"Zaļais koridors" pacientiem ar vairogdziedzera vēzi: pacientu plūsmas un diagnostikas iespēju analīze viena centra ietveros.
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Darba mērķis: Izvērtēt “Zaļā Koridora” efektivitāti, vairogdziedzera ultrasonogrāfijas un citoloģiskās izmeklēšanas diagnostisko vērtību.
Darba metodes un materiāli: Tika veikts retrospektīvs pētījums viena centra ietvaros trīs gadu laikā (2019-2021). Visi dati tika iegūti no Rīgas Austrumu klīniskās universitātes slimnīcas (RAKUS) stacionāriem Ģaiļezers un Latvijas Onkoloģijas centra (LOC). Pētījuma populācija bija pacienti, kuri tika nosūtīti caur Zaļo koridoru ar diagnozi «Izmeklēšana iespējama vairogdziedzera ļaundabīga audzēja dēļ» (kods Z03.173). Nepieciešamie dati pētījumam tika analizēti un aprakstīti.
Rezultāti: No 563 pacientiem vairogdziedzera vēzis tika pierādīts 153 pacientiem (27,2%), no kuriem sievietes bija 123 (80,4%) un vīrieši - 30 (19,6%).Vidējais vecums bija 53,5 ± 14,3 SD gadi. No visiem pacientiem 147 cilvēkiem (26%) tika veikta ķirurģiska ārstēšana un postoperatīvi histoloģiski apstiprināts vairogdziedzera vēzis. No operētiem cilvēkiem 114 (77%) citoloģisko izmeklēšanas rezultāti sakrita ar pēcoperācijas histoloģisko analīzi, jeb tika pierādīta malignitāte. Visvairāk bija pacientu ar papillāro vēži (72.8%, n=107). Otrā vietā- papillāra vēža folikulārajam variantam (trīs gados 17,0%). Medulāra vēža izplatība bija augstāka nekā folikulāram vēzim, ( 5,4%,n=8 vs2,0%, n= 3).No visiem vairogdziedzera vēžiem visbiežāk tika verificēti TIRADS 4a (34%; n=50) un 4b (29,3%;n=43). Citoloģisko lielāka prevalence izlasē bija Bethesda VI pakāpei - 49%,n=72; Bethesda V – 36%, n=53; Bethesda IV - 7%, n=10; Retākā no citoloģiskām atradnēm bija Bethesda III pakāpe -5%, n=8 un Bethesda II - 3%, n=4. Vislielākais pacientu skaits, kam tika apstiprināts vairogdziedzera vēzis patohistoloģiski, arī citoloģiski bija aizdomas par malignitāti vai malignitātes pazīmes, respektīvi diagnosticēti Bethesda III - VI pakāpes (97,3%, n=143). FNA rezultāts un histoloģijas rezultāts pētāmajiem pacientiem atbilda vairogdziedzera papillāram vēzim 96% (n=78) gadījumos (no visiem papillāriem vēžiem, n=91). Savukārt folikulārās karcinomas gadījumā tikai 8% jeb vienam pacientam. Folikulārs vēzis, kas uzradīts FNA, 4% (n=1) gadījumos atbilda papillāram vēzim, kas pieradīts ar postoperatīvu histoloģiju (no visiem folikulāriem vēžiem, n =3) . 75% (n=3) gadījumos FNA un histoloģijas rezultāti uzradīja medulāro vēzi (no visiem medulāriem vēžiem, n=4)
Secinājumi: Visbiežāk sastopamais vairogdziedzera ļaundabīgais audzējs RAKUS stacionāra ietvaros bija papillārais vēzis. Vairogdziedzera ultrasonogrāfija ir efektīva vēža skrīninga metode, kas ļauj pieņemt lēmumu par turpmāku citoloģiskās izmeklēšanas nepieciešamību. FNA ar sekojošu citoloģisko izmeklēšanu ir liela diagnostiskā vērtība, kam ir būtiska nozīme, pieņemot lēmumu par ķirurģiskās ārstēšanas nepieciešamību. Vairogdziedzera vēža diagnostikā un ārstēšanā “zaļais koridors” ir relatīvi efektīvs, ņemot vērā pētījuma rezultātus, bet to var uzlabot, optimizējot pacientu plūsmu.
