Nicolaou Mark A, Jacobs Kathleen, Bhana Sindeep, Naidu Kershlin, Nicolaou Veronique
Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa.
Department of Diagnostic Radiology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
SA J Radiol. 2019 Jun 26;23(1):1749. doi: 10.4102/sajr.v23i1.1749. eCollection 2019.
Thyroid nodules are prevalent worldwide. Detection rates are increasing because of the use of ultrasonography. Ultrasound has become the first-choice imaging modality in evaluating nodules. The decision to perform an US-guided fine-needle aspiration (FNA) is based on a nodule's sonographic features. Thus, it is essential to accurately risk stratify thyroid nodules so that they are appropriately referred for FNA.
The aim of this study was to correlate the ultrasound imaging features of thyroid nodules with FNA cytology and surgical histopathology results, and to risk stratify patients using the American Thyroid Association (ATA) classification for each imaging characteristic with the likelihood of the nodule being malignant.
Retrospective analysis of a thyroid ultrasound database at Chris Hani Baragwanath Academic Hospital, over the period 2015-2017. Frequencies and percentages were used to summarise the data. Univariate logistic regression analyses were used to assess the accuracy of sonographic features in predicting the histologically determined diagnosis for thyroid tumours.
A total of 113 nodules underwent FNA, of which 104 were diagnostic. The best three ultrasound features that pose a higher risk for malignancy are absent halo, presence of microcalcifications and hypoechoic appearance. No single nodule feature is an absolute indicator for malignancy. There is a high agreement between ATA classification and cytopathology or histology when nodule features are grouped into clusters. Agreement between the ATA classification and cytopathology/histology was 86.7% with a kappa of 0.714. The agreement between the cytopathology FNA results and lobectomy histopathology was 98.8% with a kappa of 0.973.
This study contributes to the paucity of data available for sub-Saharan Africa and provides reassurance that our results are consistent with international studies. The study confirms that the usage of a thyroid nodule classification system improves characterisation and increases accuracy in detecting thyroid malignancies, thus sparing many patients the morbidity of unnecessary thyroid surgery.
甲状腺结节在全球范围内普遍存在。由于超声检查的应用，其检出率正在上升。超声已成为评估结节的首选成像方式。决定进行超声引导下细针穿刺活检（FNA）是基于结节的超声特征。因此，准确地对甲状腺结节进行风险分层至关重要，以便将它们适当地转诊进行FNA。
本研究的目的是将甲状腺结节的超声成像特征与FNA细胞学及手术组织病理学结果相关联，并使用美国甲状腺协会（ATA）分类对每个成像特征进行风险分层，以确定结节为恶性的可能性。
对2015年至2017年期间克里斯哈尼·巴拉格瓦纳特学术医院的甲状腺超声数据库进行回顾性分析。使用频率和百分比来汇总数据。单因素逻辑回归分析用于评估超声特征在预测甲状腺肿瘤组织学诊断方面的准确性。
共有113个结节接受了FNA，其中104个诊断明确。提示恶性风险较高的最佳三个超声特征是无晕圈、存在微钙化和低回声表现。没有单一的结节特征是恶性的绝对指标。当结节特征分组时，ATA分类与细胞病理学或组织学之间有高度一致性。ATA分类与细胞病理学/组织学之间的一致性为86.7%，kappa值为0.714。细胞病理学FNA结果与叶切除术组织病理学之间的一致性为98.8%，kappa值为0.973。
本研究为撒哈拉以南非洲地区可用数据的匮乏做出了贡献，并确保我们的结果与国际研究一致。该研究证实，使用甲状腺结节分类系统可改善特征描述并提高检测甲状腺恶性肿瘤的准确性，从而使许多患者免于不必要的甲状腺手术的 morbidity（此处原文可能有误，结合语境推测可能是“并发症”之类意思）。
