Tiroid nodüllerinin benign ve malign ayırıcı tanısında gerçek zamanlı elastografinin etkinliğinin araştırılması
Öz
Amaç: Çalışmamızın amacı tiroid nodüllerinin benign-malign ayırıcı tanısında gerçek zamanlı elastografinin (GZE) etkinliğinin araştırılmasıdır.
Gereç ve yöntem: Araştırmaya 52 olgudaki 60 tiroid nodülü dahil edildi. Nodüller boyut, ekojenite, kontur özellikleri, halo ve mikrokalsifikasyon varlığı açısından değerlendirildi. Aksiyel ve longitudinal planlarda gerçek zamanlı elastografi incelemeleri gerçekleştirildi. Elastografi görüntüleri skor 1 (nodülün tamamı yumuşak) ile skor 5 arasında (nodülün tamamı ve çevre dokularda sertlik) sınıflandırıldı. Skor 1, 2 ve 3 nodüller benign, skor 4 ve 5 olan nodüller malign olarak kabul edildi. Nodül/sternokleidomastoid kası ve tiroid dokusu/nodül gerinim oranları hesaplandı. Tüm nodüllerin elastografi skorları ve ortalama gerinim oranları sitolojik ve histopatolojik tanı ile karşılaştırıldı.
Bulgular: Tüm olguların 43'ü benign, 17'si maligndi. Malignite tanısında nodül ekojenitesi doğruluğu en yüksek olan özellikti. Hipoekojenite, mikrokalsifikasyon ve halo yokluğu ile malignite arasında istatistiksel olarak anlamlı ilişki saptandı. Yüksek elastisite skoru ile malignite arasında istatistiksel anlamlı ilişiki saptanmadı. Gerinim oranının diagnostik ROC eğrisi analizi önemsiz bulundu.
Sonuç: Tiroid nodüllerinin benign-malign ayrımında gerçek zamanlı elastografinin tanısal performansı suboptimaldir. Gerçek zamanlı elastografi gri skala ultrasona alternatif olabilecek bir yöntem değildir.
Anahtar Kelimeler
Kaynakça
- 1. Ömer Bender, Yusuf Kılıç, Semih Hot, Aslı Ertürk, Zafer Ünsal Coşkun, Arzu Akan . Tiroid Nodüllerinin Değerlendirilmesinde Ultrason elastografinin Tanısal Doğruluğu ve Güvenilirliği Okmeydanı Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, Radyoloji Kliniği, İstanbul Okmeydanı Tıp Dergisi 2012 ; 28(3):151-56.
- 2. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214.
- 3. Merritt CRB. Physics of ultrasound. In: Rumack MC, Wilson RS, Charboneau JW, editors. Diagnostic Ultrasound. 3rd ed. Missouri: Mosby, 2005; 3–35.
- 4. Ako Itoh, Ei Ueno, Eriko Tohno, Hiroshi Kamma, Hideto Takahashi, Tsuyoshi Shiina et al. Breast Disease: Clinical Application of US Elastography for Diagnosis. RSNA, Radiology, 2006 doi.org/10.1148/radiol.2391041676
- 5. Moon HJ, Kim EK, Yoon JH, Kwak JY. Clinical implication of elastography as a prognostic factor of papillary thyroid microcarcinoma. Ann Surg Oncol. 2012 Jul;19(7):2279-87.
- 6. Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007 Aug;92(8):2917-22.
- 7. Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med. 2009 Jul;28(7):861-7.
- 8. Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008 May;18(5):523-31.
- 9. Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah . Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab. 2012 Dec;97(12):4524-30.
- 10. Rago T, Scutari M, Santini F, Loiacono V, Piaggi P, Di Coscio G. Real-time elastosonography: useful tool for refining the presurgical diagnosis in thyroid nodules with indeterminate or nondiagnostic cytology. J Clin Endocrinol Metab. 2010 Dec;95(12):5274-80.
- 11. Chong Y, Shin JH, Ko ES, Han BK. Ultrasonographic elastography of thyroid nodules: is adding strain ratio to colour mapping better? Clin Radiol. 2013 Dec;68(12):1241-6.
- 12. Ping Xing MD, Linfeng Wu MD, Chunmei Zhang MD, Shu Li MD, Chunbo Liu MD, Changjun Wu MD. Differentiation of Benign From Malignant Thyroid Lesions Calculation of the Strain Ratio on Thyroid Sonoelastography. 2011 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2011; 30:663–9.
- 13. Unlütürk U, Erdoğan MF, Demir O, Güllü S, Başkal N. Ultrasound elastography is not superior to grayscale ultrasound in predicting malignancy in thyroid nodules. Thyroid. 2012 Oct;22(10):1031-8.
- 14. Mansor M, Okasha H, Esmat S, Hashem AM, Attia KA, El-din Hussein H. Role of ultrasound elastography in prediction of malignancy in thyroid nodules. Endocr Res. 2012;37(2):67-77.
