Kiszka-Wiłkojć Aleksandra, Taczanowska-Niemczuk Anna, Januś Dominika, Maślanka Marcin, Godlewska Joanna, Kujdowicz Monika, Wiłkojć Michał, Górecki Wojciech
Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
Department of Pediatric Surgery, University Children's Hospital of Krakow, Krakow, Poland.
Front Endocrinol (Lausanne). 2024 Nov 15;15:1461031. doi: 10.3389/fendo.2024.1461031. eCollection 2024.
Ultrasonography is fundamental method of diagnosing focal thyroid lesions. The additional element of ultrasound examination is Strain Elastography which allows for determining the degree of elasticity of the nodule while comparing it to the surrounding thyroid parenchyma. Pediatric thyroid nodules have a higher malignancy risk than in adults, warranting the consideration of fine-needle aspiration biopsy (FNAB) in children.
A prospective data analysis of children with focal thyroid lesions treated from 2021 to 2022 was performed. The patients underwent ultrasound and elastography examinations to obtain the Strain Ratio (SR) of the nodules and were qualified for FNAB. SR was determined by the windowing method of relative strains in a semi-quantitative assessment. The FNAB score was determined on the Bethesda scale and the histological examination of the thyroid nodule was performed. The SR values were stratified in three groups: I - thyroid cancer, II - low-risk thyroid tumors, and III - benign lesion. The Kruskal-Wallis test was used to find the relation between the value of SR elastography and the malignancy, with the p value < 0.05 considered significant. The data were analyzed using the multiple comparisons test.
The 123 FNABs were performed in 100 patients. The final analysis included 119 nodules in 96 patients. In 19 cases, the nodule was malignant, in 5 cases they were low-risk tumors, and in 95 - benign lesions. A difference of the SR value between groups in the pairs of malignant and benign tumors, and malignant and low-risk tumors was revealed. Since no statistically significant difference in the level of elastography was found between benign and low-risk tumors, both groups were combined and formed a group of benign tumors. For the combined groups, the Man-Whitney test was performed, confirming that there was a statistically significant difference between the groups of malignant and benign tumors in the value of SR elastography. The cut-off point for SR for malignant tumors was >3.
The SR index of elastography is significantly higher in malignant nodules. and might be used to select changes with an increased risk of malignancy in thyroid ultrasound of children.
超声检查是诊断甲状腺局灶性病变的基本方法。超声检查的附加要素是应变弹性成像，它可以在将结节与周围甲状腺实质进行比较时确定结节的弹性程度。儿童甲状腺结节的恶性风险高于成人，因此有必要考虑对儿童进行细针穿刺活检（FNAB）。
对2021年至2022年接受治疗的患有甲状腺局灶性病变的儿童进行前瞻性数据分析。患者接受超声和弹性成像检查以获得结节的应变比（SR），并符合FNAB条件。SR通过相对应变的开窗法在半定量评估中确定。根据贝塞斯达量表确定FNAB评分，并对甲状腺结节进行组织学检查。SR值分为三组：I组 - 甲状腺癌，II组 - 低风险甲状腺肿瘤，III组 - 良性病变。使用Kruskal-Wallis检验来寻找SR弹性成像值与恶性程度之间的关系，p值<0.05被认为具有统计学意义。使用多重比较检验对数据进行分析。
100例患者进行了123次FNAB。最终分析包括96例患者的119个结节。其中19例结节为恶性，5例为低风险肿瘤，95例为良性病变。揭示了恶性与良性肿瘤对以及恶性与低风险肿瘤对之间SR值的差异。由于在良性和低风险肿瘤之间未发现弹性成像水平有统计学显著差异，因此将两组合并形成一组良性肿瘤。对合并组进行曼-惠特尼检验，证实恶性和良性肿瘤组在SR弹性成像值上存在统计学显著差异。恶性肿瘤的SR截断点>3。
弹性成像的SR指数在恶性结节中显著更高，可用于在儿童甲状腺超声检查中筛选恶性风险增加的病变。
