Introduction. Diagnosis and treatment of lesional pathology of the thyroid are important problems in Russia and worldwide. Currently, fine-needle aspiration (FNA) is the main technique of differential diagnosis of benign and malignant tumors of the thyroid. In 2023, clinical guidelines of the European Thyroid Association (ETA) on thyroid lesion treatment were published noting possible minimally invasive treatment of benign and malignant tumors of the thyroid requiring repeat cytologic verification. Despite the proven effectiveness of FNA, its informativity and specificity vary between 60 and 100 %. Additionally, this method is associated with high risk of false negative and false positive results. Therefore, there is a need to improve FNA and minimize its disadvantages.

Aim. To evaluate the capabilities of vacuum FNA of small lesions using multiparameter ultrasound in diagnosis of thyroid cancer.

Materials and methods. At the scientific and practical problem laboratory Diagnostic Studies and Minimally Invasive Technologies of the Smolensk State Medical University, a device for vacuum FNA was developed. Between 2023 and 2024, patients with thyroid lesions of size <10 mm underwent 25 vacuum FNAs. Correlation analysis with 51 FNAs performed between 2020 and 2023 was performed.

Results. A decrease in the number of nondiagnostic (category I per the Bethesda system, 2017) and undetermined (category III per the Bethesda system, 2017) results was observed. Comparison of preoperative cytologic conclusions (category V per the Bethesda system, 2017) with the results of postoperative histological examination in patients of the control group showed benign lesions in 2 (50 %) cases which correspond to false negative results. Vacuum FNA did not show this discrepancy. These results demonstrate a decrease in the probability of false negative results and effectiveness of vacuum FNA.

Conclusion. Use of vacuum FNA expedites ultrasound-guided biopsy for small thyroid lesions. Due to high negative pressure (up to –0.8 bar), single-step retrieval of cytologic material is performed which leads to a decrease in the number of nondiagnostic and undetermined cytologic conclusions by 11.7 and 1.9 %, respectively.

Introduction. Metastasis without an identified primary lesion is an unresolved and complex problem in clinical oncology. The issue of the necessity of primary lesion identification remains controversial. According to some studies, detection of the primary tumor potentially reduces the dose of radiation therapy and therefore prevents development of toxic reactions that reduce the quality of life of the patient, and in some cases completely eliminates the need for adjuvant therapy. Widespread development and application of robotic, microsurgical, and laser transoral techniques make it possible to verify latent oropharyngeal cancer. The detection of overexpression of p16 protein in metastatic affected lymph nodes may indicate the association of this pathology with human papillomavirus.

Aim. To investigate the efficacy of microsurgical palatal tonsillectomy (using a surgical microscope) in diagnosis and treatment of occult oropharyngeal cancer in patients with cervical lymph node metastases of undetected primary site, determine the frequency of expression of the surrogate marker of human papillomavirus – protein p16.

Materials and methods. The study was based on the results of diagnosing 82 patients with cervical lymph node metastases of undetected primary site. The inclusion criteria were morphologically verified cervical lymph node metastases of squamous cell carcinoma, absence of a primary tumour after a standard clinical examination. 10 patients underwent palatal tonsillectomy using a surgical microscope and cervical lymph node dissection based on the results of clinical examination and instrumental diagnostics.

Results. The use of microsurgical palatal tonsillectomy in patients with metastases of squamous cell carcinoma in the cervical lymph nodes without identified primary lesion allowed to diagnose cancer of the palatine tonsil in 12.1 % of cases, cancer of this location associated with human papilloma virus in 70 % of cases.

Conclusion. Microsurgical palatal tonsillectomy using a surgical microscope allowed us to not only verify occult palatine tonsil cancer, but also to establish accurate diagnosis and stage of the disease with subsequent determination of the scope of adjuvant therapy.

Despite the widespread use of immuno-oncological and targeted therapy in the treatment of malignant tumors, in real clinical practice the role of chemotherapy is still significant, used both in mono regimen and in combination with other antitumor drugs. Cytostatics cause a wide range of adverse events, which are often the cause of dose reduction, cyclical disorders, or even discontinuation of therapy. One of the most common symptoms is chemotherapy-induced nausea and vomiting which affect not only the quality of life, but also the results of treatment. It is important to address these issues from prevention and treatment perspectives so that patients remain committed to their treatment regimens. Since nausea and vomiting induced by chemotherapy are classified into 5 different types, the main medications for prevention and treatment include 5-hydroxytryptamine type 3 (5-HT3) and neurokinin-1 (NK1) receptor antagonists and corticosteroids. Simultaneous use of drugs from the groups of second-generation NK1 receptor blockers and 5-HT3 receptor blockers, for example: netupitant + palonosetron in combination with corticosteroids, makes it possible to achieve maximum antiemetic effect, even with the most emetogenic antitumor treatment regimens.

