The condition of lymph nodes of the neck is one of the important factors in determining the treatment tactics and its outcome in patients with malignant tumors of the thyroid gland.
The aim of the study was to improve the effectiveness of the diagnosis of metastatic lymphatic lesion in malignant tumors of the thyroid gland.
Ultrasound investigation was performed in 110 patients with malignant tumors of the thyroid gland. Ultrasound examination of patients was carried out on Aloka SSD 5500 (Aloka com.) devices with a linear sensor with a frequency of 10 MHz, using polyposition seroscale scanning (V-mode) and color Doppler mapping (CDK) in real time.
Research results. The analysis of sonographic features of altered lymph nodes revealed that metastatically affected lymph nodes in papillary thyroid cancer had an inhomogeneous structure of 89.1% due to the presence of calcinates, psammomnium cells. In follicular cancer, metastatically altered lymph nodes in 93.3% had homogeneous structure. In medullary cancer, lymph nodes had irregular shape of 75.5%, irregular 72.7% and fuzzy contours of 63.6%. The homogeneity of the structure depended on the presence of amyloid. Regardless of histological variant of thyroid gland cancer, in most cases metastatic lymph nodes had rounded shape, there was a violation of differentiation of cortical substance and sinus. In 79.6% of ultrasound in metastatic lymph nodes that did not contain necrotic masses, there was a diffuse increase in vascularization with atypical vascular pattern.
Thus, a comprehensive ultrasound examination is a highly informative method in the diagnosis and differential diagnosis of lymphatic metastases of thyroid cancer, with a sensitivity of 90%. Metastatically altered lymph nodes were detected in 19% of cases in sonography, which were not clinically determined.
EXPERIENCE IN AUTO-FLUORESCENT STUDIES OF THYROID CANCERS
In our study we studied the diagnostic possibilities of the method of auto-fluorescent examination of malignant tumors of the thyroid gland.
The essence of Autofluorescent study: when irradiating the investigated area of tissue with laser radiation of red color (wavelength 635 nm), photochemical reaction takes place in the porphyrin molecules that are part of the structure of cells and tissues (nucleotides, ge-moglobin, myoglobin, cytochromeidr). The excited molecules emit a quantum of light when returning to their normal state. As a result, they form their own, endogenous, auto-fluorescent radiation, by physical parameters different from the original, excitatory.
The more intensively the cells are divided, the brighter the auto-fluorescent radiation emanating from them. At the same time, the intensity of autofluorescence makes it possible to reliably judge the nature of proliferative processes in the studied tissue area: physiological proliferation; healing of a wound defect, benign or malignant tumor, etc.
We investigated 13 thyroid surgery drugs removed for malignant tumors. The examination was performed immediately after organ removal during the operation (within 30 minutes).
As a diagnostic criterion, we assessed the ratio of auto-fluorescence of the tumor to the surrounding unchanged tissue.
In all observations (100%), this ratio exceeded 30% (empirically established threshold level of auto-fluorescence indicating high proliferative activity in formation).
The obtained data are fully consistent with the results of auto-fluorescent studies of malignant tumors of other localizations.
The results allow further in-depth studies on the prospects of using the method for urgent intraoperative diagnosis of thyroid cancer.