Objectives: To evaluate the efficiency of the "Green Corridor", the diagnostic value of thyroid ultrasonography and cytological examination. Materials and methods: A retrospective study was conducted within one center for three years (2019-2021). All data were obtained from Riga East Clinical University Hospital (RECUH) inpatient centers and Latvian Oncology Center (LOC). The study population was patients who were referred through the Green Corridor with the diagnosis "Investigation due to possible thyroid malignancy" (code Z03.173). The data required for the study were selected from patients histories, which were analyzed and described. Results: Of the 563 patients, thyroid cancer was diagnosed in 153 patients (27.2%), of whom 123 (80.4%) were women and 30 (19.6%) were men, with a mean age of 53.5 ± 14.3 SD years. Of all patients, 147 (26%) underwent surgery and postoperatively histologically confirmed thyroid cancer. Of the operated subjects, 114 (77%) had cytological examinations consistent with postoperative histological analysis or evidence of malignancy. The overall prevalence of papillary cancer at three years was 72.8%, n = 107. In turn, the second place in terms of prevalence has papillary cancer - the follicular variant (17.0% in three years). The overall prevalence of medullary cancer is higher than of follicular cancer by three years (5.4%, n = 8 vs2.0%, n = 3). Of all thyroid cancers confirmed histologically, mostly verified TIRADS 4a (34%; n = 50) and 4b (29.3%; n = 43). The highest cytological prevalence in the sample were Bethesda grade VI - 49%, n = 72; Bethesda V - 36%, n = 53; Bethesda IV - 7%, n = 10; Rare cytological findings were Bethesda III grade -5%, n = 8 and Bethesda II grade 3%, n = 4. The highest number of patients with pathohistological evidence of thyroid cancer was suspected to have malignancy or signs of malignancy, respectively, diagnosed with Bethesda grade III-VI (97.3%, n = 143). The FNA and histology score in the study patients corresponded to 96% (n = 78) of thyroid papillary cancer (of all papillary cancers, n = 91). In contrast, in the case of follicular carcinoma only 8% or one patient. Follicular cancer reported in the FNA corresponded to papillary cancer as evidenced by postoperative histology in 4% (n = 1) (of all follicular cancers, n = 3). In 75% (n = 3) cases, FNA and histology showed medullary cancer (of all medullary cancers, n = 4) Conclusion: The most common thyroid malignancy within the RECUH hospital was papillary cancer. Thyroid ultrasonography is an effective method of cancer screening that allows a decision to be made about the need for further cytological examination. FNA with subsequent cytological examination is of great diagnostic value and plays a key role in deciding whether surgical treatment is required. The Green Corridor is relatively effective in diagnosing and treating thyroid cancer based on the results of the study, but can be improved by optimizing patient flow.
Objectives: To evaluate the efficiency of the "Green Corridor", the diagnostic value of thyroid ultrasonography and cytological examination. Materials and methods: A retrospective study was conducted within one center for three years (2019-2021). All data were obtained from Riga East Clinical University Hospital (RECUH) inpatient centers and Latvian Oncology Center (LOC). The study population was patients who were referred through the Green Corridor with the diagnosis "Investigation due to possible thyroid malignancy" (code Z03.173). The data required for the study were selected from patients histories, which were analyzed and described. Results: Of the 563 patients, thyroid cancer was diagnosed in 153 patients (27.2%), of whom 123 (80.4%) were women and 30 (19.6%) were men, with a mean age of 53.5 ± 14.3 SD years. Of all patients, 147 (26%) underwent surgery and postoperatively histologically confirmed thyroid cancer. Of the operated subjects, 114 (77%) had cytological examinations consistent with postoperative histological analysis or evidence of malignancy. The overall prevalence of papillary cancer at three years was 72.8%, n = 107. In turn, the second place in terms of prevalence has papillary cancer - the follicular variant (17.0% in three years). The overall prevalence of medullary cancer is higher than of follicular cancer by three years (5.4%, n = 8 vs2.0%, n = 3). Of all thyroid cancers confirmed histologically, mostly verified TIRADS 4a (34%; n = 50) and 4b (29.3%; n = 43). The highest cytological prevalence in the sample were Bethesda grade VI - 49%, n = 72; Bethesda V - 36%, n = 53; Bethesda IV - 7%, n = 10; Rare cytological findings were Bethesda III grade -5%, n = 8 and Bethesda II grade 3%, n = 4. The highest number of patients with pathohistological evidence of thyroid cancer was suspected to have malignancy or signs of malignancy, respectively, diagnosed with Bethesda grade III-VI (97.3%, n = 143). The FNA and histology score in the study patients corresponded to 96% (n = 78) of thyroid papillary cancer (of all papillary cancers, n = 91). In contrast, in the case of follicular carcinoma only 8% or one patient. Follicular cancer reported in the FNA corresponded to papillary cancer as evidenced by postoperative histology in 4% (n = 1) (of all follicular cancers, n = 3). In 75% (n = 3) cases, FNA and histology showed medullary cancer (of all medullary cancers, n = 4) Conclusion: The most common thyroid malignancy within the RECUH hospital was papillary cancer. Thyroid ultrasonography is an effective method of cancer screening that allows a decision to be made about the need for further cytological examination. FNA with subsequent cytological examination is of great diagnostic value and plays a key role in deciding whether surgical treatment is required. The Green Corridor is relatively effective in diagnosing and treating thyroid cancer based on the results of the study, but can be improved by optimizing patient flow.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Vairogdziedzera vēzis; TIRADS; tievās adatas aspirācija; histoloģija, Thyroid cancer; TIRADS; fine needle aspiration; histology