METHOD FOR SELECTING THERAPEUTIC APPROACH TO THYROID NODULES Russian patent published in 2024 - IPC A61B8/08 G01N33/48 G01T1/164 A61B17/00 

FIELD: medicine; surgery.

SUBSTANCE: complex laboratory-instrumental assessment of the risk of malignancy of thyroid nodules (TN) is carried out on the basis of an integral diagnostic scale on a five-point system from 0 to 4, where 0—absence, and 4—high risk of malignancy. Integral assessment of the results of modern methods of examining the thyroid nodules is carried out by calculating the sum of points of the developed scale. According to the results of thyroid ultrasound with stratification of malignancy risk depending on echographic characteristics according to the international classification system TIRADS: 0 points are assigned to TIRADS 2 category; 1 point—TIRADS 3; 2 points—TIRADS 4a; 3 points—TIRADS 4b and 4c; 4 points—TIRADS 5. When evaluating the results of the cytological examination of the material obtained by puncture fine-needle aspiration biopsy, with a description of the findings within the Bethesda system categories: 0 points is assigned to Bethesda I diagnostic category; 1—Bethesda II; 2—Bethesda IV; 3—Bethesda V; 4—Bethesda VI. Taking into account the technique of semi-quantitative evaluation of two-indicator scintigraphy data with ^99mTc-pertechnetate and ^99mTc-technetril with calculation of the wash-out index: 0 points is assigned if its value is >60%, 1—40–59.9%, 2—20–39.9%; 4—<20%. According to the results of assessing the level of expression of Galectin-3 and the presence of the V600E mutation of the BRAF gene in the puncture material: 0 points have SV with value Galectin-3 <20%, 1—20–39.9%, 2—40–59.9%, 3—60–80%, 4—>80%; detection of BRAF-mutation is evaluated as 4 points, its absence—1 point. Total score of the above laboratory-instrumental methods is calculated: from 0 to 5 points, the risk of malignancy is considered to be low and making 3–6.9%, from 6 to 10 points—medium and making 7–34.9%, from 11 to 15 points—increased and making 35–79.9%, from 16 to 20 points—high and making 80–96%. Derived data on the risk of thyroid nodules malignancy are used to justify the choice of therapeutic approach. In cases of low risk of malignancy in the absence of signs of neck compression, follow-up is recommended, if observing signs of neck compression, thyroid resection of various sizes is performed depending on involvement of lobes in the pathological process. In cases of average risk of malignancy of formations—performing organ-sparing operations in amount of hemithyroidectomy. In cases of increased risk of malignant growths—performing thyroidectomy with an individual solution to the issue of its addition with preventive central lymphadenectomy taking into account BRAF-status. In cases of high risk of malignancy of growths—radical extent of surgical intervention in amount of thyroidectomy with obligatory central lymphadenectomy.

EFFECT: method enables high-accuracy stratification of the risk of malignancy of thyroid nodules, to differentiate their nature and to substantiate the choice of rational tactics of treatment avoiding repeated surgical interventions and development of complications.

1 cl, 7 dwg, 2 tbl, 1 ex