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: | Marcelo V. Schelini, Felipe Augusto Brasileiro Vanderlei, Pedro Henrique de Marqui Moraes, Danielle Azevedo Chacon, Marcos Tavares, Marcelo Straus Takahashi, Maria Cristina Chammas |
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| Rok vydání: | 2020 |
| Předmět: |
Thyroid nodules
Adult Male medicine.medical_specialty Acoustics and Ultrasonics Biophysics Malignancy Risk Assessment 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Atypia Medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Thyroid Nodule Ultrasonography Doppler Color Correlation of Data Aged Univariate analysis Radiological and Ultrasound Technology medicine.diagnostic_test Receiver operating characteristic business.industry Echogenicity Reproducibility of Results Nodule (medicine) Middle Aged medicine.disease 030220 oncology & carcinogenesis Elasticity Imaging Techniques Female Elastography Radiology medicine.symptom business |
| Zdroj: | Ultrasound in medicinebiology. 47(5) |
| ISSN: | 1879-291X |
| Popis: | 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/Hurthle 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 χ2, 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. |
| Databáze: | OpenAIRE |
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