Dobruch-Sobczak Katarzyna Sylwia, Krauze Agnieszka, Migda Bartosz, Mlosek Krzysztof, Słapa Rafał Zenon, Bakuła-Zalewska Elwira, Adamczewski Zbigniew, Lewiński Andrzej, Jakubowski Wiesław, Dedecjus Marek
Radiology Department II, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Science, Warsaw, Poland.
Front Endocrinol (Lausanne). 2019 Mar 11;10:127. doi: 10.3389/fendo.2019.00127. eCollection 2019.
Numerous TIRADS (Thyroid Image Reporting and Data System) classifications have been developed, and various ultrasound (US) parameters are employed in different countries. The aim of our study was to introduce risk classification and management in a native population based on the Guidelines of Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma but with the addition of sonoelastography. We examined prospectively 208 patients with 305 thyroid lesions employing B-mode ultrasound and sonoelastography (SE). Nodule composition, echogenicity, margins, shape, presence or absence of calcifications, thyroid capsule, nodule size were assessed using B-mode ultrasound. Moreover, sonoelastography results were presented using the Asteria scale. In univariate analysis, the following US features were significantly associated with malignancy: >50% solid /solid component, marked hypoechogenicity, ill-defined margins, micro and macrocalcification, taller-than wide shape, no/partial halo pattern, infiltration of the capsule and an Asteria score of 4. Multivariate logistic regression analysis of B-mode features revealed that ill-defined margins (OR 10.77), markedly hypoechogenicity (OR 5.12), microcalcifications (OR 4.85), thyroid capsule infiltrations (OR 3.2), macrocalcifications (OR 3.01), and hard lesion in SE (OR 6.85) were associated with a higher Odds Ratio (OR) for malignancy. Multivariate logistic regression analysis revealed that combining two features increases the OR and the best combination was irregular margins and Asteria scale 4 (OR 20.21). Adding a third feature did not increase the OR. Sonoelastography increases the value risk of predicted malignancy, with consequent different approach to further clinical investigation and management. A solitary feature (Asteria 4) in a solid tumor can result in its categorization as TIRADS 4, but coexistence with high risk features allows it to be upgraded to TIRADS 5. The irregular margin was the strongest single feature which allowed for the assignment of a solid tumor into TIRADS 5 category. The highest accuracy was found by combining the features of age, margin, echogenicity (markedly hypoechoic), capsule infiltration, microcalcifications and sonoelastography (Asteria 3,4) of the tumors.
已经开发出了多种甲状腺影像报告和数据系统（TIRADS）分类方法，不同国家采用了各种超声（US）参数。我们研究的目的是基于波兰国家甲状腺癌诊断与治疗学会的指南，在本国人群中引入风险分类和管理方法，但增加了超声弹性成像技术。我们前瞻性地检查了208例患有305个甲状腺病变的患者，采用了B超和超声弹性成像（SE）技术。使用B超评估结节的成分、回声、边界、形状、有无钙化、甲状腺包膜、结节大小。此外，超声弹性成像结果采用Asteria分级表示。在单因素分析中，以下超声特征与恶性肿瘤显著相关：实性成分>50%/实性成分、明显低回声、边界不清、微钙化和大钙化、纵横比大于1、无/部分晕环征、包膜浸润以及Asteria评分为4。对B超特征进行多因素逻辑回归分析显示，边界不清（OR 10.77）、明显低回声（OR 5.12）、微钙化（OR 4.85）、甲状腺包膜浸润（OR 3.2）、大钙化（OR 3.01）以及超声弹性成像中的硬病变（OR 6.85）与恶性肿瘤的较高优势比（OR）相关。多因素逻辑回归分析显示，结合两个特征会增加OR，最佳组合是边界不规则和Asteria分级4（OR 20.21）。添加第三个特征并不会增加OR。超声弹性成像增加了预测恶性肿瘤的风险值，从而导致对进一步临床研究和管理采取不同的方法。实体瘤中的单一特征（Asteria 4）可导致其被归类为TIRADS 4，但与高风险特征共存则可将其升级为TIRADS 5。边界不规则是最强的单一特征，可将实体瘤归为TIRADS 5类别。通过结合肿瘤的年龄、边界、回声（明显低回声）、包膜浸润、微钙化和超声弹性成像（Asteria 3、4）等特征，发现准确性最高。
