Okasha Hussein Hassan, Mansor Mona, Sheriba Nermine, Assem Maha, Abdelfattah Yasmine, Ashoush Omar A, Rakha Maha, Abdelfattah Dalia, El-Sawy Shereen Sadik, Elshenoufy Mai, Mohsen Ahmed Amr, Sedrak Heba Kamal, Abdellatif Abeer Awad
Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt.
Ain Shams University, Cairo, Egypt.
Arch Endocrinol Metab. 2021 May 18;64(6):735-742. doi: 10.20945/2359-3997000000283.
Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules.
From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC.
Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign ( < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules ( < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders.
Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.
超声检查（US）是诊断甲状腺结节最准确且性价比最高的成像方法。为解决甲状腺结节细针穿刺活检（FNAC）的结节选择问题，已提出一种实用的甲状腺影像报告和数据系统（TIRADS）对甲状腺结节进行分类。实时弹性成像和应变率（SR）是一种用于评估甲状腺结节硬度并预测其恶性程度的方法。本研究的目的是评估弹性成像、SR以及TIRADS评分系统在鉴别甲状腺恶性结节与良性结节中的作用。
2015年至2018年期间，开罗大学医院的409例甲状腺结节患者被转诊接受甲状腺超声检查。根据TIRADS将每个结节分类为1至5级。评估结节的定性弹性成像评分和半定量SR。最终诊断通过甲状腺切除术后组织病理学检查或超声引导下FNAC完成。
我们的研究纳入了409例甲状腺结节患者。他们的平均年龄为39±10标准差；男性36例，女性373例。有22个恶性结节和387个良性结节。在TIRADS分类、SR、前后径/横径比、回声程度、边界、钙化情况以及无晕环征方面，良性结节与恶性结节之间存在统计学差异（<0.001）。甲状腺结节的弹性特性在截断值>2.32时被证明是鉴别恶性结节与良性结节的良好指标（<0.001），敏感性为95.2%，特异性为86.5%。SR每增加一个单位，恶性风险增加近2倍。边界不规则的患者发生恶性病变的风险比边界规则的患者高近17倍。
弹性成像和SR在鉴别良性结节与恶性结节方面具有高度显著价值，因此我们建议将其纳入TIRADS分类。
