Department of Surgery, University of Pisa, 56126 Pisa, Italy.
J Clin Endocrinol Metab. 2011 Nov;96(11):E1826-30. doi: 10.1210/jc.2011-1021. Epub 2011 Aug 24.
Although fine-needle aspiration cytology remains the mainstay of the preoperative workup of thyroid nodules, those with follicular proliferation still represent a diagnostic challenge. Real-time elastography (RTE) estimates the stiffness/elasticity of lesions and is regarded as a promising technique for the presurgical selection of thyroid nodules (including those with indeterminate cytology).
Our aim was to verify the potential role of RTE in the presurgical diagnosis of cancer in a large cohort of consecutive patients with follicular thyroid nodules.
One hundred two patients were submitted to conventional ultrasonography and RTE evaluation before being operated on for thyroid nodule with indeterminate cytology (54% single nodules). Tissue stiffness on RTE was scored from 1 (greatest elasticity) to 4 (no elasticity).
At conventional ultrasonography examination, the nodules (median diameter 2.2 cm) were solid (cystic areas < 10%); microcalcifications were detected in 56% of them and a hypoechoic pattern in 64%. Elasticity was high in eight cases only (score 1-2) although low in 94 (score 3-4). Cancer was diagnosed in 36 nodules (35%), being associated with microcalcifications (P < 0.0001) and inversely related to nodule diameter (P < 0.01). Malignancy was detected in 50% of the nodules with RTE score 1-2 and in 34% of those with score 3-4. Therefore, either the positive (34%) or the negative predictive value (50%) was clinically negligible.
The current study does not confirm the recently reported usefulness of RTE in presurgical selection of nodules with indeterminate cytology and suggest the need for quantitative analytical assessment of nodule stiffness to improve RTE efficacy.
虽然细针穿刺细胞学检查仍然是甲状腺结节术前评估的主要方法，但那些具有滤泡增生的结节仍然是一个诊断挑战。实时弹性成像（RTE）估计病变的硬度/弹性，被认为是甲状腺结节（包括那些细胞学不确定的结节）术前选择的一种很有前途的技术。
我们的目的是在一个连续的具有滤泡性甲状腺结节的大患者队列中验证 RTE 在术前诊断癌症中的潜在作用。
102 例患者在因细胞学不确定的甲状腺结节（54%为单结节）进行手术前接受了常规超声和 RTE 评估。RTE 上的组织硬度评分从 1（最大弹性）到 4（无弹性）。
在常规超声检查中，结节（直径中位数 2.2 厘米）为实性（囊性区域<10%）；其中 56%有微钙化，64%呈低回声。只有 8 例（评分 1-2）弹性高，而 94 例（评分 3-4）弹性低。36 个结节（35%）诊断为癌症，与微钙化有关（P<0.0001），与结节直径呈负相关（P<0.01）。RTE 评分 1-2 的结节中恶性肿瘤检出率为 50%，评分 3-4 的结节中为 34%。因此，阳性（34%）或阴性预测值（50%）在临床上可以忽略不计。
本研究不证实 RTE 在术前选择细胞学不确定的结节中的近期报道的有用性，并提示需要对结节硬度进行定量分析评估以提高 RTE 的效果。
