Department of Endocrinology and Metabolism, Ankara University School of Medicine, Ankara, Turkey.
Thyroid. 2012 Oct;22(10):1031-8. doi: 10.1089/thy.2011.0502. Epub 2012 Aug 9.
Several studies have evaluated the ability of ultrasound elastography (USE) to diagnose malignant nodules. However, these studies had important limiting factors, selection bias and small sample size. The aims of the present study were to prospectively assess, in a large group of patients, the diagnostic power of USE for detecting malignancy in thyroid nodules, and to compare this technique with B-mode grayscale ultrasonography (BUS) and power Doppler ultrasonography (PD).
There were 194 patients with 237 thyroid nodules who were examined using BUS, PD, and USE. USE scores were classified according to the elasticity: score 1 as high, score 2 as intermediate, and score 3 as low (i.e., a high degree of stiffness). Fine-needle aspiration cytology (FNAC) was performed in all nodules at least two different times. Nodules having two benign FNAC readings that did not change the diameter during a 6-month follow-up period were classified as benign. Patients having thyroid nodules with indeterminate, suspicious, or malignant cytology had total or hemithyroidectomy to remove the nodule and treat the malignancy.
Fifty eight (25%) nodules in 45 (23%) patients were found to be malignant. USE had a limited sensitivity and a positive predictive value in detecting malignant thyroid nodules and was not superior to BUS. USE had almost the same specificity and a negative predictive value as BUS. A power Doppler type-3 pattern was not of sufficient sensitivity to detect malignancies in thyroid nodules.
In contrast to earlier reports, this current study noted a lower sensitivity and specificity of USE for the diagnosis of malignancy in thyroid nodules than previously reported.
多项研究评估了超声弹性成像（USE）诊断恶性结节的能力。然而，这些研究存在重要的限制因素，包括选择偏倚和样本量小。本研究的目的是前瞻性评估 USE 在诊断甲状腺结节恶性肿瘤中的诊断效能，并与 B 型灰阶超声（BUS）和功率多普勒超声（PD）进行比较。
对 194 例 237 个甲状腺结节患者进行 BUS、PD 和 USE 检查。根据弹性评分将 USE 评分分为 1 分为高，2 分为中，3 分为低（即高度僵硬）。所有结节均至少进行了两次细针穿刺细胞学检查（FNAC）。如果两次良性 FNAC 检查结果不变且在 6 个月的随访期间结节直径无变化，则将结节归类为良性。如果患者的甲状腺结节细胞学检查为不确定、可疑或恶性，则进行甲状腺全切除术或甲状腺叶切除术以切除结节并治疗恶性肿瘤。
45 例（23%）患者的 58 个（25%）结节被发现为恶性。与 BUS 相比，USE 检测甲状腺恶性结节的敏感性和阳性预测值有限，并不优于 BUS。USE 具有与 BUS 几乎相同的特异性和阴性预测值。PD 类型 3 模式对检测甲状腺结节恶性肿瘤的敏感性不足。
与早期报告相比，本研究发现 USE 诊断甲状腺结节恶性肿瘤的敏感性和特异性均低于既往报告。
