Some Aspects of Modern Diagnosis and Surgical Tactics in Follicular Thyroid Neoplasms

The study analyzed the examination and treatment outcomes of patients with surgical thyroid pathology. Objective: to systematize preoperative diagnostic methods and develop a comprehensive approach to organ-preserving surgeries in patients with follicular thyroid neoplasms. Material and Methods. The study analyzed the examination and treatment outcomes of 749 patients treated at the Precarpathian Clinical Oncology Center, Ivano-Frankivsk, Ukraine, between 2019 and 2024. All patients underwent fine-needle aspiration biopsy of clinically significant thyroid gland nodules at the preoperative stage. Results. The causes of the disease were as follows: colloid nodular goiter in 566 (75.6%, 95% CI 72.3-78.6%) patients, adenomatous nodular goiter with follicular neoplasms in 72 (9.6%, 95% CI 7.612.0%) cases, papillary carcinoma in 54 (7.2%, 95% CI 5.5-9.3%) patients, suspicious for papillary carcinoma in 17 (2.3%, 95% CI 1.3-3.6%) cases (based on cytological examination), medullary carcinoma in 12 (1.6%, 95% CI 0.8-2.8%) patients, anaplastic carcinoma in 6 (0.8%, 95% CI 0.3-1.7%) cases, and other tumors in 22 (2.9%, 95% CI 1.8-4.4%) patients. The results were statistically processed using the standard software package “Statistica 6.0 for Windows” (StatSoft, USA). Hemithyroidectomy was performed in 28 (42.4%, 95% CI 0.31-0.54%) cases, thyroidectomy in 16 (24.2%, 95% CI 0.12-0.32%) cases, subtotal lobectomy in 19 (28.7%, 95% CI 0.16-0.37%) cases, and lobectomy in 9 (13.6%, 95% CI 0.05-0.20%) cases. Central compartment lymph node dissection as an adjunct to thyroidectomy was performed on six (31.0%, 95% CI 0.32-0.61%) patients. Conclusions. The primary method for preoperative diagnosis of follicular neoplasms is fine-needle aspiration biopsy, followed by cytological examination. In follicular neoplasms against the background of multinodular goiter, thyroidectomy is recommended. In all other cases, the initial surgical approach should prioritize organ-preserving procedures to improve quality of life. The extent of the final surgical intervention depends on the pathological findings. If a patient with follicular neoplasms refuses surgery, prolonged monitoring by an oncological surgeon is essential. Molecular genetic diagnostics can facilitate the preoperative identification of follicular carcinoma, guiding the subsequent treatment algorithm.