Ha Su Min, Chung Yun Jae, Ahn Hye Shin, Baek Jung Hwan, Park Sung Bin
Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
BMC Med Imaging. 2019 Apr 4;19(1):28. doi: 10.1186/s12880-019-0328-2.
The malignancy risks of various echogenic foci in thyroid nodules are not consistent. The association between malignancy and echogenic foci and various Thyroid Imaging Reporting and Data System (TIRADS) in thyroid nodules has not been evaluated. We evaluated the malignancy probability and diagnostic performance of thyroid nodules with various echogenic foci and in combination with TIRADS.
This retrospective study was approved by Institutional Review Board. The data were retrospectively collected from January 2013 to December 2014. In total, 954 patients (mean age, 50.8 years; range, 13-86 years) with 1112 nodules were included. Using χ test, we determined the prevalence of benign and malignant nodules among those with and without echogenic foci; we associated each of 6 echogenic foci types with benign and malignant nodules. Diagnostic performance was compared between the 6 types alone and in combination with various TIRADS.
Among 1112 nodules, 390 nodules (35.1%) were found to have echogenic foci, and 722 nodules (64.9%) were not. Among nodules with echogenic foci, 254 nodules (65.1%) were malignant. The punctate echogenic foci with comet-tail artifact showed malignancy rate of 77.8% in solid and predominantly solid nodules. Our study demonstrated relatively low PPV (33.3-56.4%) in nodules with large echogenic foci without shadowing, macrocalcification, and peripheral curvilinear or eggshell echogenic foci with or without shadowing. However, when combined with high suspicion category of TIRADS, PPV increased to 50.0-90.9%.
Combination with TIRADS with different types of echogenic foci offer better stratification of the malignancy risk.
甲状腺结节中各种回声灶的恶性风险并不一致。甲状腺结节中恶性与回声灶及各种甲状腺影像报告和数据系统（TIRADS）之间的关联尚未得到评估。我们评估了具有各种回声灶并结合TIRADS的甲状腺结节的恶性概率和诊断性能。
本回顾性研究经机构审查委员会批准。数据于2013年1月至2014年12月进行回顾性收集。共纳入954例患者（平均年龄50.8岁；范围13 - 86岁），其共有1112个结节。使用χ检验，我们确定了有或无回声灶的患者中良性和恶性结节的患病率；我们将6种回声灶类型中的每一种与良性和恶性结节相关联。比较了单独的6种类型以及与各种TIRADS联合时的诊断性能。
在1112个结节中，发现390个结节（35.1%）有回声灶，722个结节（64.9%）没有。在有回声灶的结节中，254个结节（65.1%）为恶性。伴有彗尾伪像的点状回声灶在实性及以实性为主的结节中的恶性率为77.8%。我们的研究表明，在具有无阴影的大回声灶、粗大钙化以及有或无阴影的周边曲线状或蛋壳样回声灶的结节中，阳性预测值（PPV）相对较低（33.3 - 56.4%）。然而，当与TIRADS的高可疑类别联合时，PPV增加到50.0 - 90.9%。
不同类型回声灶与TIRADS联合可更好地分层恶性风险。
