KARAKTERISTIKE NALAZA NA SCINTIGRAMU ŠTITASTE ŽLEZDE SA 99mTc-PERTEHNETATOM KOD PACIJENATA SA DIFERENCIRANIM TIREOIDNIM KARCINOMOM
Sažetak
Uvod: Diferencirani karcinom štitaste žlezde (DTC), poreklom iz folikularnih ćelija, najučestaliji je endokrini malignitet koji se najčešće javlja kod pacijenata sa tireoidnim nodusima.
Cilj: Cilj ove retrospektivne analize je procena scintigrafskog nalaza štitaste žlezde dobijenog 99mTc-pertehnetatom kod pacijenata sa DTC pre tireoidektomije.
Materijal i metode: Analizom medicinske dokumentacije obuhvaćeno je 95 ispitanika kod kojih je rađena preoperativna evaluacija tireoidnih nodusa. Ukupno je bilo 18 muškaraca (51,5 ± 8,7 godina, rang 43-68 godina) i 77 žena (48 ± 12 godina, rang 14-72 godina). Analizirani su nalazi drugih testova koji su rađeni tokom preoperativnog ispitivanja i to: ultrazvučni pregled štitaste žlezde (EHO) i određivanje koncentracije tireotropina i tireoglobulina.
Rezultati: Od 95 ispitanika sa DTC, kod 20 (21%) je tokom preoperativne evaluacije, pored kliničkog pregleda, urađen EHO štitaste žlezde, dok je kod 75 (79%) urađen i scin tigram 99mTc-pertehnetatom. Kakva je distribucija scintigraskih nalaza? Najveća uče stalost DTC nađena je u polinodoznim strumama, i to kod 61 (64%) ispitanika, dok je kod 31 (33%) ispitanika karcinom nađen u afunkcijskom, “hladnom” nodusu. Najčešći histopatološki nalaz unutar scintigrafski detektovanih afunkcijskih nodusa i polinodozne strume bio je papilarni tireoidni karcinom. Karcinom štitaste žlezde nađen je i kod dvoje ispitanika sa Grejvsovom (Graves) strumom i kod jednog ispitanika sa normalnim scintigrafskim nalazom. Vrednost tireotropnog hormona bila je normalna kod 71% sa DTC i povišena kod manjeg broja (21%). Ultrazvučni pregled je kod samo 18 ispitanika (19%) ukazivao na visokorizične karakteristike nodusa.
Zaključak: Najčešći scintigrafski nalazi kod pacijenata sa dokazanim DTC bili su polinodozna struma i afunkcijski ,,hladni“ nodus. Kod manjeg procenta ispitanika tireoidna neoplazma nađena je kod pacijenata sa hipertireoidizmom. Rezultati studije pokazali su da scintigrafija štitaste žlezde 99mTc-pertehnetatom i dalje ima značajnu dijagnostičku ulogu u ispitivanju tireoidnih nodusa.
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