超声弹性成像在甲状腺结节术前恶性预测中是传统超声检查和细针穿刺的有用辅助手段：印度北部视角
Ultrasound Elastography is a Useful Adjunct to Conventional Ultrasonography and Needle Aspiration in Preoperative Prediction of Malignancy in Thyroid Nodules: A Northern India Perspective.
作者信息
Garg Monika, Khandelwal Deepak, Aggarwal Vivek, Raja Kiran B, Kalra Sanjay, Agarwal Bhoopendra, Dutta Deep
机构信息
Department of Radiology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
Department of Endocrinology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
出版信息
Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):589-596. doi: 10.4103/ijem.IJEM_634_17.
INTRODUCTION
Data on ultrasound elastography (USE) are scant from India. This study aimed to compare the sensitivity and specificity of USE with thyroid ultrasonography (USG) and fine-needle aspiration (FNA) as preoperative predictor of malignancy, using postoperative histopathology as gold standard.
MATERIALS AND METHODS
Consecutive patients with thyroid swelling/goiter underwent thyroid USG followed by USE. Patients with pure cystic nodules or eggshell calcification were excluded. Patients with nodules >10 mm with one or more high-risk USG features underwent FNA. Patients with no USG high-risk features, benign score on USE, and benign FNA were conservatively followed. All other patients underwent thyroidectomy.
RESULTS
246 consecutive patients underwent USG. Data from 97 patients (117 nodules) were analyzed. Median age of patients was 43 years with 85.4% females. All patients with USE score-1 had benign USG and FNA characteristics. Of 86 nodules having USE score-2, 18.6% nodules were hypoechoic and 16.28% had microcalcification. Hypoechogenicity and microcalcifications were observed in 66.67% nodules with USE score-3. All nodules with USE score-4 and 5 were hypoechoic and had microcalcifications. Histopathology was benign in 84 and malignant in 33 patients. Occurrence of malignancy in USE scores 1-5 was 0, 4.65, 100, 90.5, and 100%, respectively. All eight nodules with diagnosis of follicular adenoma had preoperative USE score-2. The sensitivity of preoperative USG, USE, and FNA in picking up malignancy was 66.67, 87.88, and 69.70%, respectively. Specificity of USG, USE, and FNA in detecting thyroid malignancy was 88.10, 100, and 97.6%, respectively. False positivity rates for USG, USE, and FNA in diagnosing thyroid malignancy was 11.9, 0, and 2.4%, respectively. The overall diagnostic accuracy of USG, USE, and FNA cytology in this study was 82.05, 96.58, and 89.74%, respectively.
CONCLUSION
USE may be better than USG for preoperative detection of malignancy in thyroid nodules.
引言
来自印度的超声弹性成像（USE）数据很少。本研究旨在以术后组织病理学为金标准，比较USE与甲状腺超声检查（USG）及细针穿刺活检（FNA）作为甲状腺恶性肿瘤术前预测指标的敏感性和特异性。
材料与方法
连续的甲状腺肿大/甲状腺肿患者先接受甲状腺USG检查，然后进行USE检查。纯囊性结节或蛋壳样钙化的患者被排除。直径>10mm且具有一个或多个高危USG特征的结节患者接受FNA检查。无USG高危特征、USE检查为良性评分且FNA检查为良性的患者进行保守观察。所有其他患者接受甲状腺切除术。
结果
246例连续患者接受了USG检查。对97例患者（117个结节）的数据进行了分析。患者的中位年龄为43岁，女性占85.4%。所有USE评分为1的患者USG和FNA检查结果均为良性。在86个USE评分为2的结节中，18.6%的结节为低回声，16.28%有微钙化。USE评分为3的结节中，66.67%有低回声和微钙化。所有USE评分为4和5的结节均为低回声且有微钙化。组织病理学检查结果为良性的患者有84例，恶性的有33例。USE评分1 - 5的患者中恶性肿瘤的发生率分别为0、4.65%、100%、90.5%和100%。所有诊断为滤泡性腺瘤的8个结节术前USE评分为2。术前USG、USE和FNA检测恶性肿瘤的敏感性分别为66.67%、87.88%和69.70%。USG、USE和FNA检测甲状腺恶性肿瘤的特异性分别为88.10%、100%和97.6%。USG、USE和FNA诊断甲状腺恶性肿瘤的假阳性率分别为11.9%、0和2.4%。本研究中USG、USE和FNA细胞学检查的总体诊断准确性分别为82.05%、96.58%和89.74%。
结论
在术前检测甲状腺结节中的恶性肿瘤方面，USE可能优于USG。
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