Introduction. The role of peptides in antinociceptive system regulation has became a subject of interest for scientists worldwide. The first registered peptide analgesic tyrosyl-D-arginyl-phenylalanyl-glycinamide acetate which currently can be used in clinical practice was developed in Russia under the name Taphalgin® (PharmFirma “Sotex”, Russia). The effectiveness and safety of this pharmaceutical in postoperative pain management was evaluated in the all-Russia multicenter prospective observation program NICITA (Non-interventional Clinical Trial of Taphalgin ®).

Aim. To analyze the effectiveness and safety of Taphalgin® in postoperative pain management in various surgical fields.

Materials and methods. The observational program NICITA included 887 patients including patients with malignant tumors of various locations from 15 study centers in different Russian cities. All patients underwent surgical interventions in various anatomical areas under general, regional and combination anesthesia. The principal scheme of postoperative pain management was based on the multimodal approach which included peptide opioid agonist alongside acetaminophen, cyclooxygenase inhibitors in combination with regional anesthesia or without it. The study also included patients who underwent small-volume surgeries, and pain was managed through Taphalgin® monotherapy with subsequent switch to cyclooxygenase inhibitors. The primary endpoint of the NICITA observational program was response to therapy after the first Taphalgin® administration. Decreased pain syndrome per the numerical rating scale 15–60 min after subcutaneous injection and maintenance of analgesic effect 3 h later were considered treatment response. The secondary endpoints included mean time to analgesia start after administration of the 1st single drug dose (in min), duration of effect, types and frequency of adverse reactions including serious in the central nervous system, pulmonary system, gastrointestinal tract developed during the observational program, as well as patient and research physician satisfaction with pain management. To evaluate the significance of pain intensity change at rest and in motion in time, analysis of variance with repeat measurements was used; for pairwise comparison of two time periods, Student’s t-test for dependent samples was used. The differences were considered significant at p = 0.05.

Results. Statistically significant decrease in pain intensity in the total patient group was observed 15 minutes after Taphalgin® administration; it reached its minimum 40 min after the injection (р <0.05). The percentage of patients responding to analgesic therapy with Taphalgin® was 96.5 %. During administration of the drug, insignificant decrease (10–15 mmHg) in arterial blood pressure (1.7 % of cases) and vertigo (1 % of cases) were observed. In some patients, several adverse reactions were observed. Satisfaction with analgesic effect of Taphalgin® was relatively high both in patients and research physicians.

Conclusion. Taphalgin® has pronounced analgesic effect and is effective for pain management after surgical interventions of various volumes and injury level. The use of this drug is associated with low rate of adverse reactions and absence of pulmonary depression characterizing opioid agonists. Therefore, Taphalgin® can be recommended for clinical use for postoperative pain management after various types of surgical interventions.

Introduction. Surgical intervention with subsequent chemoradiation therapy is one of the treatment standards in squamous cell carcinoma of the nasal cavity and paranasal sinuses. However, the question of the optimal therapy for this pathology remains open.

Aim. To compare treatment results in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses after conservative and surgical treatment.

Materials and methods. The study included 86 patients with squamous cell carcinoma of the nasal cavity and paranasal sinuses, stages III–Iva, who between 2000 and 2020 received treatment at the N.N. Blokhin National medical Research Oncology Center. Surgical treatment with subsequent radiation or chemoradiation therapy was performed in 31 patients, conservative treatment (radiation or chemoradiation therapy) was performed in 55 patients.

Results. Five-year overall survival in the conservative treatment group was 46.2 %, in the surgical treatment group – 59.7 % (р = 0.081); 5-year progression-free survival was 17 and 50.5 %, respectively (p = 0.002). In patients with Т3N0 tumor who received surgical treatment, 5-year progression-free survival was significantly higher than in patients who received conservative treatment (p <0,05). Comparison of overall survival and progression-free survival of patients who achieved objective response (complete response + partial response) after conservative treatment (n =36) and after surgical treatment (n = 31) did not show statistically significant differences (р = 0.469 and р = 0.183, respectively). The overall 5-year survival rate in the salvage surgery treatment group (24/55) was 63.1 % compared with 59.7 % in the surgical treatment group (n = 31), there were also no significant differences (p = 0.95). In patients with T3 tumor who received conservative treatment in this study, higher risk of progression was observed compared to patients who underwent surgical treatment.

