Methods for assessing the malignant potential of thyroid nodes

Yu.S. Solomadin, Yu.P. Sych, V.V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Thyroid cancer (TC) ranks first in prevalence among malignant neoplasms of the endocrine glands. It accounts for 0.5% in the total structure of oncological diseases and up to 5% among head and neck cancers. The main task of the specialist in identifying the thyroid node is to assess the prognosis of tumor mass using ultrasound, radionuclide and molecular genetic diagnostics. The combination of ultrasound, cytological and radiological characteristics of the node makes up its phenotypic image. Ultrasound is the method of choice in the diagnosis of thyroid nodes, which allows to determine the indications for a fine needle aspiration (FNA). According to the FNA results, the article gives a cytological conclusion in accordance with the Bethesda classification: the thyroid node is assigned to one of 6 categories. At the same time, the most difficult to assess the ris k of malignancy are Bethesda III and IV categories (follicular tumors). The risk of follicular tumor malignancy varies from 6% to 30%, which requires diagnostic hemithyroidectomy with histology of the biopsy specimen or the use of molecular genetic research methods (mutations in RAS/MAPK, BRAFV600E, TERT, and microRNA expression). MIBI scintigraphy (methoxyisobutylisonitrile, labeled with 99mTc-pertechnetate) is a promising test for the exclusion of malignancy in follicular tumors. This review is devoted to the methods concerning preoperative assessment of the malignancy of thyroid follicular tumors.

Keywords: thyroid, nodular goiter, TIRADS classification, scintigraphy, 99mTc-MIBI, review.

For citation: Solomadin Yu.S., Sych Yu.P., Fadeev V.V. Methods for assessing the malignant potential of thyroid nodes. RMJ. 2022;1:31–35.