Giusti Massimo, Campomenosi Claudia, Gay Stefano, Massa Barbara, Silvestri Enzo, Monti Eleonora, Turtulici Giovanni
Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy ; UO Clinica Endocrinologica, Viale Benedetto XV, 6, I-16100 Genoa, Italy.
Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
Thyroid Res. 2014 Dec 5;7(1):9. doi: 10.1186/s13044-014-0009-8. eCollection 2014.
The pre-surgical selection of thyroid nodules with indeterminate cytology (Thy 3 according to British Thyroid Association) after fine-needle aspiration biopsy (FNAB) is currently required in order to reduce unnecessary total thyroidectomy. The objective of our study was to use a surgical series of Thy 3 nodules to evaluate the predictive role of ultrasound elastosonography (USE) and contrast-enhanced ultrasonography (CEUS) in pre-surgical diagnoses of malignancy.
We enrolled 63 patients with Thy 3 nodules in which cytological-histological correlation was available. The ELX 2/1 strain index was obtained by means of semi-quantitative USE, which was performed before surgery in addition to conventional ultrasonography (US) and contrast-enhanced US (CEUS) on the Thy 3 nodules. The ELX 2/1 strain index, a five-item US score and both peak (P) index and time to peak (TTP) index from CEUS were correlated with the histological results. After surgical diagnosis, the data were analysed by using a receiver-operating characteristic (ROC) curve.
Histology was benign in 50 and malignant in 13 Thy 3 nodules. No difference in maximal diameter was noted between benign (22.8 ± 1.6 mm) and malignant (18.9 ± 2.9 mm) nodules. Significant correlations were found between histology and cumulative US findings (p=0.005), ELX 2/1 index (p=0.002), P index (p=0.01) and TTP index (p=0.02). On analysing data from US, USE and CEUS, significant ROC areas under the curve were observed (p<0.0001). A cut-off value was set for US (>2), ELX 2/1 (>0.95), P index (<0.99) and TTP index (>0.98) scores. The diagnostic power of the cumulative pre-surgical analysis of Thy 3 nodules with US, USE and CEUS, considering the experimental cut-off points obtained from the ROC curves was: sensitivity 64%, specificity 92%, PPV 75% and accuracy 84%.
The ELX 2/1 index in conjunction with the US score can be useful in orienting surgical strategies in Thy 3 nodules. The information added by CEUS is less sensitive than that provided by US and USE. The use of a cut-off based on histology can reduce thyroidectomy. Observation should be the first choice when not all instrumental results are suspect.
为减少不必要的甲状腺全切术，目前需要在细针穿刺活检（FNAB）后对细胞学检查结果不确定的甲状腺结节（根据英国甲状腺协会标准为Thy 3）进行术前评估。本研究的目的是利用一组Thy 3结节的手术病例，评估超声弹性成像（USE）和超声造影（CEUS）在术前恶性肿瘤诊断中的预测作用。
我们纳入了63例Thy 3结节患者，这些患者的细胞学与组织学结果具有相关性。通过半定量USE获得ELX 2/1应变指数，除了对Thy 3结节进行常规超声（US）和超声造影（CEUS）检查外，还在手术前进行USE检查。将ELX 2/1应变指数、五项超声评分以及CEUS的峰值（P）指数和达峰时间（TTP）指数与组织学结果进行相关性分析。手术诊断后，使用受试者操作特征（ROC）曲线对数据进行分析。
50例Thy 3结节组织学结果为良性，13例为恶性。良性结节（22.8±1.6 mm）和恶性结节（18.9±2.9 mm）的最大直径无差异。组织学与累积超声检查结果（p = 0.005）、ELX 2/1指数（p = 0.002）、P指数（p = 0.01）和TTP指数（p = 0.02）之间存在显著相关性。对US、USE和CEUS的数据进行分析时，观察到曲线下有显著的ROC面积（p<0.0001）。为US（>2）、ELX 2/1（>0.95）、P指数（<0.99）和TTP指数（>0.98）分数设定了截断值。考虑到从ROC曲线获得的实验截断点，对Thy 3结节进行US、USE和CEUS术前累积分析的诊断效能为：敏感性64%，特异性92%，阳性预测值75%，准确性84%。
ELX 2/1指数与超声评分相结合有助于指导Thy 3结节的手术策略。CEUS提供的信息不如US和USE敏感。基于组织学的截断值的应用可减少甲状腺切除术。当并非所有仪器检查结果都可疑时，观察应作为首选。
