实时弹性成像在直径大于20毫米的甲状腺结节中检测乳头状癌时相对于甲状腺超声的附加价值。

The additive value of real-time elastography to thyroid ultrasound in detecting papillary carcinoma in nodules over 20 mm in diameter.

作者信息

Angelopoulos Nikolaos, Goulis Dimitrios G, Chrisogonidis Ioannis, Livadas Sarantis, Paparodis Rodis D, Androulakis Ioannis, Jaume Juan Carlos, Iakovou Ioannis

机构信息

2nd Academic Department of Nuclear Medicine, AHEPA University Hospital, Faculty of Medicine, School of Health Sciences, Thessaloniki, Greece.

Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.

出版信息

Endocrine. 2025 Apr 24. doi: 10.1007/s12020-025-04248-1.

DOI:10.1007/s12020-025-04248-1

PMID:40274686

Abstract

PURPOSE

Ultrasonography (US) is the most accurate and cost-effective imaging method for identifying thyroid nodules. The difficulty in determining which nodules to sample for fine-needle aspiration (FNA) cytology has prompted the introduction of the Thyroid Imaging Reporting and Data Systems (TIRADS), which assesses the malignancy risk associated with thyroid nodules. Real-time elastography (RTE), coupled with strain ratio (SR) measurements, offers a means to evaluate the nodule stiffness and potentially discern their likelihood of being malignant. The present study aimed to investigate the efficacy of RTE and SR, combined with the TIRADS grading systems, in distinguishing between benign and malignant thyroid nodules.

METHODS

From 1094 patients with thyroid nodules referred for thyroid ultrasound at a University Hospital, those with thyroid nodules ≥20 mm in diameter were enrolled. Each nodule was categorized according to European (EU)- and American College of Radiology (ACR)-TIRADS systems, ranging from 2-5. Nodules' SRs were evaluated together with RTE. The thyroid nodule diagnosis was documented by post-thyroidectomy histopathological examination and/or US-guided FNA according to the Bethesda classification of the examined smears.

RESULTS

The study involved 267 patients (mean age 60.3 ± 14.3 years; 46 males and 221 females) with 308 nodules categorized into EU-TIRADS categories 3, 4, and 5. Of these nodules, 22 proved malignant, and 286 benign. The elastography ratio exhibited high predictive performance in diagnosing thyroid malignancy (p < 0.001) at a threshold value of >0.84 (sensitivity 90.9%, specificity 73.4%). In the 168 nodules with EU-TIRADS 3, this threshold had 100% sensitivity and 75.1% specificity in discriminating malignant thyroid nodules.

CONCLUSION

Combining TIRADS with data derived from RTE reduces unnecessary FNAs and surgeries in patients with thyroid nodular disease.

摘要

目的

超声检查（US）是识别甲状腺结节最准确且性价比最高的成像方法。确定哪些结节需进行细针穿刺抽吸（FNA）细胞学检查存在困难，这促使了甲状腺影像报告和数据系统（TIRADS）的引入，该系统可评估与甲状腺结节相关的恶性风险。实时弹性成像（RTE）结合应变率（SR）测量，提供了一种评估结节硬度并潜在辨别其恶性可能性的方法。本研究旨在探讨RTE和SR结合TIRADS分级系统在区分甲状腺良恶性结节方面的有效性。

方法

从一家大学医院因甲状腺超声检查而转诊的1094例甲状腺结节患者中，纳入直径≥20毫米的甲状腺结节患者。每个结节根据欧洲（EU）和美国放射学会（ACR）-TIRADS系统进行分类，范围为2至5级。结节的SR与RTE一起进行评估。甲状腺结节诊断通过甲状腺切除术后组织病理学检查和/或根据所检查涂片的贝塞斯达分类进行的超声引导下FNA记录。

结果

该研究纳入了267例患者（平均年龄60.3±14.3岁；男性46例，女性221例），共308个结节，分为EU-TIRADS 3、4和5级。其中，22个结节被证实为恶性，286个为良性。弹性成像比率在诊断甲状腺恶性肿瘤方面表现出较高的预测性能（p<0.001），阈值>0.84时（敏感性90.9%，特异性73.4%）。在168个EU-TIRADS 3级结节中，该阈值在鉴别甲状腺恶性结节时敏感性为100%，特异性为75.1%。