- 15. Dighe M, Luo S, Cuevas C, Kim Y. Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules. Eur J Radiol. 2013 Jun;82(6):e274-80.
- 16. Köseoğlu R.D, Filiz NO. The Oncocytic Variant of Papillary Thyroid Carcinoma Turk J Med Sci 2006;36(6):387-92.
- 17. Lloyd RV, Buehler D, Khanafshar E. Papillary thyroid carcinoma variants. Head Neck Pathol. 2011;5(1):51-6.
- 18. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US Features of thyroid malignancy: pearls and pitfalls. Radiographics. 2007 May-Jun;27(3):847-60; discussion 861-5.
- 19. Kagoya R, Monobe H, Tojima H. Utility of elastography for differential diagnosis of benign and malignant thyroid nodules. Otolaryngol Head Neck Surg. 2010 Aug;143(2):230-4.
- 20. Shweel M, Mansour E. Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules. Eur J Radiol. 2013 Jun;82(6):995-1001.
- 21. Cappelli C, Pirola I, Gandossi E, Agosti B, Cimino E, Casella C. Real-time elastography: a useful tool for predicting malignancy in thyroid nodules with nondiagnostic cytologic findings. J Ultrasound Med. 2012 Nov;31(11):1777-82.
- 22. Shuzhen C. Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol. 2012 Aug;81(8):1806-11.
- 23. Lippolis PV, Tognini S, Materazzi G, Polini A, Mancini R, Ambrosini CE. Is elastography actually useful in the presurgical selection of thyroid nodules with indeterminate cytology? J Clin Endocrinol Metab. 2011 Nov;96(11):E1826-30.
- 24. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005 Oct;237(1):202-11.
- 25. Cantisani V, Grazhdani H, Ricci P, Mortele K, Di Segni M, D'Andrea V. Q-elastosonography of solid thyroid nodules: assessment of diagnostic efficacy and interobserver variability in a large patient cohort. Eur Radiol. 2014 Jan;24(1):143-50.
- 26. Chong Y, Shin JH, Ko ES, Han BK. Ultrasonographic elastography of thyroid nodules: is adding strain ratio to colour mapping better? Clin Radiol. 2013 Dec;68(12):1241-6.
- 27. Hu X, Liu Y, Qian L. Diagnostic potential of real-time elastography (RTE) and shear wave elastography (SWE) to differentiate benign and malignant thyroid nodules: A systematic review and meta-analysis. Medicine (Baltimore). 2017 Oct;96(43):e8282.
- 28. Ning CP, Jiang SQ, Zhang T, Sun LT, Liu YJ, Tian JW. The value of strain ratio in differential diagnosis of thyroid solid nodules. Eur J Radiol. 2012 Feb;81(2):286-91.
Evaluation of the effectiveness of real-time elastography in the differential diagnosis of benign and malignant thyroid nodules
Öz
Aim: The aim of this study was to evaluate the efficiency of real-time elastography (RTE) in the differential diagnosis of thyroid nodules.
Materials and Methods: Fifty-two patients with 60 thyroid nodules were included in this study. Real-time elastography examinations were performed on the axial and longitudinal planes. Elastography images were classified between score 1 (whole nodule is soft) and score 5 (hardness in whole nodule and surrounding tissues). Nodules with scores of 1, 2 and 3 were considered benign, and nodules with scores of 4 and 5 were considered malignant. Nodule-to-sternocleidomastoid and thyroid tissue-to-nodule strain ratios (SR) were calculated. The nodules were evaluated by means of size, echogenicity, border, presence of halo and microcalcifications. Elasticity scores and mean strain ratios of all nodules were compared with the cytological or histopathological diagnosis.
Results: Forty-three of all cases were benign, and seventeen were malignant. Hypoechogenicity, microcalcifications and absence of halo were statistically related but irregular margins, and a high elasticity score were not statistically related to malignancy. The diagnostic performance of strain ratio was found insignificant. Nodule echogenicity had the highest accuracy among all nodule characteristics.
Conclusion: Diagnostic performance of real-time elastography in the differentiation of benign and malignant thyroid nodules is suboptimal. Real-time elastography is not an alternative to gray scale ultrasound.
Anahtar Kelimeler
Kaynakça
- 1. Ömer Bender, Yusuf Kılıç, Semih Hot, Aslı Ertürk, Zafer Ünsal Coşkun, Arzu Akan . Tiroid Nodüllerinin Değerlendirilmesinde Ultrason elastografinin Tanısal Doğruluğu ve Güvenilirliği Okmeydanı Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, Radyoloji Kliniği, İstanbul Okmeydanı Tıp Dergisi 2012 ; 28(3):151-56.
- 2. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214.
- 3. Merritt CRB. Physics of ultrasound. In: Rumack MC, Wilson RS, Charboneau JW, editors. Diagnostic Ultrasound. 3rd ed. Missouri: Mosby, 2005; 3–35.
