Korkelia A. Development of individual approaches to the volume of operations in patients with papillary thyroid cancer

The paper presents the solution of the problem of treatment of patients with papillary cancer of the thyroid gland by developing individual approaches to the choice of the volume of surgery depending on the data of the clinical, instrumental, histological and immunohistochemical study of the tumor. The study is based on the results of the examination and surgical treatment of 273 patients who were divided into 2 groups: I - the comparison group - 155 patients, in which the traditional approaches were used, II - the main - 118 patients, in which, mainly applied organo-friendly approaches and close Immunohistochemistry was performed in 53 patients with standard histological examination.The application of ultrasound diagnosis and biopsy (TIRADS and TBSRTC system) according to the proposed diagnostic algorithm increased the sensitivity to 96.7% and the specificity to 85.7% compared with the traditional use of TIRADS and TBSRTC systems (sensitivity 85.3%, specificity 81,6%). The evaluation of the histological type of tumor revealed that the adenocarcinoma of the cylindrical cells was characterized by the highest aggressiveness. An analysis of immunohistochemical markers has shown that over-expressing ki67 and TTF1, as well as loss of ability to express NIS, indicate a greater malignant tumor potential. Formulated individualized indications for organ organopreserving operations taking into account aggressive forms of papillary cancer, including the use of histologic and immunohistochemical markers of aggressiveness of the tumor, which allowed performing organopreserving operations in 53,6% of patients and reducing the number of early complications from 17,4% to 11,9% , organopreserving approaches in the core group improved functional results, reducing the incidence of hypothyroidism and side effects of substitution therapy. Key words: papillary carcinoma of the thyroid gland, organoscandy approaches immunohistochemistry, results of surgical treatment.