Performance of Elastography for the Evaluation of Thyroid Nodules: A Prospective Study
Performance of Elastography for the Evaluation of Thyroid Nodules: A Prospective Study
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DOI：
10.1089/thy.2012.0227
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发表时间：
2013-06-01
期刊：
影响因子：
6.6
通讯作者：
Malchoff, Carl
中科院分区：
文献类型：
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作者：
Azizi, Ghobad;Keller, James;Malchoff, Carl
背景：在超声对肿块的评估中，弹性成像测量僵硬，这可能预示恶性肿瘤。对小的或选定的亚组的研究表明，弹性成像在甲状腺结节(TNS)的评估中可能是有用的。我们前瞻性地检验了这样的假设，即应变弹性成像(SE)测量的TN硬度是未选择的TN中甲状腺癌(TC)的独立预测因子。方法：在706例未选择的912个TN符合ATA细针吸取活检(FNAB)标准的患者中，我们首先进行了常规甲状腺超声和SE。根据Es 0到Es 3的弹性成像评分(ES)，结节硬度从最小到最硬。对于FNAB结果不明显良性的，建议手术切除。单因素和多因素回归分析确定了TC的独立预测因素。结果：共有86个恶性TN。ES是TC的显著预测因子(p=0.0001)。ES 3组158个TN中有57个(36.1%)，ES 2组有12个(7.7%)，ES 1组有16个(2.8%)，ES 0组33个TN中有1个(3%)。经多元回归分析，影响TC的独立因素为ES、微钙化、低回声和峡部位置。ES的阳性预测值(PPV)为36.1%，与微钙化的PPV(35.9%)相近，但高于低回声(13.6%)和峡部(16.9%)。ES的阴性预测值(NPV)为97.2%，优于其他任何预测恶性病变的指标。结论：弹性成像测量的TN硬度是预测TC的独立预测指标，其PPV等于或大于常规超声特征。NPV比任何其他预测恶性肿瘤的指标都要大。
Background: In the ultrasound evaluation of masses, elastography measures stiffness, which may predict malignancy. Studies of small or selected subgroups suggest that elastography may be useful in the evaluation of thyroid nodules (TNs). We prospectively tested the hypothesis that TN stiffness, as measured by strain elastography (SE), is an independent predictor of thyroid cancer (TC) in unselected TNs.Methods: In 706 unselected patients with 912 TNs meeting the ATA criteria for a fine-needle aspiration biopsy (FNAB), we first performed conventional thyroid ultrasound and SE. Nodule stiffness was graded from least to most stiff by an elastography score (ES) of ES 0 to ES 3. Surgical resection was recommended for FNAB results that were not clearly benign. Bivariate and multivariate regression analyses identified the independent predictors of TC.Results: There were 86 malignant TNs. ES was a significant predictor of TC (p = 0.0001). The prevalence of TC was 57 of the 158 TNs (36.1%) for the ES 3 group, 12 of the 158 TNs (7.7%) for the ES 2 group, 16 of the 565 TNs (2.8%) for the ES 1 group, and 1 of the 33 TNs (3%) for the ES 0 group. By multivariate regression analysis, the independent predictors of TC were ES, microcalcifications, hypoechogenicity, and isthmus location. The positive predictive value (PPV) of ES was 36.1%, which was similar to the PPV of microcalcifications (35.9%), but greater compared with hypoechogenicity (13.6%) and isthmus location (16.9%). The negative predictive value (NPV) of ES was 97.2%, which was better than any other predictor for malignancy.Conclusions: We conclude that TN stiffness measured by elastography is an independent predictor of TC with a PPV that is equal to or greater than that of conventional ultrasonographic characteristics. NPV was greater than any other predictor of malignancy.