Acoustic Radiation Force Impulse Imaging for Differentiation of Thyroid Nodules

Introduction: Thyroid nodular goitre is one of the most common endocrine disorders. Differentiating between benign and malignant lesions is an emerging challenge in endocrinological practice. Ultrasonography (US) remains the most commonly applied method in the preliminary assessment of lesions and is the basis for the decision as to fine needle aspiration biopsy (FNAB) and further diagnostics. Many studies have evaluated the diagnostic value of US malignancy features. However, they focused mainly on papillary thyroid cancer (PTC). It remains unclear whether other types of thyroid carcinoma (TC) are also characterised by the same US features. The aim of this study was to assess the usefulness of US features considered as markers in the diagnosis of medullary thyroid cancer (MTC). Material and methods:The PubMed/MEDLINE and Cochrane Library databases were searched to identify studies on US features of MTCs. The random-effects model was used to calculate pooled sensitivity and specificity and odds ratios (OR) -if a comparison with PTCs was available. Results: Hypoechogenicity was present in 83.4% of MTCs, and 32.7% were markedly hypoechogenic. None of the 157 MTCs was hyperechogenic. Sensitivity of halo absence was 88.9%, but irregular margins were present in 38.0%. 35.5% of MTCs had microcalcifications, and 27.0% had macrocalcifications. 14.4% presented 'taller than wide feature' (higher anteroposterior than transverse diameter). Apart from macrocalcifications, all these features occurred insignificantly less often in MTCs than in PTCs. Conclusions: US features commonly considered as markers of malignancy can be useful also in the diagnostics of MTCs. However, MTCs tend to possess suspicious US features slightly less often than PTCs. Some features, such as hyperechogenicity, can be considered to be strong markers of benign status. Although the US appearance of the thyroid lesion is an important diagnostic factor, it is worth remembering that it does not allow for a definitive differentiation between benign and malignant nodules. In the case of MTCs, as well as other TCs, US examination remains a valuable diagnostic tool, but should always be interpreted carefully in the context of other examinations.

Section: Discussionmentioning

confidence: 99%

Cechy sonograficzne raków rdzeniastych tarczycy — przegląd systematyczny i metaanaliza

Woliński

Rewaj-Łosyk

Ruchała

2014

“…A large retrospective study performed by Ahn et al [20] reported that mean size of benign nodules was 17.9 mm, malignant -12.1 mm. In a prospective study performed by Bojunga et al [21], TCs were slightly bigger than other lesions but the difference was statistically insignificant. According to our results, taking into account the size as the most important feature, and US features of malignancy only in a case of lesions presenting equal size, would lead to the omission of 60% of cancers in MNG if one puncture is performed and 40% in case of two punctures per procedure.…”

Section: Discussionmentioning

confidence: 82%

Jak typować guzy do biopsji aspiracyjnej cienkoigłowej w wolu wieloguzkowym? Rola konwencjonalnej ultrasonografii oraz elastografii fali poprzecznej — badanie pilotażowe

Woliński¹,

Szczepanek‐Parulska²,

Stangierski³

et al. 2014

Introduction: The wide prevalence and relatively low malignancy ratio of thyroid nodular disease (TND) make the selection of suspicious lesions for fine-needle aspiration biopsy (FNAB) a vital problem in endocrinology. Apart from the decision as to whether FNAB is necessary, there is often a second problem -which nodule or nodules to choose in a case of multinodular goitre (MNG), when the number of lesions may be high. The aim of this study was to compare the usefulness of conventional ultrasonography (US) to that of a novel method of tissue stiffness assessment -shear wave elastography (SWE) -in differentiating between malignant and benign nodules and in selecting the most suspicious lesions in MNG. Material and methods: Patients with MNG, referred for thyroidectomy irrespectively of indications for surgery, underwent thyroid US and SWE examination before surgery, between August and December 2010. Results of these examinations were correlated with the histopathological outcomes. Results: 80 patients with 339 thyroid nodules were included. Ten thyroid cancers (TCs) in ten patients were diagnosed in histopathology. All ten cancers were the least elastic lesions in MNG (using quantitative data on maximal tissue stiffness). Four cancers appeared as the biggest lesions in MNG, while one was equally the biggest in a particular goitre (there were other lesions of the same size) taking into account maximal diameter. Three of ten cancers possessed the highest number of suspicious features in MNG, a further four had the highest number equally, with at least one other lesion in the same goitre. Conclusions: On the basis of our results, the relatively high stiffness of a lesion compared to other nodules from the same MNG should be considered as a strong argument for choosing that particular one for FNAB. (Endokrynol Pol 2014; 65 (2): 114-118)

