Stoian Dana, Borcan Florin, Petre Izabella, Mozos Ioana, Varcus Flore, Ivan Viviana, Cioca Andreea, Apostol Adrian, Dehelean Cristina Adriana
"Victor Babes" University of Medicine and Pharmacy Timisoara, Internal Medicine 2nd Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania.
"Victor Babes" University of Medicine and Pharmacy Timisoara, Analytical Chemistry Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania.
Diagnostics (Basel). 2019 Sep 13;9(3):119. doi: 10.3390/diagnostics9030119.
Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6-13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases.
细针穿刺抽吸活检（FNA）被认为是甲状腺结节诊断的金标准。采用推荐的贝塞斯达报告系统，高达20%的结果被归类为中等程度的细胞学结果。由于对于超声评估、叶切除术或手术是否为最佳治疗方案尚无共识，中等程度的细胞学结果被视为FNA的灰色地带。我们研究的主要目的是评估联合先进超声技术在FNA后中等程度细胞学病例的诊断和评估过程中的性能。我们使用传统B超（2B）和应变弹性成像技术，采用线性多频率6 - 13 MHz线性探头（日本日立公司的Hitachi Prerius机器），对54例FNA结果为中等程度细胞学的连续病例进行了评估。所有结节均根据我们提出的甲状腺影像报告和数据系统（TI-RADS）模型进行分类，考虑因素包括：垂直外观，前后径大于横径，即所谓的高大于宽的形状、边界不规则、结节内不均匀性、显著低回声、微钙化、可疑淋巴结的存在以及硬度增加提示恶性可能性大。将分类结果与被视为金标准诊断的病理结果进行比较。癌症患病率为28.8%，45例中有13例被明确诊断为癌症。6例被诊断为交界性滤泡性肿瘤，这是一个演变不明确的类别，在影像结果分析中也被视为恶性。总共19例癌症病例中有16例弹性成像显示硬度增加。癌症患病率随TI-RADS类别增加，TI-RADS 4b类为25%，TI-RADS 5类为92.8%。单独弹性成像在鉴别恶性甲状腺结节方面的受试者操作特征曲线下面积（AUROC）为74.9%；弹性成像和传统超声特征相结合产生了更好的AUROC，为84.5%。联合传统超声和弹性成像在中等程度细胞学病例中识别甲状腺癌的敏感性为89.5%，特异性为50%。在应变弹性成像上，由高风险传统超声特征和硬度增加联合识别出的高风险甲状腺结节，在中等程度细胞学病例中对恶性肿瘤具有高度预测性。
