Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital Seoul, Seoul, Korea.
Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Korean J Intern Med. 2019 Jul;34(4):850-857. doi: 10.3904/kjim.2016.326. Epub 2018 Feb 23.
BACKGROUND/AIMS: The aim of this study was to address the role of the elasticity index as a possible predictive marker for detecting papillary thyroid carcinoma (PTC) and quantitatively assess shear wave elastography (SWE) as a tool for differentiating PTC from benign thyroid nodules.
One hundred and nineteen patients with thyroid nodules undergoing SWE before ultrasound-guided fine needle aspiration and core needle biopsy were analyzed. The mean (EMean), minimum (EMin), maximum (EMax), and standard deviation (ESD) of SWE elasticity indices were measured.
Among 105 nodules, 14 were PTC and 91 were benign. The EMean, EMin, and EMax values were significantly higher in PTCs than benign nodules (EMean 37.4 in PTC vs. 23.7 in benign nodules, p = 0.005; EMin 27.9 vs. 17.8, p = 0.034; EMax 46.7 vs. 31.5, p < 0.001). The EMean, EMin, and EMax were significantly associated with PTC with diagnostic odds ratios varying from 6.74 to 9.91, high specificities (86.4%, 86.4%, and 88.1%, respectively), and positive likelihood ratios (4.21, 3.69, and 4.82, respectively). The ESD values were significantly higher in PTC than in benign nodules (6.3 vs. 2.6, p < 0.001). ESD had the highest specificity (96.6%) when applied with a cut-off value of 6.5 kPa. It had a positive likelihood ratio of 14.75 and a diagnostic odds ratio of 28.50.
The shear elasticity index of ESD, with higher likelihood ratios for PTC, will probably identify nodules that have a high potential for malignancy. It may help to identify and select malignant nodules, while reducing unnecessary fine needle aspiration and core needle biopsies of benign nodules.
背景/目的：本研究旨在探讨弹性指数作为预测指标在检测甲状腺乳头状癌（PTC）中的作用，并定量评估剪切波弹性成像（SWE）在鉴别 PTC 与良性甲状腺结节中的应用。
对 119 例行 SWE 检查的甲状腺结节患者进行分析，在超声引导下细针抽吸活检和核心针活检前进行 SWE。测量 SWE 弹性指标的平均值（EMean）、最小值（EMin）、最大值（EMax）和标准差（ESD）。
105 个结节中，14 个为 PTC，91 个为良性。PTC 的 EMean、EMin 和 EMax 值明显高于良性结节（EMean：PTC 为 37.4，良性结节为 23.7，p = 0.005；EMin：PTC 为 27.9，良性结节为 17.8，p = 0.034；EMax：PTC 为 46.7，良性结节为 31.5，p < 0.001）。EMean、EMin 和 EMax 与 PTC 显著相关，诊断比值比（OR）分别为 6.74~9.91，特异性分别为 86.4%、86.4%和 88.1%，阳性似然比（LR+）分别为 4.21、3.69 和 4.82。PTC 的 ESD 值明显高于良性结节（6.3 vs. 2.6，p < 0.001）。ESD 的截断值为 6.5 kPa 时，特异性最高（96.6%），LR+为 14.75，OR 为 28.50。
ESD 的剪切弹性指数具有更高的 PTC 似然比，可能有助于识别具有高恶性潜能的结节。它可能有助于识别和选择恶性结节，同时减少对良性结节的不必要的细针抽吸和核心针活检。