“…The results are obtained in m/s [4]. Bojunga et al proposed a median velocity in ARFI for healthy thyroid gland (1.76 m/s), benign lesions (1.90 m/s) and malignant tumours (2.69 m/s) [16]. This method also can be used in standard ultrasound devices [4].…”

Section: Elastography Techniquesmentioning

confidence: 99%

“…To assess thyroid tissue stiffness, the four-point modified Ueno scale (Table 1) and three-point Rago scale have been proposed, ranging from 0 to 240 kPa and linked with colour-coded scale [16].…”

Section: Elastography Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Zastosowanie sonoelastografii w diagnostyce i monitorowaniu leczenia zapaleń oraz choroby autoimmunologicznej tarczycy

Ruchała

Szmyt

Sławek

et al. 2015

Sonoelastography (USE) is a constantly evolving imaging technique used for the noninvasive and objective estimation of tissue stiffness. Several USE methods have been developed, including Quasi-Static or Strain Elastography and Shear Wave Elastography. The utility of USE has been demonstrated in differentiating between malignant and benign thyroid lesions. Recently, USE has been applied in the evaluation of thyroiditis and autoimmune thyroid disease (AITD). Thyroid inflammatory illnesses constitute a diverse group of diseases and may manifest various symptoms. These conditions may share some parallel clinical, biochemical, and ultrasonographic features, which can lead to diagnostic difficulties. USE may be an additional tool, supporting other methods in the diagnosis and treatment monitoring of thyroid diseases, other than thyroid nodular disease. The aim of this article was to analyse and summarise the available literature on the applicability of different elastographic techniques in the diagnosis, differentiation and monitoring of various types of thyroiditis and AITD. Advantages and limitations of this technique are also discussed. StreszczenieSonoelastografia (USE) jest stale rozwijającą się techniką obrazowania stosowaną do nieinwazyjnej i obiektywnej oceny sprężystości tkanki. Jak dotąd opracowano wiele metod USE, które można podzielić na dwie zasadnicze grupy: quasi-statyczną elastografię i elastografię fali poprzecznej (SWE). Wykazano wysoką skuteczność USE w różnicowaniu łagodnych i złośliwych zmian ogniskowych w gruczole tarczowym. Coraz częściej USE znajduje zastosowanie w ocenie zapaleń gruczołu tarczowego, w tym autoimmunologicznej choroby tarczycy (AITD). Zapalne choroby tarczycy stanowią bardzo zróżnicowaną grupę chorób, których wczesne objawy są nieswoiste. Trudności diagnostyczne mogą wynikać zarówno ze wspólnych cech klinicznych, biochemicznych, jak i ultrasonograficznych zapaleń tarczycy. Sonoelastografia może być uznana za dodatkowe narzędzie, wspierające inne stosowane metody w diagnostyce i monitorowaniu leczenia chorób tarczycy innych niż choroba guzkowa tarczycy. Celem niniejszego artykułu była analiza i podsumowanie dostępnej literatury na temat możliwości zastosowania technik elastograficznych w rozpoznawaniu, różnicowaniu i monitorowaniu różnych typów zapalenia gruczołu tarczowego. Przedstawiono zarówno wady, jak i zalety stosowania tej techniki w chorobach tarczycy. (Endokrynol Pol 2014; 65 (6): 520-531)