Chernyshov S. Regional lympf nodes metastases of papillary thyroid carcinomas in children and adolescents: clinical characteristic, diagnostic and surgery treatment

Object of the study: malignant tumours of thyroid gland (TG). Aim of the study: to determine the adequacy of treatment of patients of child's and adolescent's age in case of papillary thyroid carcinoma. Based on a study of clinico-morphological features of the tumours detected in the period after the Chornobyl sccident, to develop a protocol of diagnosis and surgical treatment of metastatically invaded regional lymph nodes, aimed at improving the effectiveness of surgery. Methods of study and equipment: clinical, instrumental, surgical, histological, statistical methods; ultrasound device "Toshiba 240", cryostat, electron microscope "Leica" and microscope "Zeiss" (Germany). Theoretical and practical results: based on a combined analysis of ultrasound examinations, results of use of preoperative and intraoperative diagnostic methods, taking into consideration structural, invasive features of papillary thyroid carcinomas (PTC), tumour size, localization in TG, and metastatic spreading to cervical lymphnodes (CLN) of different sectors; a protocol of diagnosis of metastatic injury of CLN and surgical intervention on regional collectors of lymph drainage has been developed. A differential approach to the volume of surgery on regional collectors of lymph drainage has been proposed, based on an analysis of data of stage-by-stage express-histological analysis of morphological features of PTC and lymph nodes of different collectors of the neck, and based on a comparison of the results of surgical treatment, data of postoperative scintigraphy with NaI-131 and structural changes in the relapses of regional metastases in remote terms after primary surgical treatment. Novelty: for the first time a relationship has been established between histological structure of PTC, its invasive properties, localization in the thyroid, and peculiarities of regional metastatic spreading in children and adolescents of Ukraine, who had been operated on after the Chornobyl accident. The rationale has been proved, of a combined stage-by-stage express-histological analysis of thyroid tumours and lymph nodes of regional collectors of the neck. A comparative analysis has been carried out, of the results of surgical treatment and postoperative scintigraphy with NaI-131 in children and adolescents. Significant changes have been established in structural features of metastases, directed towards an increasing aggressiveness of the process in metastases detected in 1-7 years after primary surgery. Degree of introduction: the results may be used in the treatment of patients with thyroid neoplasms. Sphere of application: endocrinology, surgery, oncology.