Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin N.T, Hong Kong, PR China.
Clin Radiol. 2011 Sep;66(9):799-807. doi: 10.1016/j.crad.2011.03.011. Epub 2011 Apr 29.
To evaluate real-time qualitative ultrasound elastography for focal thyroid masses undergoing fine-needle aspiration in a routine thyroid ultrasound clinic.
Ninety-four thyroid nodules scheduled for fine-needle aspiration cytology in a thyroid ultrasound clinic also underwent real-time freehand elastography. Colour-scaled elastograms were graded visually on the stiffness of the solid component of nodules relative to thyroid parenchyma using an elastography score (ES) scale from 1 (soft) to 4 (stiff). The ES for benign and malignant nodules and the influence of cystic change on ES were analysed using Chi-square with trend and Fishers exact tests, with a p<0.05 used to indicate statistical significance.
There were 19 papillary carcinomas, five metastases, 57 hyperplastic nodules, and four follicular adenomas based on definitive cytology (n=54) or histology (n=31). Nine nodules were excluded due to indeterminate cytology and no histology. Of malignancies (all solid), two were ES=1, four were ES=2, eight were ES=3, and 10 were ES=4. Of benign nodules, 17 were ES=1, 17 were ES=2, 16 were ES=3, and 11 were ES=4. An ES>2 was more common in benign nodules with predominant cystic components (17/18) than mildly cystic (3/12) or completely solid (7/31) benign nodules (p=0.0004, p<0.0001). The ES was not significantly different between benign and malignant nodules (p=0.09) unless partially cystic nodules were excluded (p=0.005). For solid nodules, an ES>2 optimally predicted malignancy, achieving 74% sensitivity, 77% specificity, and 76% accuracy.
Qualitative real-time thyroid elastography predicts malignancy only if predominantly cystic nodules are excluded, which may limit its utility in routine clinical practice.
评估实时定性超声弹性成像在常规甲状腺超声检查中对行细针抽吸的局灶性甲状腺肿块的诊断价值。
在甲状腺超声检查室，94 个计划行细针抽吸细胞学检查的甲状腺结节同时接受实时自由手超声弹性成像检查。彩色弹性图根据结节实性部分相对于甲状腺实质的硬度，在弹性评分（ES）量表上进行目测评分（1 分为软，4 分为硬）。采用卡方检验（趋势）和 Fisher 确切概率法分析良性和恶性结节的 ES 以及囊性变对 ES 的影响，p＜0.05 为差异有统计学意义。
根据明确的细胞学（n=54）或组织学（n=31）结果，共发现 19 例甲状腺癌、5 例转移瘤、57 例增生性结节和 4 例滤泡性腺瘤。由于细胞学检查不确定和没有组织学检查，9 个结节被排除在外。所有恶性肿瘤（均为实性）中，ES=1 者 2 例，ES=2 者 4 例，ES=3 者 8 例，ES=4 者 10 例。良性结节中 ES=1 者 17 例，ES=2 者 17 例，ES=3 者 16 例，ES=4 者 11 例。伴有明显囊性成分的良性结节中 ES＞2 的比例（17/18）明显高于轻度囊性（3/12）或完全实性（7/31）的良性结节（p=0.0004，p＜0.0001）。良性和恶性结节的 ES 无显著差异（p=0.09），除非排除部分囊性结节（p=0.005）。对于实性结节，ES＞2 可最佳预测恶性肿瘤，其敏感性为 74%，特异性为 77%，准确性为 76%。
定性实时甲状腺弹性成像仅在排除主要囊性结节时才能预测恶性肿瘤，这可能限制了其在常规临床实践中的应用。
