Różnicowanie zmian ogniskowych w wolu guzkowym tarczycy z zastosowaniem nowych technik ultrasonograficznych — doniesienia wstępne

Abstract

Introduction: To evaluate the relative value of technical ultrasound advances in differentiation of thyroid nodules in multinodular goitre. Material and methods:The study included patients with multinodular goitre, who were referred for thyroidectomy. Ultrasound evaluation of suspicious nodules was performed with: improved B-mode (spatial compound imaging and differential tissue harmonics), dedicated mapping of microcalcifications, mapping of the nodule vessels, and strain elastography evaluated qualitatively and semi quantitatively. Results: A total of 163 nodules in 124 patients with multinodular goitre were evaluated (147 benign and 16 cancers). Improved B-mode imaging was: 76.76% sensitive and 62.5% specific with AUC 0.740. Differentiating B-mode features were: shape -taller than wide OR 15.8, markedly hypoechoic OR 14.7, absence of cystic areas OR 6.6, absence of halo OR 5.0, and blurred/microlobulated margins OR 3.7. Addition of MicroPure imaging was 80.28% sensitive and 68.75% specific with AUC 0.771. MicroPure alone, power Doppler, and strain elastography were not statistically significant. Conclusions: Among singular modes of ultrasound imaging, only improved B-mode imaging proved to have a significant role in differentiation of thyroid nodules in multinodular goitre. Additional gain was seen with the addition to B-mode of the mapping of microcalcifications with MicroPure imaging. Power Doppler and strain elastography did not prove to be useful techniques in multinodular goitre. (Endokrynol Pol 2016; 67 (2): 157-165)

Evaluation of Four Variants of the Thyroid Imaging Reporting and Data System (TIRADS) Classification in Patients with Multinodular Goiter

“…Data from our analysis compared to the original results are as follows: sensitivity 0.875 vs. 0.957 (B-mode) and 0.985 (B-mode + elastography), specificity 0.293 vs. 0.61 (B-mode) and 0.447 (B-mode + elastography), PPV 0.119 vs. 0.06 (B-mode) and 0.016 (B-mode + elastography), NPV 0.956 vs. 0.997 (B-mode) and 0.998 (B-mode + elastography), and diagnostics accuracy 0.35 vs. 0.62 (B-mode) and 0.483 (B-mode + elastography). It was disappointing to find that TIRADS classification with elastography fared worse than classification based on B-mode as presented in Table III and reported previously by Moon et al and Migda et al [15,24]. These authors showed clearly that grey-scale with elastography has poorer results for distinguishing benign from malignant nodules compared to single grey-scale assessment.…”

“…Numerous ultrasound techniques, such as classic B-mode, Power, and Color Doppler imaging, as well as newer techniques, such as elastography and contrastenhanced ultrasound, have been investigated for their ability to differentiate thyroid nodules. However, recent studies indicate that the most valuable in this regard is B-mode ultrasound [15,[19][20][21][22]. Additionally, grey-scale imaging of focal lesions is simpler and cheaper than newer techniques, which require greater experience, more expensive equipment, and, in cases where microvascularisation is assessed, additional costs associated with the contrast agent.…”

“…Analysis of this material and procedure was previously described [15]. During an ultrasound examination the dominant nodules, based on ultrasound features, were selected [15]. A total of 163 dominant nodules, including 16 papillary cancers, were evaluated.…”