Integral diagnostic scale in thyroid surgery

BACKGROUND: An increase in the number of patients with thyroid nodules necessitates a detailed study of diagnostic capabilities that improve the quality of their preoperative verification and the choice of optimal treatment tactics. In this regard, the active improvement and introduction of new high-tech techniques continues, which require justification of the effectiveness of their use in clinical practice.

AIM: To develop an integrated diagnostic scale for assessing the risk of malignancy of thyroid nodules, contributing to the choice of the optimal surgical treatment.

MATERIALS AND METHODS: To assess the validity of the treatment and diagnostic tactics and select the optimal volume of surgical intervention with the development of an original integral diagnostic scale, a retrospective analysis of the results of the examination and treatment of 244 patients with thyroid nodules, as well as a prospective study, including 65 clinical observations, was carried out.

RESULTS: In the course of the study, a systematic approach to the differential diagnosis of thyroid nodules was implemented using the most effective modern methods of laboratory and instrumental examination as part of the development of an original integral scale. It has been proven that the use of an integrated diagnostic scale allows predicting the risk of malignancy of formations: low (3–7%) with 0–5 points, medium (7–35%) — 6–10, increased (35–80%) — 11–15, high (80–96%) — 16–20. It has been established that in patients with an increased and high risk of malignancy, the diagnostic accuracy of  the proposed integrated scale in detecting highly differentiated thyroid cancer increases to 90.2% when determining the expression of Galectin-3 above 31.2% in the puncture material, as well as in papillary carcinoma — up to 100% when the BRAF V600E mutation is detected. The treatment and diagnostic algorithm for clinical use has been optimized, allowing individualization of treatment tactics: for patients with an increased and high risk of malignancy, it is advisable to perform thyroidectomy with central lymphadenectomy; with an average risk — hemithyroidectomy; with low risk in the absence of signs of compression of the neck organs — dynamic observation, and if it is present — resection of the thyroid gland. It is shown that the implementation of a modified diagnostic and treatment algorithm, taking into account the use of an integral diagnostic scale, provides good immediate results of treatment.

CONCLUSION: The introduction of an improved diagnostic and treatment algorithm, taking into account the use of an integrated scale for a comprehensive laboratory and instrumental assessment of thyroid nodules, makes it possible to increase the efficiency of their preoperative differential diagnosis and to choose an individualized surgical treatment option.

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