O.I. Kaganov, V.A. Solovov, A.A. Makhonin, O.N. Ablekova, A.A. Fedulov
Samara Regional Clinical Oncological Dispensary, Samara
Kaganov O.I. — MD, Professor, Head of the Department of Oncology, Chief Doctor of Samara Regional Clinical Oncological Dispensary
Address: 50 Solnechnaya St., 443031 Samara, tel.: +7 (846) 994-06-99, e-mail: o.kaganov@yandex.ru, ORCID ID: 0000-0003-1765-6965
Abstract. Thyroid cancer accounts for approximately 4.0–6.5% of all thyroid neoplasms. The current European guidelines for ultrasound-based thyroid nodule risk stratification (European Thyroid Imaging Reporting and Data System, EU-TIRADS) rely mainly on criteria derived from papillary thyroid carcinoma, while cytological diagnostics does not always allow differentiating the malignant neoplasm variants. As a result, other histological variants are often categorized as having intermediate or low malignancy risk.
The study objective was to assess the diagnostic potential of ultrasound and cytology in different variants of thyroid cancer.
Material and methods. The retrospective study included the results of preoperative ultrasound examination of the thyroid gland and fine-needle aspiration biopsy in 2,626 patients who underwent thyroid surgery at the Samara Regional Clinical Oncological Dispensary between 2020 and 2024. Among them, 834 patients (31.8%) had papillary thyroid carcinoma (PTC), 31 (1.2%) had medullary thyroid carcinoma (MTC), 17 (0.6%) had follicular thyroid carcinoma (FTC), 553 (21.1%) had follicular adenoma (FA), and 1,191 (45.3%) had nodular goiter (NG).
Results. The diagnostic sensitivity and accuracy of ultrasound were 71.9 and 75.7% (AUC = 0.8021) for PTC, 48.6 and 80.4% (AUC = 0.6203) for MTC, 47.1 and 81.4% (AUC = 0.6749) for FTC. The diagnostic sensitivity and accuracy of cytological examination were 97.7 and 79.5% (AUC = 0.9719) for PTC, 85.7 and 49.7% (AUC = 0.8965) for MTC, 64.7 and 47.9% (AUC = 0.7037) for FTC.
Conclusion. The standard diagnostic algorithm based on ultrasound (TIRADS) and fine-needle aspiration biopsy is optimal for detecting papillary thyroid carcinoma but has significant limitations for medullary and follicular carcinoma. A combined approach that integrates sonography, cytology, laboratory tests, and modern ultrasound imaging technologies may ensure timely detection of these variants and improve patient outcomes.
Key words: thyroid cancer, ultrasound diagnostics, TIRADS, fine-needle aspiration biopsy, Bethesda