Cytological features of the diagnosis of recurrent nodular hyperplasia of thyroid gland
DOI:
https://doi.org/10.63341/ijmmr/1.2025.95Keywords:
cellular atypia, hypoechoic structure, fibrous transformation, risk stratification, neoplastic transformationAbstract
The study aimed to improve diagnostic approaches to the assessment of recurrent nodal tumours in the remaining thyroid tissue after surgical treatment, incorporating morphological, ultrasound and clinical and anamnestic features. The methodology included the examination of 69 patients with recurrent lesions classified as Bethesda categories III and IV, who underwent fine-needle aspiration core biopsy under ultrasound imaging, Doppler ultrasound with blood flow assessment, histological verification, and immunocytochemical staining. The results showed that in the Bethesda III group, the presence of malignant tumours was confirmed in 37% of cases, while in Bethesda IV only 24%, which casts doubt on the traditional notions of the risk of neoplasia in these categories. The Bethesda III was dominated by signs associated with malignancy: hypoechogenicity (57%), vertical orientation of the nodule (43%), intranodular blood flow (57%), and indistinct or irregular contours (25%). In group IV, follicular adenomas with benign echostructural features were more common (38%). Three morphotypes were identified: proliferative (69.6%), pseudo-recurrent inflammatory
fibrous (14.5%) and true neoplastic (13%), with severe cellular atypia recorded in 2.9% of cases. A low correspondence between cytological and histological results (12-16%) was found, which justifies the need for a comprehensive diagnosis. The study determined that the presence of three or more independent risk factors significantly increases the probability of neoplastic transformation. The practical significance of the study is the formation of a multifactorial stratification system that can increase the accuracy of preoperative diagnosis, justify the choice of surgical tactics and reduce the frequency of misdiagnosis in clinical practice
Received: 08.08.2024 | Revised: 30.01.2025 | Accepted: 27.05.2025
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