Diagnosis Of Focal Formations Of The Thyroid Gland With The Use Of Complex Of Methods

The research paper presents the results of diagnosis and treatment of 82 patients with focal thyroid masses. Based on a complex study of patients, main specific diagnostic criteria were determined, the use of which allows to detect thyroid cancer in their early stages. It was educed, that multiself-reactance ultrasonic research, including В -mode, EDC, DDC, spectral Doppler and elastography assist upgrading of research in the early exposure of chasse of thyroid.

. The introduction of the TI-RADS classification system in the work of an ultrasound doctor reduced the total number of TAPBs by 31.8%. The TI-RADS classification, based on ultrasound data, reflects the differentiation of the thyroid nodule depending on the oncological risk. TI-RADS allows you to standardize ultrasound examination of the thyroid gland, to minimize the subjective factor in the interpretation of the ultrasound picture of the thyroid nodule; to develop a unified codified approach to the nodes of the formation of the thyroid gland on the part of ultrasound diagnostics doctors and clinicians. The use of TI-RADS helps to determine the indications for TAPP thyroid nodules and surgical treatment, and, consequently, to reduce the number of nonnecessary minimally invasive and surgical interventions on the thyroid gland [3]. Currently, the study in B-mode, color and power Doppler mapping is of great importance in ultrasound diagnostics of thyroid diseases. Differential diagnosis of thyroid diseases is based on an assessment of the size of the gland, its echogenicity, echostructure, and information about regional lymph nodes. Nodular formations in the gland are differentiated by localization, size, shape, borders, contours, echogenicity, internal echostructure, state of the capsule and vascularization of the gland [7, 11, 25].
According to numerous domestic and foreign publications, the sensitivity and specificity of the gray scale technique in the differential diagnosis of qualitative and benign processes ranges from 55-70% [19,23]. The use of pulsewave Doppler sonography, which allows assessing blood flow in the nodes and the thyroid gland, increases the sensitivity of the method slightly to 65-75% [7]. Modern complex ultrasound diagnostics, consisting of echography and Doppler sonography, has been supplemented by a third technologyelastography. Shear wave elastography is a method that allows for a quantitative assessment of tissue elasticity, which excludes the possibility of subjective interpretation of the data [2,12,18]. Physically, a shear wave is an elastic transverse wave (ultrasonic wavelongitudinal), the displacement of the particles of the medium in this direction perpendicular to the wave. The principle of operation of the technique is based on the generation of a shear wave in the tissues caused by an ultrasonic pulse and an assessment of the speed of its advance. In this case, the shear wave propagation is also visualized by the ultrasonic sensor itself. Numerical values of the elasticity index are given in m / s or kPa, depending on the type of shear wave elastography, the method is called quantitative ultrasound elastography or elastometry.

RESEARCH OBJECTIVE
Improving the differential and clarifying diagnosis of thyroid nodules by using sonoelastography. Ultrasound was performed according to the standard technique with gray-scale study, color and power Doppler mapping (CDC, EDC, spectral Doppler), and also sonoelastography mode (compression and shear waves) was used, which was used to assess the rigidity of the focal formations of the thyroid gland.
The defeat of the thyroid gland was mainly observed in 34 women of reproductive age (36.1%). The largest group, of the examined (n = 49) 40.1%, consisted of various variants of diffuse-nodular goiter.
During elastography, the normative range was 18.4 ± 7.8 kPa. In benign lesions, the arithmetic mean stiffness was 47.5 ± 10 kPa, which is significantly higher than the norm: (p <0.05). Hypoechoic focal formations 5-10 mm in size were characterized by uniform staining in blue during elastography.
When identifying nodules of mixed echogenicity with sizes exceeding 10 mm, as well as isoechoic formations with a hypoechoic rim along the periphery, cytological and histological findings were follicular adenomas without proliferation. The formations had a mosaic pattern of staining with a predominance of blue areas and several harder green areas. Elastograms showed a mixed type of mapping with a predominance of rigid, rigid blue areas. The arithmetic mean stiffness in malignant tumors was 156.2 ± 34.3 kPa, which is significantly higher than the norm, and significantly higher than the stiffness indicators (p <0.01). (Figure 1.2.3.4).