Furkan UFUK, Şenay TOPSAKAL, Pınar ÇAKMAK, Osman ALPARSLAN, Semin Melahat FENKÇİ, Ergin SAĞTAŞ

Elastografinin benign ve malign tiroid nodüllerinin ayırımındaki rolü

Amaç: Ultrason elastografi tiroid nodüllerini değerlendirmeye yarayan non-invaziv ultrason tekniği olup dokunun sertlik ve elastikiyetini inceler ve baskı ile yumuşak dokuların sert dokulara göre daha kolay deforme olabilmesi prensibine dayanır. Dokunun deforme olabilme özelliği malign ve benign lezyonların ayırımında kullanılır. Bu çalışmanın amacı benign ve malign tiroid nodüllerini ayırmada elastografinin tanı değerini araştırmaktır. Gereç ve Yöntem: Yüzyetmişüç hastada 173 tiroid nodülü ince iğne aspirasyon biyopsisi öncesi gri skala ultrasonografi ve elastografi ile incelenmiştir. Elastografi sonuçları ince iğne aspirasyon biyopsisi sonuçları ile karşılaştırılarak, tiroid nodüllerine uygulanan elastografinin duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri hesaplamıştır. Bulgular: Histopatoloji sonuçları 162 olguda (% 93,6) benign, 11 olguda(% 6,4) malign olan nodüller için elastografinin karsinom belirlemedeki duyarlılığı % 45,4, özgüllüğü % 55,5, pozitif öngörü değeri % 6, negatif öngörü değeri % 94 olarak bulundu. Bu değerlere göre elastografi benign ve malign tiroid nodüllerinin ayırımında istatistiksel olarak anlamlı bulunmamıştır (p>0,005). Sonuç: Bizim çalışmamızda tiroid nodüllerinin preoperatif tanısında elastografinin duyarlılık ve özgüllük değerleri önceki çalışmalara göre daha düşük bulunmuştur. Buna göre tiroid nodüllerinin değerlendirilmesinde biyopsi halen en güvenilir tanı yöntemi olarak geçerliliğini korumaktadır.

Anahtar Kelimeler:

tiroid nodülü, ultrasonografi, elastografi, ince iğne aspirasyon biyopsisi

The role of elastography in differantiating malignant from benign thyroid nodules.

Purpose: Elastography is a novel noninvasive diagnostic tool that is helpfull in the evaluation of the thyroid nodules. This technique examines the stiffness and hardness of tissue. With the principle that the softer tissue is easily deformed than the harder tissue under external compression, the deformability of tissue was applied to differentiate malignant from benign lesions. The aim of this study was to evaluate the diagnostic value of elastography in differentiating malignant from benign thyroid nodules. Materials and methods: A total of 173 thyroid nodules were examined by gray scale ultrasonography and elastography before fine needle aspiration biopsy in 173 patients. Sensitivity, specificity, positive and negative predictive values of elastography, have been determined by comparing elastography results with fine needle aspiration biopsy results. Results: For thyroid nodules of which 162 were benign (93,6 %) and 11 malignant (6,4 %) according to histopathology results; the sensitivity, specificity, positive and negative predictive values of elastography in identification of carcinoma were 45,4 %, 55,5 %, 6 % and 94 % respectively. According to these values elastography was not statistically significant in differantiating benign and malignant thyroid nodules (p>0,005). Conclusion: In our study the sensitivity and specificity values of elastography in preoperative diagnosis of thyroid nodules were found to be lower in contrast to earlier reports. Our study suggests biopsy is still the most reliable method for the evaluation of thyroid nodules.

