Multiparametric Ultrasound Evaluation of the Thyroid: Elastography as a Key Tool in the Risk Prediction of Undetermined Nodules (Bethesda III and IV)-Histopathological Correlation.

Autor:	Moraes PHM; Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. Electronic address: pedrohenrique.mmoraes@gmail.com., Takahashi MS; Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., Vanderlei FAB; Head and Neck Surgery Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., Schelini MV; Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., Chacon DA; Pathology Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., Tavares MR; Head and Neck Surgery Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., Chammas MC; Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Ultrasound in medicine & biology [Ultrasound Med Biol] 2021 May; Vol. 47 (5), pp. 1219-1226. Date of Electronic Publication: 2021 Feb 12.
DOI:	10.1016/j.ultrasmedbio.2021.01.019
Abstrakt:	The purpose of this study was to select thyroid nodules most at risk for malignancy among those cytologically undetermined by fine-needle aspiration biopsy (FNAB), using B-mode, color duplex Doppler and 2-D shear wave shear wave elastography (2-D-SWE). This was a prospective diagnostic accuracy study with 62 Bethesda III/IV nodules according to FNAB (atypia/follicular lesion of undetermined significance or follicular neoplasia/Hürthle cell neoplasm). Ultrasonography (US) data were compared with resection histologic results, revealing 35 of 62 benign nodules (56.4%) and 27 of 62 carcinomas (43.6%). Conventional US was uses to evaluate nodule echogenicity, dimensions, contours, presence of halo and microcalcifications. Doppler US was used to assess the vascularization (exclusively or predominantly peripheral or central) and mean resistance index of three nodule arteries. Elastography was used to evaluate the nodule elastographic pattern; mean nodule deformation index; deformation ratio between nodule and adjacent thyroid parenchyma; and mean deformation ratio between nodule and pre-thyroid musculature (MDR). Statistical analysis included χ 2 , Fisher's exact, Student's t, Mann-Whitney tests and multivariable analysis by multiple logistic regression. Areas under the receiver operating characteristic curves (AUC-ROCs) were used for accuracy analysis. Fifty-eight participants (54.7 ± 14.0 y, 51 women) were studied. The parameters that were statistically significant to the univariate analysis were hypo-echogenicity, nodule diameter greater than width and all parameters analyzed from Doppler and elastography. Multivariate analysis revealed that the MDR (in kPa) was the best parameter for risk analysis of indeterminate nodules. Nodules with MDRs >1.53 exhibited a greater chance of malignancy (AUC-ROC = 0.98). We conclude that 2-D-SWE is able to select malignant nodules among those cytologically indeterminate, thus avoiding unnecessary surgery in these cytologic groups. Competing Interests: Conflict of interest disclosure Our institution had partial funding from GE for this research. (Copyright © 2021 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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