Introduction Thyroid cancer (TC) demonstrates steady growth in incidence worldwide and remains an urgent problem in oncology. The detection of sentinel lymph nodes (SLN) with a selective dye and further histological examination in selecting the proper (personalized) surgical strategy and the volume of surgical intervention for clinically undetermined regional lymph nodes. The purpose of the study is to evaluate the effectiveness and safety of intraoperative detection of SLN with a 1% toluidine blue aqueous solution. Material and methods The significant tasks are to identify the pattern of TC metastases to cervical lymph nodes, to establish the prevalence of “skip” metastases, to compare the frequency of complications after total thyroidectomy and central neck dissection and lateral neck dissection with total thyroidectomy and central neck dissection, and to determine the feasibility of the application of lateral neck dissections in patients with papillary and follicular TC without metastases to regional lymph nodes (according to physical examination and ultrasound). Results According to our data the SLN identification rate was 97.6%. Sensitivity, specificity, positive predictive value, negative predictive value, and frequency of false negative and false positive results was 89.2, 94.6, 88.03, 95.16, 10.8, and 5.4%, respectively. The most common metastasis was in the central neck compartment (83.7%). Skip metastases were determined in 4.9% of patients. Conclusions The low prevalence of “skip” metastases and a significant risk of postoperative complications (wound exudation, lymphorrhagia, inflammation, hypoparathyroidism, paresis of the vocal cords) support the idea that lateral neck dissection is appropriate only in cases of confirmed metastases by physical examination and/or ultrasound at the preoperative stage.
Папілярний рак щитоподібної залози з біомінералізацією:клініко-морфологічні особливості 1 Сумський державний університет, 2 Сумський обласний клінічний онкологічний диспансер Ключові слова: папілярний рак щитоподібної залози (ПРЩЗ), гідроксиапатит, дистрофічна кальцифікація.Папілярний рак щитоподібної залози (ПРЩЗ) є найпоширенішою формою злоякісних пухлин цього органа, займаючи близько 70% у структурі захворюваності. Патологічна біомінералізація часто є першою діагностичною ознакою при ультразвуковому дослідженні органа.Мета роботи -дослідження клініко-морфологічного значення біомінералізації при папілярному раку щитоподібної залози. Матеріали та методи. Досліджено 30 зразків ПРЩЗ з ознаками біомінералізації та 30 зразків ПРЩЗ без проявів біоміне-ралізації. Під час дослідження використали гістологічні, гістохімічні методи та сканувальну електронну мікроскопію з рент-генівською дифракцією. Усіх пацієнтів із ПРЩЗ, в яких виявлені ознаки патологічної біомінералізації (30 осіб), об'єднали у І групу -27 жінок і 3 чоловіки (9:1); середній вік пацієнтів -56,93±2,18 року. У хворих І групи діагностували різні гістологічні варіанти ПРЩЗ: 22 випадки класичного варіанта, 3 -дифузно-склеротичного, по 2 -фолікулярного та висококлітинного й 1 випадок солідного варіанта ПРЩЗ.Результати. Пацієнти, які мали ПРЩЗ без ознак мінералізації, ввійшли до ІІ групи: 30 осіб, 24 жінки та 6 чоловіків (4:1). Для І групи встановлено, що максимальний розмір пухлинного вузла в середньому -1,84±0,13 см, в ІІ групі цей показник становив 1,44±0,09 см (р<0,07). Порівнюючи кількість пацієнтів із метастазами в обох групах (7 -І група, 8 -ІІ група) та характеризуючи розміри пухлинних вузлів за умов наявності і відсутності метастазів у хворих (2,09±0,2 см та 1,31±0,17 см), виявили вірогідну різницю між показниками груп (p<0,02).Висновки. Основним мінералом, котрий утворюється внаслідок розвитку патологічної біомінералізації ПРЩЗ при всіх її типах, є гідроксиапатит. Папиллярный рак щитовидной железы с биоминерализацией: клинико-морфологические особенностиПапиллярный рак щитовидной железы (ПРЩЖ) является наиболее распространённой формой злокачественных опухолей этого органа, занимая около 70% в структуре заболеваемости. Патологическая биоминерализация часто является первым диа-гностическим признаком при ультразвуковом исследовании щитовидной железы.Цель работы -изучение клинико-морфологических особенностей биоминерализации при папиллярном раке щитовидной железы.Материалы и методы. Исследовано 30 образцов ПРЩЖ с признаками биоминерализации и 30 образцов без биоминерализа-ции. В ходе исследования использовали гистологические, гистохимические методы и сканирующую электронную микроскопию с рентгеновской дифракцией. Все пациенты с ПРЩЖ, у которых обнаружены признаки патологической биоминерализации, были объединены в I группу (30 человек) -27 женщин и 3 мужчин (9:1). Средний возраст больных -56,93 ± 2,18 лет. У паци-ентов I группы диагностировали различные гистологические варианты ПРЩЖ: 22 случая классического варианта, 3 случая диффузно-склеротического, по 2...