- 4. Ako Itoh, Ei Ueno, Eriko Tohno, Hiroshi Kamma, Hideto Takahashi, Tsuyoshi Shiina et al. Breast Disease: Clinical Application of US Elastography for Diagnosis. RSNA, Radiology, 2006 doi.org/10.1148/radiol.2391041676
- 5. Moon HJ, Kim EK, Yoon JH, Kwak JY. Clinical implication of elastography as a prognostic factor of papillary thyroid microcarcinoma. Ann Surg Oncol. 2012 Jul;19(7):2279-87.
- 6. Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007 Aug;92(8):2917-22.
- 7. Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med. 2009 Jul;28(7):861-7.
- 8. Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008 May;18(5):523-31.
- 9. Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah . Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab. 2012 Dec;97(12):4524-30.
- 10. Rago T, Scutari M, Santini F, Loiacono V, Piaggi P, Di Coscio G. Real-time elastosonography: useful tool for refining the presurgical diagnosis in thyroid nodules with indeterminate or nondiagnostic cytology. J Clin Endocrinol Metab. 2010 Dec;95(12):5274-80.
- 11. Chong Y, Shin JH, Ko ES, Han BK. Ultrasonographic elastography of thyroid nodules: is adding strain ratio to colour mapping better? Clin Radiol. 2013 Dec;68(12):1241-6.
- 12. Ping Xing MD, Linfeng Wu MD, Chunmei Zhang MD, Shu Li MD, Chunbo Liu MD, Changjun Wu MD. Differentiation of Benign From Malignant Thyroid Lesions Calculation of the Strain Ratio on Thyroid Sonoelastography. 2011 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2011; 30:663–9.
- 13. Unlütürk U, Erdoğan MF, Demir O, Güllü S, Başkal N. Ultrasound elastography is not superior to grayscale ultrasound in predicting malignancy in thyroid nodules. Thyroid. 2012 Oct;22(10):1031-8.
- 14. Mansor M, Okasha H, Esmat S, Hashem AM, Attia KA, El-din Hussein H. Role of ultrasound elastography in prediction of malignancy in thyroid nodules. Endocr Res. 2012;37(2):67-77.
- 15. Dighe M, Luo S, Cuevas C, Kim Y. Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules. Eur J Radiol. 2013 Jun;82(6):e274-80.
- 16. Köseoğlu R.D, Filiz NO. The Oncocytic Variant of Papillary Thyroid Carcinoma Turk J Med Sci 2006;36(6):387-92.
- 17. Lloyd RV, Buehler D, Khanafshar E. Papillary thyroid carcinoma variants. Head Neck Pathol. 2011;5(1):51-6.
- 18. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US Features of thyroid malignancy: pearls and pitfalls. Radiographics. 2007 May-Jun;27(3):847-60; discussion 861-5.
- 19. Kagoya R, Monobe H, Tojima H. Utility of elastography for differential diagnosis of benign and malignant thyroid nodules. Otolaryngol Head Neck Surg. 2010 Aug;143(2):230-4.
- 20. Shweel M, Mansour E. Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules. Eur J Radiol. 2013 Jun;82(6):995-1001.
- 21. Cappelli C, Pirola I, Gandossi E, Agosti B, Cimino E, Casella C. Real-time elastography: a useful tool for predicting malignancy in thyroid nodules with nondiagnostic cytologic findings. J Ultrasound Med. 2012 Nov;31(11):1777-82.
- 22. Shuzhen C. Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol. 2012 Aug;81(8):1806-11.
- 23. Lippolis PV, Tognini S, Materazzi G, Polini A, Mancini R, Ambrosini CE. Is elastography actually useful in the presurgical selection of thyroid nodules with indeterminate cytology? J Clin Endocrinol Metab. 2011 Nov;96(11):E1826-30.
- 24. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005 Oct;237(1):202-11.
- 25. Cantisani V, Grazhdani H, Ricci P, Mortele K, Di Segni M, D'Andrea V. Q-elastosonography of solid thyroid nodules: assessment of diagnostic efficacy and interobserver variability in a large patient cohort. Eur Radiol. 2014 Jan;24(1):143-50.
- 26. Chong Y, Shin JH, Ko ES, Han BK. Ultrasonographic elastography of thyroid nodules: is adding strain ratio to colour mapping better? Clin Radiol. 2013 Dec;68(12):1241-6.
- 27. Hu X, Liu Y, Qian L. Diagnostic potential of real-time elastography (RTE) and shear wave elastography (SWE) to differentiate benign and malignant thyroid nodules: A systematic review and meta-analysis. Medicine (Baltimore). 2017 Oct;96(43):e8282.
- 28. Ning CP, Jiang SQ, Zhang T, Sun LT, Liu YJ, Tian JW. The value of strain ratio in differential diagnosis of thyroid solid nodules. Eur J Radiol. 2012 Feb;81(2):286-91.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Radyoloji ve Organ Görüntüleme |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Haziran 2023 |
| Gönderilme Tarihi | 19 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2023 |