Conclusion. Surgical intervention remains an important treatment method for patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, especially in cases of smaller tumor extent. Conservative therapy seems promising but large-scale prospective controlled randomized clinical trials are necessary to confirm its effectiveness and safety in various patient groups.

Introduction. Laryngeal cancer is the most common malignant neoplasm of the ENT organs. The preferred and primary therapy for this pathology is surgical intervention. The search for highly effective organ-saving methods of surgical treatment aimed at minimization of resection volume and preservation of functioning of the larynx continues. Current endolaryngeal surgery allows to improve functional results and is the most modern and advanced method.

Aim. To compare functional and oncological results of surgical treatment of patients with laryngeal squamous cell carcinoma Т2N0M0 performed through transcervical and endolaryngeal accesses.

Materials and methods. The results of surgical treatment of patients with squamous cell carcinoma of the vocal folds part of the larynx T2N0M0 performed between 2015 and 2020 at the Oncological Division of Head and Neck Tumors of the The National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of Russia were analyzed. The study included 49 men aged 52–72 years; the diagnosis was confirmed by histological examination. All patients underwent standard exams which led to diagnosis per the Tumor, Nodus and Metastasis international system.

Results. Three-year recurrence-free survival after endolaryngeal resection of cancer of the vocal folds part of the larynx Т2N0M0 was 88.47 %, after transcervical resections it was 91.31 %. Analysis of functional and surgical results showed that compared to patients who underwent surgery through external access, in patients who underwent surgery with endolaryngeal access the rate of complications associated with the surgical wound in the early postoperative period was 13.04 % lower, frequency of cicatricial stenoses of the larynx was 20.06 % lower, and abnormalities of separating function of the larynx were 49.33 % rarer.

Conclusion. In patients who underwent endolaryngeal resection of the larynx, better functional and surgical results were achieved compared to patients who underwent surgery through external access. Moreover, there was no statistically significant difference in oncological results between the study groups. This allows to conclude that minimally invasive endolaryngeal approaches are highly effective and functional in organ-saving surgeries for patients with squamous cell carcinoma of the vocal fold part of the larynx T2N0M0.

Introduction. Surgery is the leading treatment for tongue cancer, performance which leads to impaired speech function. Because speech is one of the most important tools of social interaction, its disorder can significantly affect patients’ quality of life. To date, there is no generally accepted objective approach to assessing the quality of speech that would make it possible to analyze speech changes at different stages of therapy and help in development of treatment strategy.

Aim. To compare the sound reproduction of patients with tongue cancer after hemiglossectomy with and without reconstruction using an objective assessment method, namely – a special software.

Materials and methods. The study included 29 patients who received surgical treatment in the volume of hemiglossectomy with ipsilateral cervical lymphodissection. The patients were divided into 2 groups: the group 1 included 14 patients who underwent reconstruction with submental, radial and buccal flaps, the group 2 – 15 patients who did not underwent it. Sound reproduction by each patient was recorded before the operation, no earlier than 10–12 days after it (session of type 1) and after the end of specialized treatment: radiation therapy, chemoradiation therapy (session of type 2). If adjuvant therapy was not prescribed, the type 2 session was performed 3–6 months after surgery. The records made during sessions of the types 1 and 2 were compared with records of preoperative session. During each session, the pronunciation of 30 syllables containing 3 problematic sounds was recorded: [k], [s] and [t] (10 syllables with each of the sounds). The differences in the data obtained during the sessions types 1 and 2 were analyzed according both the syllable set and separately for each sound studied.

Results. The reconstruction performed improves sound pronunciation [t] after hemiglossectomy both after surgery and 3–6 months after the end of specialized treatment (p <0.01). After completion of specialized treatment, the pronunciation of the sound [s] significantly improved in both groups. However, in the reconstruction group, the variations in pronunciation values of this sound before the operation and after it obtained in the groups 1 and 2 were significantly reduced. During the assessment of the pronunciation of sound [k], the similar data were obtained. When comparing the quality of speech of patients during the type 2 session, the best results were obtained in group 1: in patients of this group, there were smaller mean differences in the sounds pronunciation as compared to the initial recording (p <0.001) than in patients of group 2.