Introduction. Treatment of patients with thyroid cancer (TС) with clinically undetected metastases to regional lymph nodes remains an unsolved problem of modern oncology. The search for reliable diagnostic methods, which underlie the decision to perform an adequate lymphadenectomy for TC, is one of the priorities of oncosurgery. The aim of the research: to find an effective method of intraoperative contrasting of sentinel lymph nodes (SLN) in patients with TC using toluidine blue and to evaluate its effectiveness. Methods. A study of 123 patients with TC who underwent surgical treatment using the contrast-visual method in the amount of thyroidectomy with central and bilateral selective cervical lymph node dissection (levels VI; IIA; III; IV). During surgery, a 1% solution of toluidine blue was injected into the tumor using a syringe. Surgical treatment was performed in two stages. At the first stage – thyroidectomy was performed in a block with a central lymphatic collector of the neck (level IV), which included removal of paratracheal, prelaryngeal, parathyroid tissue of the neck. Urgent intraoperative histological examination of thyroid tumor and distant SLN was performed. In the second stage of the operation performed cervical lymph node dissection with removal of fiber IIA; III; IV levels of the neck, with mandatory revision of the level of VB. After the operation, the final histological examination of the removed specimen with the tumor and all lymph nodes was performed. Results. After the application contrasting technique, SLN were found in 120 (97.6%) patients. Their number varied from 2 to 12. These lymph nodes were mainly localized in the central collector of the neck on the side of the primary tumor (central, ipsilateral SLN) in 91 (75.8%) patients. Based on the results of an intraoperative study of SLN, metastases were found in 33 (27.5%) of 120 patients. In most cases (83.3%) SLNs were detected in the central lymphatic collector of the neck (level VI). In 76 (63.3%) patients, staining of the lymph nodes of the III level of the neck (middle ipsilateral jugular lymphatic collector) occurred, in 11 (9.2%) SLNs were found only at levels III, IV and VB of the neck. Very rarely (5.8%), the lymph nodes of the anterior-superior mediastinum were contrasted. Conclusions. The method of contrast visualization of the regional collector in patients with TC using a 1% solution of toluidine blue is a highly informative study that allows to determine the regional lymph nodes affected by metastases and to differentiate the choice of the volume of lymph node dissection in the early stages of tumors. The method is simple to implement, does not involve considerable costs and can be recommended for use in oncology clinics.
Introduction. Thyroid cancer ranks ninth in the structure of malignant neoplasms. Since the 1980s, most countries in the world have seen a rapid increase in the incidence rate and a relatively stable or even decreasing mortality rate. The objective of our study was to analyze the thyroid cancer morbidity and mortality trends in the Sumy region during 2014–2021, to study the prevalence of histological variants and sex-age-specific characteristics, and to compare them with all-Ukrainian and global data. Study results. According to the National Cancer Registry of Ukraine, 24,626 people were diagnosed with thyroid cancer between 2014 and 2021, including 4,556 men (18.5%) and 2,0070 women (81.5%). On average, 3078.25 ± 136.15 people were diagnosed per year. The incidence rate among women is 3.8 times higher than among men. The average incidence rate in Ukraine in 2014–2021 was 6.5 per 100,000 population, while in the Sumy region – 8.9 per 100,000 population. The average mortality rates among residents of the Sumy region and Ukraine did not differ and amounted to 0.4 per 100,000 population. A distinctive feature was represented by the lower male and higher female mortality rates in the Sumy region compared to all-Ukrainian indicators (0.2 versus 0.3 per 100,000 population and 0.6 versus 0.4 per 100,000 population, respectively). The study of histological types of thyroid malignancies demonstrated that papillary variant was most common (70.5 to 81.9%). The specific share of follicular cancer ranged from 12.8 to 19.2%. The medullary variant occured much less often – in 1.5 to 4.6% of cases, while undifferentiated and squamous cell cancer was extremely rare (0.2 to 3.3% of cases). In Buryn district, Velyka Pysarivka district, Konotop district, Krasnopillia district, Krolevets district, Lebedyn district, Nedrygailiv district, Putyvl district, Sumy district, Trostyanets district and the city of Sumy, a significantly higher incidence rate was observed. Women aged 50–64 and men aged 55–69 are most often affected in Ukraine. The highest mortality rate is reported for the age range of 70–84 years for both males and females. Conclusions. During 2014–2021, the incidence and mortality rates among the population of Ukraine remained at a stable level and were lower compared to global indicators. Since 2017, the Sumy region has been presenting with a decrease in the incidence rate, which corresponds to European trends. In the Sumy region, papillary thyroid cancer remains the most common histological variant. In general, the shares of papillary, follicular, medullary, and anaplastic cancers are consistent with the European figures. In general, the age trends in Ukraine and other countries of the world are similar.
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