DIAGNOSTIC SIGNIFICANCE OF SOME ULTRASONOGRAPHIC PARAMETERS IN THE HIDDEN CLINICAL COURSE OF THYROID CARCINOMA

R. ZAMANOV, N. ALIYEVA, R. MAHMUDOV

Scientific Surgical Center named after ac. M.A.Topchubashov. Baku, AZERBAIJAN

Introduction.The role of ultrasonographic examinations widely applied in the clinical practice in the hidden clinical course of thyroid carcinoma have been investigated very slightly, and was not properly systemized.

Purpose: To study diagnostic significance of “gray-mode” general ultrasound, color Doppler mapping and energy mapping analyses performed preoperatively in in patients with postoperatively detected thyroid carcinomawith hidden clinic course by means of retrospective analysis.

Materials and methods. The population consists of 201 patients with asymptomatic thyroid cancer postoperatively detected in 2000-2009.Possible diagnostic significance of the following indicators of ultrasonographic examination conducted in preoperative period were studied: sizes of the parts of the organ, enlargement nature of the organ (diffuse, nodular, mixed, diffuse-nodular), number of nodular enlargement (single or multiple), sizes of nodular enlargements, homogeneityorheterogeneity of the enlargement area, sizes of regional lymphatic nodes, echo-structure. In addition to general ultrasound analysis of the organ, vascularization type of the nodular formation in the dopplerographic mapping, maximum systolic speed of blood flow, resistance index, speed of blood flow in upper thyroid artery were also determined.

Results.“Hypoechogeneity, heterogeneity, indistinct limits and unclear countours” of nodular formation, is in only weak statistically significant direct proportion tothyroid carcinomawith hidden clinical course, as compared to strong relation during clinically express carcinoma (r=0,35; p<0,05; c²=11,9). In preoperative period, there is relation in just some morphologic types and variants of thyroid carcinomawith hidden clinical courseand ultrasound conditions of regional lymphatic nodes, which requires systematic investigations. At least 4 types of the organ and its internal nodular vascularization were systemized. There was found high statistically reliable inversely proportional correlation between “mixed type vascularization” and “thyroid carcinoma” (r=0,74; p<0,03; c²=27,8).In 33.3% of patients “maximum systolic speed” and “the speed of blood flow in upper thyroid artery” has increased, and the resistance index, has decreased. But the changes do not have statistically significant relation with thyroid carcinoma with hidden clinic course.

Conclusion. There are few preoperative general and Doppler-ultrasonographic determination criteria of thyroid carcinoma with hidden clinic course, they are not completely studied and this situation necessitates conduct of systemized investigations in this direction.

ON THE OPTIMIZATION OF THE VOLUME OF SURGICAL OPERATIONS DURING THYROID CARCINOMAS WITH HIDDEN COURSE

R. ZAMANOV, O. SHAHSUVAROV, Y. GULIYEV

Scientific Surgical Center named after ac. M.A.Topchubashov. Baku, AZERBAIJAN

Introduction. There are still difficulties in the diagnostics, selection of treatment tactics and forecasting of thyroid carcinoma with hidden clinic course. In the majority of cases diagnosis is set in only postoperative pathomorphplogic analysis. This leads to radical changes in the treatment tactics and forecasting in postoperative period.

The purpose Todetermined optimal volume of initial surgical intervention by the comparative analysis of the development, recurrence and metastasis of thyroid carcinoma with hidden course in the postoperative period after various volumes of surgeries.

Materials and methods. Retrospective analysis of materials of 201 patients with postoperatively thyroid cancer was carried out in 2000-2009. Patients were divided into 3 main groups according to the volume and variant of initial surgical operation: 1) strumectomies and partial resections; 2) subtotal thyroid resections; 3) thyroidectomies. Each of the 2^nd and 3^rd clinical groups were divided into 3 subgroups: patientswithout lymphodissection; withsimple(limited) regional limphodissection and with expanded lymphodissection. 1, 2, 3, 5 and 10 years after the operation there was conducted corellative statistical analysis by means of non-parametric statistical methods(p; r; c²) between the recurrence, metastasis and volume of concrete surgical intervention.

Results. In the period after simple strumectormy, recurrence and metastatis indicator of the majority of clinical and morphologic variants of thyroid carcinoma within 24-36 months, are statistically significantly higher than in other groups: for recurrence - c² = 29,7; r = 0,61; p<0,05; for metastatis - c² = 21,1; r = 0,44; p<0,05. Postoperative recurrence and metastasis indicators are lower in papillary, follicular and dimorph (papillary-follicular) thyroid cancers after subtotal resections. In “anaplastic” and medullar types of carcinomas, patients with recurrences are encountered very rarely, and relations are statistically insignificant. However, the metastasis indicators of same type carcinomas within 30,0-60,0 months after the operation increase in statistically significant nature. In patients with actual-total thyroidectomy, relatively optimal results were observed after expanded lymphodissection thyroidectomy operations, despite the lack of statistically significant difference from the main parameters of the previous clinical group.

Conclusion. In patients with thyroid carcinomawith hidden course, two of the factors of surgical intervention in the postoperative period: that is, prognostic positive significance of 1) degree of efficacy of the elimination of initial formation: 2) scope of lymphodissection level were proved.

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Date: 2014-12-28; view: 890