Lyshchik Andrej, Moses Ryan, Barnes Stephanie L, Higashi Tatsuya, Asato Ryo, Miga Michael I, Gore John C, Fleischer Arthur C
Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675, USA.
J Ultrasound Med. 2007 Jun;26(6):837-46. doi: 10.7863/jum.2007.26.6.837.
The purpose of our study was to analyze the accuracy of quantitative analysis of tumor vascularity on power Doppler sonograms in differentiating malignant and benign solid thyroid nodules using tumor histologic evaluation as the reference standard. Methods. Eighty-six solid thyroid tumors (46 malignant and 40 benign) in 56 consecutive patients (mean age +/- SD, 53.1 +/- 11.6 years; 12 male and 44 female) referred for the surgical treatment were included in our study. Visual and qualitative analysis of patterns of nodule vascularity was performed for all tumors. Quantification of the power Doppler sonograms was performed with normalized and weighted vascular indices (VIs). The accuracy of sonographic criteria for thyroid cancer was evaluated with univariate analysis. Results. Among benign thyroid tumors, there was a statistically significant increase in the levels of intranodular vascularization with an increase in tumor size (P < .001). In all tumors, increased intranodular vascularization showed 65.2% sensitivity, 52.5% specificity, and 58.9% overall accuracy in differentiation between benign and malignant thyroid lesions. In tumors smaller than 2 cm, it had 65.5% sensitivity, 85.7% specificity, and 72.1% overall accuracy. Quantitative analysis of tumor vascularity significantly overperformed visual analysis of power Doppler patterns (P < .05). Among thyroid lesions with diameters of less than 2 cm, a normalized VI of greater than 0.14 had 72.4% sensitivity, 100% specificity, and 86.2% overall accuracy. A weighted VI of greater than 0.24 showed compatible results, with 69.0% sensitivity, 100% specificity, and 84.5% overall accuracy.
Our study indicates that in small thyroid nodules, quantitative analysis of tumor vascularity has benefits over visual inspection and can be useful in differentiation between benign and malignant thyroid tumors.
本研究旨在以肿瘤组织学评估为参考标准，分析能量多普勒超声对甲状腺实性结节血管定量分析在鉴别良恶性方面的准确性。方法。本研究纳入了56例连续接受手术治疗患者的86个甲状腺实性肿瘤（46个恶性和40个良性）（平均年龄±标准差，53.1±11.6岁；12例男性和44例女性）。对所有肿瘤进行结节血管模式的视觉和定性分析。使用标准化和加权血管指数（VI）对能量多普勒超声进行定量分析。通过单因素分析评估甲状腺癌超声标准的准确性。结果。在良性甲状腺肿瘤中，随着肿瘤大小增加，结节内血管化水平有统计学意义的升高（P <.001）。在所有肿瘤中，结节内血管化增加在鉴别甲状腺良恶性病变时显示出65.2%的敏感性、52.5%的特异性和58.9%的总体准确性。在小于2 cm的肿瘤中，其敏感性为65.5%，特异性为85.7%，总体准确性为72.1%。肿瘤血管的定量分析明显优于能量多普勒模式的视觉分析（P <.05）。在直径小于2 cm的甲状腺病变中，标准化VI大于0.14时，敏感性为72.4%，特异性为100%，总体准确性为86.2%。加权VI大于0.24时显示出类似结果，敏感性为69.0%，特异性为100%，总体准确性为84.5%。
我们的研究表明，在小甲状腺结节中，肿瘤血管的定量分析优于视觉检查，可用于鉴别甲状腺良恶性肿瘤。
