超声弹性成像在鉴别甲状腺良恶性结节中的应用：一项前瞻性研究。
Use of ultrasound elastography in differentiating benign from malignant thyroid nodules: a prospective study.
作者信息
Shingare Awesh, Maldar Aasim N, Chauhan Phulrenu H, Wadhwani Raju
机构信息
Department of Endocrinology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India.
出版信息
J Diabetes Metab Disord. 2023 May 31;22(2):1245-1253. doi: 10.1007/s40200-023-01239-9. eCollection 2023 Dec.
PURPOSE
Elastography is a real-time non-invasive ultrasonography modality wherein the tissue stiffness is evaluated by calculating the degree of tissue distortion in response to an external force. This study was undertaken to assess the diagnostic value of elastography in differentiating benign from malignant thyroid nodules.
METHODOLOGY
In this prospective comparative study, a total of 52 thyroid nodules from 44 euthyroid patients undergoing fine needle aspiration cytology were assessed. Elastography was performed by a single experienced sonologist, wherein the nodules were graded as per elastography scoring (ES), and the strain ratio (SR) for each nodule was computed. Final histopathology findings of the patients undergoing surgery were compared to elastography findings, and measures of diagnostic accuracy to differentiate between benign and malignant nodules were determined for ES and SR.
RESULTS
Thirty (68.2%) females and 14 (31.8%) males, with a mean age of 45.18 ± 11.23 years, were assessed. Fourteen (31.8%) patients underwent thyroidectomy, and histopathology was reported for 18 (34.6%) nodules. In all, nine (17.3%) nodules were malignant, and 43 (82.7%) nodules were considered benign. ES demonstrated a sensitivity of 88.9%, specificity of 88.3%, PPV of 61.5%, NPV of 97.4%, and accuracy of 88.5% to identify benign thyroid nodules. The mean SR for benign nodules was significantly lower as compared to malignant nodules (2.72 ± 0.62 vs. 4.52 ± 0.75, < 0.0001). The optimal cut-point value for SR to differentiate benign and malignant thyroid nodules was determined to be 3.8, with the sensitivity, specificity, PPV, NPV, and accuracy being 88.9%, 95.4%, 80%, 94.6%, and 94.2%, respectively.
CONCLUSION
Ultrasound elastography (ES and SR) demonstrated good diagnostic efficacy to differentiate benign thyroid nodules from the malignant ones, and can be a good supplementary tool to gray-scale ultrasonography. It can also help in reducing the rates of unnecessary fine needle-aspiration biopsy.
目的
弹性成像技术是一种实时无创超声检查方法，通过计算组织在外部力作用下的变形程度来评估组织硬度。本研究旨在评估弹性成像技术在鉴别甲状腺良恶性结节方面的诊断价值。
方法
在这项前瞻性对比研究中，对44例甲状腺功能正常且接受细针穿刺细胞学检查的患者的52个甲状腺结节进行了评估。由一位经验丰富的超声科医生进行弹性成像检查，根据弹性成像评分（ES）对结节进行分级，并计算每个结节的应变率（SR）。将接受手术患者的最终组织病理学结果与弹性成像结果进行比较，并确定ES和SR鉴别良恶性结节的诊断准确性指标。
结果
共评估了30名（68.2%）女性和14名（31.8%）男性，平均年龄为45.18±11.23岁。14名（31.8%）患者接受了甲状腺切除术，18个（34.6%）结节有组织病理学报告。总共有9个（17.3%）结节为恶性，43个（82.7%）结节被认为是良性的。ES鉴别良性甲状腺结节的灵敏度为88.9%，特异度为88.3%，阳性预测值为61.5%，阴性预测值为97.4%，准确率为88.5%。良性结节的平均SR显著低于恶性结节（2.72±0.62对4.52±0.75，<0.0001）。鉴别甲状腺良恶性结节的SR最佳切点值确定为3.8，其灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为88.9%、95.4%、80%、94.6%和94.2%。
结论
超声弹性成像（ES和SR）在鉴别甲状腺良恶性结节方面显示出良好的诊断效能，可作为灰阶超声的良好辅助工具。它还有助于降低不必要的细针穿刺活检率。
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