Abstract
Purpose
This study was done to compare quantitative elastosonography and ultrasound analysis in the characterisation of thyroid nodules.
Materials and methods
From July 2009 to September 2011, 123 patients with 147 thyroid nodules were included in our study. All patients enrolled had to undergo thyroidectomy because of nodular thyroid disease (goitre or nodules). After preliminary examination with conventional ultrasound (US) and colour Doppler US, the patients were examined with elastosonography, using high-level equipment (Toshiba Aplio XG) and quantitative software (Elasto-Q). Each lesion was characterised using an US score (echogenicity, borders, microcalcifications and colour Doppler pattern), and then by elastosonographic strain ratio. Each patient subsequently underwent thyroidectomy. Histological results were used as the gold standard.
Results
Histological examination demonstrated 89 benign and 58 malignant lesions. On average, the strain ratio value was 2.84±2.69 (range, 0.05–14.5; p=0.001). Sensitivity and specificity of the US score were about 56% and 72%, respectively, whereas those of the strain ratio were 93% and 89%, using a cut-off of 2 obtained with receiver operating characteristic (ROC) curve analysis. Elastosonography was more accurate than US and colour Doppler US in characterising thyroid nodules (p=0.002).
Conclusions
Quantitative elastosonography is a useful diagnostic tool in the evaluation of thyroid lesions, and can be used to limit fine-needle aspiration cytology and improve the selection of patients for thyroidectomy.
Riassunto
Obiettivo
Scopo del presente lavoro è stato confrontare elastosonografia quantitativa ed analisi ecografica nella caratterizzazione del nodulo tiroideo.
Materiali e metodi
Tra luglio 2009 e settembre 2011 sono stati arruolati 123 pazienti con 147 noduli candidati all’intervento di tiroidectomia totale per la presenza di patologia nodulare tiroidea. Dopo valutazione preliminare con ecografia e color Doppler, i pazienti sono stati sottoposti ad elastosonografia, mediante software quantitativo Elasto-Q con apparecchiatura Toshiba Aplio XG. Ogni nodulo è stato caratterizzato mediante ecoscore (ecogenicità, margini, microcalcificazioni, pattern color Doppler) e indice di deformabilità (strain ratio). I risultati istologici sono stati utilizzati come gold standard.
Risultati
I noduli esaminati sono risultati benigni in 89 casi e maligni in 58. Alla valutazione elastosonografica la media dei valori di strain ratio è stata 2,84±2,69 (p=0,001). Si sono ottenuti valori di sensibilità e specificità rispettivamente 56% e 72% per l’eco-score e 93% e 89% per lo strain ratio, utilizzando un cut-off pari a 2, con un valore predittivo positivo del 55% e dell’82% rispettivamente. La tecnica elastosonografica ha mostrato maggiore accuratezza dell’ecografia e del color Doppler nella caratterizzazione delle lesioni tiroidee (p=0,002).
Conclusioni
L’elastosonografia quantitativa è uno strumento valido per la caratterizzazione dei noduli tiroidei, utile per ridurre il ricorso all’agoaspirato, in particolare nei casi incerti.
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Cantisani, V., D’Andrea, V., Mancuso, E. et al. Prospective evaluation in 123 patients of strain ratio as provided by quantitative elastosonography and multiparametric ultrasound evaluation (ultrasound score) for the characterisation of thyroid nodules. Radiol med 118, 1011–1021 (2013). https://doi.org/10.1007/s11547-013-0950-y
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DOI: https://doi.org/10.1007/s11547-013-0950-y