THE VALUE OF ULTRASONIC STUDY USED AS A COMPONENT OF THE McGill THYROID NODULE SCORE+ (MTNS)
Timofeeva L.A.1,2, Aleksandrov Yu.K.3, Stepanov V.G.1,2
1 - I.N. Ulianov Chuvash State University. Cheboksary, Russia.
2 - Republican clinical oncological dispensary. Cheboksary, Russia.
3 - Yaroslavl state medical University. Yaroslavl, Russia.
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urpose. To evaluate the impact of ultrasound findings on the overall assessment of focal pathology of the thyroid gland using the McGill Thyroid Nodule Score+.
Materials and methods. Data from the 211 clinical cases of the patients with thyroid nodules of various morphological structures were analyzed: benign non-tumor thyroid diseases (group 1) – 91 cases, benign thyroid tumors (group 2) – 60 cases, thyroid cancer (group 3) – 60 case. Before surgical operations, all patients underwent ultrasound examination of the neck organs, including the thyroid gland. A standard ultrasound protocol was used, including B-mode, color Doppler and power Doppler.
The selection criteria for this study were the presence in medical records of data necessary for scoring within the framework of the McGill Thyroid Nodule Score+ scale. As a result, 19 parameters were taken into account (4 parametric and 15 non-parametric), including 7 ultrasonic features.
Results. As a result of the study, according to the criteria of the adapted McGill Thyroid Nodule Score scale, patients with nodular goiter "scored" from 2 to 11 points. In patients with thyroid adenomas, the spread of indicators was from 4 to 28 points. In the group of patients with thyroid cancer, the indicators were from 12 to 31 points.
In cases of follicular colloidal goiter clinical and laboratory signs are of primary importance (the most significant were the size (tKendall = 0.418602; p-value = 0.000000) and palpability of large nodes (tKendall = 0.452689; p-value = 0.000000). In cases of thyroid tumors (adenomas and cancer) ultrasound and cytological examination data were prioritized (atypia - tKendall = 0.547138; p-value = 0.000000). Ultrasound criteria in groups of the patients with different morphology had different parameters, the signs of "echogenicity" had the greatest significance (tKendall = -0.406347; p-value = 0.000004), "height >width" (tKendall = 0.404337; p-value = 0.000005) and "calcification" (tKendall = 0.342115; p-value = 0.000112).
Discussion. Diagnosis of thyroid nodules is a task with many components. The complex polyparametric Scale McGill Thyroid Nodule Score, including ultrasound, is the optimal solution to the problem. Ultrasound signs have different high significance depending on the morphological variant of thyroid pathology. In particular, the sign "calcifications" and its gradations have different interpretations depending on the nature of the pathology. In the diagnosis of thyroid tumors, ultrasound and morphological examination data are of greater importance, and clinical signs fade into the background. In the diagnosis of thyroid cancer the most significant are ultrasound signs "height" > "width" and "microcalcifications", which have a high diagnostic weight.
Conclusion. The McGill Thyroid Nodule Score differs from the narrowly focused TI-RADS and Bethesda systems in its breadth of coverage of a large number of data that complement each other. The value of ultrasound signs on the scale has a different diagnostic weight for different focal pathologies of the thyroid gland. Their presence in colloid nodes and tumors of varying degrees of malignancy forces a differentiated approach to their assessment.
Keywords: ultrasound examination, focal pathology, thyroid gland, McGill Thyroid Nodule Score+.
Corresponding author: Timofeeva L.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Timofeeva L.A., Aleksandrov Yu.K., Stepanov V.G. The value of ultrasonic study used as a component of the McGill Thyroid Nodule Score+ (MTNS). REJR 2023; 13(4):44-55. DOI: 10.21569/2222-7415-2023-13-4-44-55.
Received: 10.10.23 Accepted: 30.10.23