According to the results of the ultrasound method, 60 patients aged 21 to 83 years.Patients were divided into three groups (according to the Bethesda System). The 3rd group was prognostically important among them: smoking; working in harmful conditions; the tendency of genetic predisposition to pathology of the thyroid gland). It was found that for patients of group 1 with is characterized by a probable decrease in hemoglobin (103,3 ± 7.1 g / l), Mean Corpuscular Hemoglobin (26,4 ± 1.8 pg) and Mean Corpuscular Hemoglobin Concentration (296,2 ± 7,4 g / l). . The 2nd group is characterized by a probable decrease in the total number of platelets (220,4 ± 39,5×109 / l) and platelet count (0,25 ± 0.04 %), as well as an increase in the Mean Platelet Volume (11,23 ± 0,28 fl) and the percentage of platelet large cell ratio (35 ± 2,5 %). Indicators of blood in the malignant process in the thyroid gland differ significantly in the number of white blood cells (9,55 ± 1,51×109/ l) and the proportion of eosinophils (4,33 ± 1,51 %) and basophils (0,68 ± 0,12 %).
Thus, despite the fact that the average level of TSH in the serum of patients of all groups did not exceed the reference range, it had its own differentiation. Benign nature of the formation (1,45 ± 0,28 μIU / l); tumor malignancy is suspected (1,57 ± 0,23 μIU / l) and malignancy (2,00 ± 0,14 μIU / l), respectively. In benign thyroid lesions, the level of fT4 was (11,91 ± 2,09 pmol / l). In contrast, the vast majority of patients with suspected malignancy (4,17 ± 1,39 pmol / l) and the malignancy itself (5,46 ± 2,19 pmol / l) had lower values.
Due to the results of the assessment of the concentration of fT3 in the serum of the majority of patients, their values were also not found of the reference interval. In particular for benign formations (5,61 ± 0,22 pmol / l) and in case of suspicion of malignancy (6,43 ± 0,45 pmol / l), and in case of malignant lesion (5,10 ± 0,36 pmol / l) compared to previous ones. Thyroid index (TI) and progressive peripheral conversion index (IpPC) differed significantly between groups (p <0,01) and were the highest of patients with benign tumors — TI≥16,0; IpPC≤2,0; with suspected malignancy — TI ≤10,0; IpPC≤0,7; in malignancy — TI≤7,0; IpPC≤ 1,2.The value of the level of cancer-embryonic antigen (CEA) in the serum was studied for the first time. A direct influence between the indicators of the observation groups (r = 0,33) was revealed. In benign thyroid lesions, the average level of CEA was 1,23 ± 0,35 ng / ml. In patients (group 2), this figure was — 2,06 ± 0,28 ng / ml. Whereas in group 3 its level was 16,69 ± 1,0 ng / ml, which is higher than the reference value in contrast to the previous two. In the 2nd group of patients there was an increase in the intensity of the reaction with antibodies to thyroglobulin: only in 20,0 % of cases the expression was weak, and in 80,0 % — moderate (p <0,001 compared with the 1st group). Patients in group 3 with BSRTC-VI category had high thyroglobulin expression in 63.6 % of patients, moderate — in 9,1 %, a negative result was obtained in 18,2 % of cases (p <0,001 against data in the 1st and 2nd groups). In the benign process in all cases the negative status of TTF-1 expression was established, in the 2nd group on tumor malignancy – a weak reaction (+) in 100 % of patients (p <0.001), in the 3rd group — in 18, 2 % of cases strong expression, in 72.7 % — moderate, in 9.1 % — weak (p <0.001 compared to previous groups).The presence of a positive reaction of E-cadherin was noted in all biopsies (100 %) with suspicion of malignancy (group 2), including weak was observed in 90,0 % of cases, moderate — in 10,0 %.Strong expression of cytokeratin-19 was observed in 40,0 % of cases with BSRTC-V and 45,4 % with BSRTC-VI, moderate — in 50,0 % and 36,4 % of cases, respectively, weak – in 10,0 % and 18,2 %, without significant differences between groups (p> 0,05). The scientific innovativeness.The three-stage principle of complex diagnostics of thyroid neoplasms is substantiated on the basis of prognostic values of current methods with the subsequent objectified grouping.For the first time, a direct correlation between the level of cancer-embryonic antigen in the serum and the Bethesda system for the assessment of thyroid cytology was proved.It was found that the substantiated immunocytochemical panel has prognostic value for the diagnosis of thyroid neoplasms at the preoperative stage.The practical significance of the obtained results is that the threshold values of general clinical and immunochemical research methods are established within the reference ranges, which allows providing a differentiated approach to the diagnosis of thyroid tumors. For the first time, the prognostic property of cancer-embryonic antigen at the preoperative stage of diagnosis of thyroid tumors was revealed. The expediency of CEA application at the preoperative stage of diagnosis is proved.
