Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España; Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, España; Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España.
Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España; Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, España; Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España.
Med Clin (Barc). 2018 Aug 10;151(3):89-96. doi: 10.1016/j.medcli.2017.09.016. Epub 2017 Oct 31.
Fine needle aspiration biopsy (FNAB) is the gold standard screening technique used in the diagnostic protocol for thyroid nodules. However, it is not free of complications.
To identify thyroid nodules in which FNAB could be avoided during the diagnostic process by means of the use of a high-resolution ultrasonography or elastography.
A prospective, non-randomized study was carried out. Single thyroid nodules and dominant nodules of multinodular goiter were included. Patients who had undergone thyroid surgery in the past were excluded. All patients underwent a high-resolution ultrasound and elastography, and, subsequently, a FNAB. We analyzed the ultrasound variables in 2D and Doppler, followed by the elastographic variables, and the results of the FNAB according to Bethesda. To correlate the data, the nodules were classified as benign or malignant. Student's t test, the Chi-square test and a logistic regression analysis were applied for the statistical analysis.
A total of 221 thyroid nodules were analyzed, 32 of which were malignant (14%). The most predictive ultrasound findings of malignancy (P<.05) were a hypoechoic or complex echostructure (OR=11.832), the presence of microcalcifications (OR=9.637) and chaotic vascularization observed in the Doppler (OR=46.464). With regard to the elastography, elastographic patterns i and ii were seen to be associated with benignity (P=.0004 and P<.0001, respectively). When type i or ii elastography was combined with an ultrasound showing a non-hypoechoic nor complex echostructure, without microcalcifications nor chaotic vascularization in the Doppler ultrasound, 100% of the cases were benign with a specificity of 100% and a sensitivity of 14%.
The combination of a high-resolution ultrasound with an elastography makes it possible to select cases where a FNAB does not have to be performed. Cases susceptible to a periodic follow-up without the use of a FNAB are those without a hypoechoic nor complex structure, no microcalcifications, non-chaotic vascularization and a type i or ii elastography.
细针抽吸活检（FNAB）是诊断甲状腺结节的金标准筛查技术。然而，它并非没有并发症。
通过使用高分辨率超声或弹性成像来确定 FNAB 可在诊断过程中避免的甲状腺结节。
进行了一项前瞻性、非随机研究。纳入单发甲状腺结节和多结节性甲状腺肿的优势结节。排除既往接受过甲状腺手术的患者。所有患者均接受高分辨率超声和弹性成像检查，随后进行 FNAB。我们分析了 2D 和多普勒超声的变量，随后是弹性成像变量，以及根据 Bethesda 分类的 FNAB 结果。为了进行数据相关性分析，将结节分为良性或恶性。应用 Student's t 检验、卡方检验和逻辑回归分析进行统计学分析。
共分析了 221 个甲状腺结节，其中 32 个为恶性（14%）。最具预测性的恶性超声表现（P<.05）是低回声或复杂回声结构（OR=11.832）、微钙化的存在（OR=9.637）和多普勒观察到的杂乱血管化（OR=46.464）。关于弹性成像，i 型和 ii 型弹性图被认为与良性相关（P=.0004 和 P<.0001）。当 i 型或 ii 型弹性成像与超声显示非低回声或非复杂回声结构、多普勒超声无微钙化或杂乱血管化相结合时，100%的病例为良性，特异性为 100%，敏感性为 14%。
高分辨率超声与弹性成像相结合，可选择无需进行 FNAB 的病例。无低回声或复杂结构、无微钙化、非杂乱血管化和 i 型或 ii 型弹性图的病例，可进行无需 FNAB 的定期随访。