Conclusion. Resection of the tongue most negatively affects pronunciation of the dental-alveolar sounds than the whistling or palatine-dental sounds. The time factor has a positive effect on the speech quality of patients, therefore, the assessment of sound reproduction in patients after hemiglossectomy should be performed no earlier than 3–6 months after the end of specialized treatment.

In the recent decade, the number of laryngeal cancer cases increased worldwide by 23 %. Currently, laryngeal cancer morbidity and associated mortality do not show statistically significant trends toward a decrease. The main risk factors for laryngeal carcinoma are smoking, alcohol consumption, human papilloma virus (HPV) infection, recurrent respiratory papillomatosis, and genetic predisposition.

Aim. To evaluate the incidence and role of HPV in etiology and clinical course of laryngeal cancer and recurrent respiratory papillomatosis.

Analysis of the available literature sources published in the Medline, Pubmed, and eLibrary databases was performed. The review is based on 59 of 584 identified scientific studies. Frequency of HPV detection in laryngeal cancer tumor tissue varies and is associated with the studied country’s geographical location. The incidence of these viruses in tumor tissue varies between 2.7 and 62.6 %. Genotype 16 human papilloma virus is more common in women between the ages of 31 and 40 years and is mostly located near the glottic aperture. Genotype 6 and 11 human papilloma viruses promote development of recurrent respiratory papillomatosis of the larynx and are detected in 0–87.5 % of cases. It is noted that in patients with HPV-positive neoplasms of the larynx, better response to radiation therapy and higher survival rates are observed compared to patients without the virus. In countries where national programs of vaccination against HPV infection have been implemented, a significant decrease in the incidence of recurrent respiratory papillomatosis is observed.

The incidence of HPV in laryngeal cancer and recurrent respiratory papillomatosis varies. The role of these viruses in carcinogenesis has not yet been fully understood. Clinical course of HPV-associated laryngeal carcinoma is more favorable than HPV-free laryngeal carcinoma, however, this statement requires further confirmation. Evaluation of the results of programs of vaccination against HPV and their effect on recurrent respiratory papillomatosis and laryngeal cancer morbidity is important.

The larynx is a vital and socially important organ performing respiratory, vocal, and protective functions. Therefore, organ-preserving approaches are the preferred methods in treatment of patients with laryngeal cancer.

The article presents a possibility of performing organ-preserving surgical treatment of locally advanced laryngeal cancer, describes a clinical case of extended resection of the larynx, demonstrates options for defect reconstruction stages. The goal of the presented technique is to improve patients’ quality of life.

Nowadays, doctors of almost all specializations have to deal with patients who have one or another voluminous formations of the skin and subcutaneous tissue with localization in the head and neck region, which are heterogeneous in their etiology. It’s important to remember that sometimes neoplasms can turn out to be a manifestation of an infectious disease, in particular helminthosis. One of the representatives from this group of diseases is dyrofilariasis, is a zoonotic transmissible tropical helminth disease caused by roundworms – filarias of the genus Dirofilaria, which parasitize in humans mainly in the subcutaneous tissue and lymphatic system. A single filariasis of the Dirofilaria repens type is found in humans in temperate regions of Russia. Generally, dirofilariosis imitates the clinical picture of some other non-parasitic disease. Because of the lack of awareness of this disease among doctors, the process of making a diagnosis is almost always difficult. Often the correct diagnosis is only made during surgical treatment.

The article presents a clinical observation of dirofilariosis with lesions subcutaneous tissue of the dorsum nose.

Differentiated thyroid cancer is one of the most common malignant diseases of the endocrine system. Usually, it responds well to the standard treatment (surgery + radioiodine therapy), especially at early stages. During both treatment and dynamic observation, distant metastases are detected in 10–15 % of patients. In these cases, the patients continue treatment with radioactive iodine. If tumor cells have insufficient ability to capture and retain 131I or completely lose this ability, the effect of radioiodine therapy becomes limited and the disease progresses during therapy which leads to 5–10 % decrease in 10-year survival. The main problem in treatment of differentiated thyroid cancer is communication between radiologists in centers performing radioiodine therapy and clinical oncologists performing surgeries and observation at patient’s place of residence. For both specialists, the main goal is to identify clinical situations where early and effective treatment intervention can be beneficial without the risk of overdiagnosis and excessive treatment.

The article considers common questions arising during multidisciplinary interactions with radiologists of radioiodine centers and presents concise guidelines on the observation and treatment procedures for patients with differentiated thyroid cancer.