Analiza prediktora maligniteta folikulskih tumora štitaste žlezde
Sažetak
Uvod/Cilj. Prema raspoloživim dijagnostičkim metodama nije moguće preoperativno razlikovati benigne od malignih folikulskih tumora štitaste žlezde, a najčešće ni intraoperativno zbog veoma slične ćelijske morfologije folikulskih adenoma i folikulskih karcinoma i nemogućnosti citološkog dokaza invazije kapsule ili krvnih sudova karakteristične za folikulske karcinome. U ovoj studiji, istraživali su se mogući prediktivni faktori maligniteta kod bolesnika s folikulskim karcinomom štitaste žlezde koji bi omogućili ispravnu selekciju bolesnika za hirurško lečenje, a potom i izvođenje adekvatnog tipa operacije kod bolesnika s folikulskom tireoidnom neoplazmom. Metode. Ovom retrospektivnom studijom su obuhvaćeni svi bolesnici operisani zbog postojanja folikulskog tumora štitaste žlezde u tercijarnoj univerzitetskoj zdravstvenoj ustanovi endokrine hirurgije, tokom petogodišnjeg perioda (2008–2012). U istraživanje su bila uključena 263 operisana bolesnika. Na osnovu definitivnog histopatološkog nalaza ispitanici su bili podeljeni u dve grupe: folikulske adenome (n = 97) i folikulske karcinome (n = 166). Najvažnije demografske i kliničke karakteristike operisanih bolesnika analizirane su univarijantnom i multivarijantnom logističkom regresionom analizom. Rezultati. U grupi bolesnika operisanih zbog folikulskog adenoma (19 osoba muškog i 78 ženskog pola) starosna dob je iznosila 19–79 godina s prosečnom starošću od 50 godina. U grupi bolesnika operisanih zbog folikulskog karcinoma (35 muških, 131 ženska osoba) starosna dob je bila u rasponu 15–78 godina, a prosečna starost 48 godina. Univarijantnom analizom pokazano je da se koncentracija tireoglobulina ≥ 500 ng/mL, promer tumora < 30 mm, prisustvo više od jednog tireoidnog čvora i nalaz afunkcijskog/hipofunkcijskog čvora značajno češće nalaze kod folikulskog karcinoma u odnosu na folikulski adenom. Nezavisni prediktivni faktori maligniteta bili su povišena preoperativna koncentracija tireoglobulina (≥ 500 ng/mL) i prisustvo više od jednog čvora. Ovi rezultati su, u cilju primene u praksi, prikazani i nomogramom, dvodimenzionalnim dijagramom dizajniranim da omogući približno preoperativno grafičko izračunavanje verovatnoće postojanja maligniteta. Zaključak. Povišena preoperativna koncentracija tireoglobulina, ≥ 500 ng/mL, i prisustvo više od jednog čvora su nezavisni prediktori maligniteta folikulskih karcinoma štitaste žlezde.
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