Keywords:

thyroid nodüle, ultrasound, elastography, fine needle aspiration biopsy,

PDF

___

1-Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977;7:481-493.
2. Cooper DS, Doherty GM, Haugen BR, et al. American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214.
3. Gharib H, Papini E, Garber JR, et al. The AACE/ACE/AME task force on thyroid nodule. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi, Guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2016;22:622-39.
4. Gharib H, Papini E, Paschke R. Thyroid nodules: a review of current guidelines, practices, and prospects. Eur J Endocrinol 2008;159:493-505.
5.Aghini-Lombardi F, Antonangeli L, Martino E, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab 1999;84:561-566.
6. Lim DJ, Luo S, Kim MH, et al. Interobserver agreement and intraobserver reproducibility in thyroid ultrasound elastography. Am J Roenthenol 2012;198:896-901.
7. Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764-1771.
8. Hegedus L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev 2003;24:102-132.
9. Carmeci C, Jeffrey RB, McDougall IR, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid 1998;8:283-289.
10. Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation–multicenter retrospective study. Radiology 2008;247:762-770.
11. Sipos, J. Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid 2009;19:1363-1372.
12. Hegedus L. Can elastography stretch our understanding of thyroid histomorphology? J Clin Endocrinol Metab 2010;95:5213-5215.
13. Ophir J, Alam SK, Garra B, et al. Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proc Inst Mech Eng H 1999;213:203-233.
14. Cantisani V, D'Andrea V, Biancari F, et al. Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. European Journal of Radiology 2012;81(10):2678-2683.
15. Lyshchik A, Higashi T, Asato R, et al. Cervical lymph node metastases: diagnosis at sonoelastography-initial experience. Radiology 2007;243:258-267.
16. Thomas A, Fischer T, Frey H, et al. Real-time elastography-an advanced method of ultrasound: first results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 2006;28:335-340.
17. Wang Y, Dan HJ, Dan HY, LI T, Hu B. Differential diagnosis of small single thyroid nodules using real time ultrasound elastography. J Int Med Res 2010;38:466-472.
18. Azizi G, Keller J, Lewis M, Puett D, Rivenbark K, Malchoff C. Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid 2013;23:734-740.
19. Asteria C, Giovanardi A, Pizzocaro A, et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 2008;18:523-531.
20. Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 2007;92:2917-2922.
21. Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 2012;262:1002-1013.
22. Kwak JY, Kim EK, Kim HJ, Kim MJ, Son EJ, Moon HJ. How to combine ultrasound and cytological information in decision making about thyroid nodules. Eur Radiol 2009;19:1923-1931.
23. Razavi SA, Hadduck TA, Sadigh G, Dwamena BA. Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis. AJR Am J Roentgenol 2013;200:1317-1326.
24. Cakir B, Aydin C, Korukluoglu B, et al. Diagnostic value of elastosonographically determined strain index in the differential diagnosis of benign and malignant thyroid nodules. Endocrine 2011;39:89-98.
25.Cantisani V, Grazhdani H, Ricci P, et al. Q-elastosonography of solid thyroid nodules: assessment of diagnostic efficacy and interobserver variability in a large patient cohort. Eur Radiol 2014;24:143-150.
26. Kwak JY, Kim EK. Ultrasound elastography for thyroid nodules: recent advances. Ultrasonography 2014;33:75-82.
27. Ding J, Cheng HD, Huang J, Zhang Y, Liu J. An improved quantitative measurement for thyroid cancer detection based on elastography. Eur J Radiol 2012;81:800-805.
28. Choi SH, Kim EK, Kwak JY, Kim MJ, Son EJ. Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Thyroid 2010;20:167-172.
29. Xing P, Wu L, Zhang C, Li S, Liu C, Wu C. Differentiation of benign from malignant thyroid lesions: calculation of the strain ratio on thyroid sonoelastography. J Ultrasound Med 2011;30:663-669.
30. Ning CP, Jiang SQ, Zhang T, Sun LT, Liu YJ, Tian JW. The value of strain ratio in differential diagnosis of thyroid solid nodules. Eur J Radiol 2012;81:286-291.
31. Unluturk U, Erdogan MF, Demir O, Gullu S, Başkal N. Ultrasound elastography is not superior to grayscale ultrasound in predicting malignancy in thyroid nodules. Thyroid 2012;22:1031-1038.
32. Kagoya R, Monobe H, Tojima H. Utility of elastography for differential diagnosis of benign and malignant thyroid nodules. Otolaryngol Head Neck Surg 2010;143:230-234.