Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Department of Medical Sciences, Section of Endocrinology & Internal Medicine, University of Ferrara, Ferrara, Italy.
Endocrine. 2017 Dec;58(3):488-494. doi: 10.1007/s12020-017-1277-6. Epub 2017 Mar 11.
Real-time elastography has been proposed to increase the sensitivity of ultrasound and improve the detection of thyroid nodules at risk of malignancy. To date sparse data on real-time elastography assessment of autonomously functioning thyroid nodules exist. Here, we investigated the potential role of real-time elastography in autonomously functioning thyroid nodule assessment. Specifically, the correlation between serum hormones and real-time elastography score, as well as other clinical and ultrasound features, was analyzed.
Patients with autonomously functioning thyroid nodule identified by I-123 scintigraphy from September 2015 to July 2016 and undergoing ultrasound, real-time elastography, and thyroid function evaluation were selected. All autonomously functioning thyroid nodule were classified as RTE I (prevalence of red or green color with blue in up to 25% of the nodule area), RTE II (blue in 25-75%), or RTE III (blue in more than 75%). The association between suppressed thyroid stimulating hormone and patient's age, nodule's size, ultrasound presentation, and real-time elastography scoring was analyzed by Odds Ratio in univariate fashion and multivariate model.
A number of 47 subjects with single autonomously functioning thyroid nodule were enrolled. Median age of 63 years, median size of 2.0 cm, and suppressed thyroid stimulating hormone levels in 32% of cases were found. Those nodules classified by ultrasound at high risk underwent fine-needle aspiration cytology and cancer was excluded. At real-time elastography evaluation, a 45% of autonomously functioning thyroid nodule had a hard appearance (RTE III) and had thyroid stimulating hormone significantly lower than the other (p < 0.0001). A model of multivariate logistic regression including nodule's size, ultrasound characteristics, and elastographic presentation showed that only RTE III was significantly associated with suppressed thyroid stimulating hormone (Odds Ratio of 50).
Autonomously functioning thyroid nodule may have variable elasticity at real-time elastography examination, being hard score associated with reduced/suppressed thyroid stimulating hormone. For clinical practice, the presence of autonomously functioning thyroid nodule should be considered in patients with hard lesions. Also, as quoted by the most recent ATA guidelines, elastography should not be accounted for risk stratification of thyroid nodules.
实时弹性成像技术已被提出用于提高超声的灵敏度，并提高恶性风险甲状腺结节的检出率。迄今为止，有关自主功能甲状腺结节实时弹性成像评估的数据很少。在这里，我们研究了实时弹性成像在自主功能甲状腺结节评估中的潜在作用。具体而言，分析了血清激素与实时弹性成像评分以及其他临床和超声特征之间的相关性。
从 2015 年 9 月至 2016 年 7 月，通过 I-123 闪烁扫描术选择了患有自主功能甲状腺结节的患者，并进行了超声、实时弹性成像和甲状腺功能评估。所有自主功能甲状腺结节均分为 RTE I 级（红色或绿色为主，蓝色占结节面积的 25%以下）、RTE II 级（蓝色占 25-75%）或 RTE III 级（蓝色占 75%以上）。通过优势比（OR）在单变量和多变量模型中分析抑制性甲状腺刺激素与患者年龄、结节大小、超声表现和实时弹性成像评分之间的关系。
共纳入 47 例单发自主功能甲状腺结节患者。中位年龄为 63 岁，中位结节大小为 2.0cm，32%的患者甲状腺刺激素水平受到抑制。那些通过超声评估为高危的结节进行了细针抽吸细胞学检查，排除了癌症。在实时弹性成像评估中，45%的自主功能甲状腺结节表现为硬外观（RTE III 级），其甲状腺刺激素显著低于其他（p<0.0001）。包括结节大小、超声特征和弹性成像表现的多变量逻辑回归模型显示，只有 RTE III 级与抑制性甲状腺刺激素显著相关（OR 为 50）。
自主功能甲状腺结节在实时弹性成像检查中可能具有不同的弹性，硬度评分与甲状腺刺激素减少/抑制有关。对于临床实践，在有硬病变的患者中应考虑存在自主功能甲状腺结节。此外，正如最新的 ATA 指南所述，弹性成像不应用于甲状腺结节的风险分层。
