600E, as well as the aggressiveness of the tumor process.