Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?
Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?
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DOI：
10.1186/1471-2407-13-550
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发表时间：
2013-11-16
期刊：
影响因子：
3.8
通讯作者：
Kwak, Jin Young
中科院分区：
文献类型：
--
作者：
Park, Mina;Park, So Hee;Kwak, Jin Young
背景资料：甲状腺的不均匀回声与弥漫性甲状腺疾病有关，良性和恶性结节可与弥漫性甲状腺疾病共存。潜在的不均匀回声可能使超声难以区分良恶性结节。因此，本研究的目的是评估潜在的甲状腺回声对使用US.Methods诊断甲状腺恶性肿瘤的影响：共1,373例患者接受了US引导下细针穿刺1,449甲状腺结节从2009年6月至2009年8月。根据潜在的甲状腺回声，计算并比较超声评估甲状腺结节的诊断性能。使用Logistic回归和GEE（广义估计方程）方法，比较了根据基础实质回声诊断甲状腺恶性肿瘤的US评估的诊断性能。结果：在1,449个甲状腺结节中，恶性结节325个（22.4%），良性结节1,124个（77.6%）。与回声均匀的甲状腺相比，回声不均匀的甲状腺的特异性、PPV和准确性明显较低，分别为76.3%比83.7%、48.7%比60.9%和77.6%比84.4%（P分别= 0.009、0.02和0.005）。在良性甲状腺结节中，回声不均匀者边缘微分叶或不规则者明显多于回声均匀者（P < 0.001）。结论：甲状腺回声不均匀明显降低了超声对甲状腺结节鉴别诊断的特异性、阳性预测值和准确性。因此，在评价甲状腺实质中检测到的甲状腺结节显示不均匀回声时需要谨慎。
Background: Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.Methods: A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.Results: Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P = 0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P < 0.001).Conclusion: Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.