Abstract

Background. Over the last 15 years, there have been many recommendations for the management of patients with thyroid nodules, based on the assessment of various ultrasound (US) criteria in B-mode. In 2020, the EUTIRADS system (2017) was included in Russian Clinical Practice Guidelines. Shear wave elastography (SWE) increases the diagnostic efficacy of ultrasonic B-mode examination of thyroid nodules and can be recommended for inclusion in the existing classification system. Objective. To assess the diagnostic efficacy of multiparametric US combining SWE and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EUTIRADS system for deciding on the need for fine-needle aspiration biopsy. Material and methods. A total of 150 thyroid nodules from 116 patients were analyzed. Lesions were then classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean). In all tumors, cytological and histological (in operated patients) verification was carried out. Results. After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EUTIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 – EU-TIRADS 3 (28%), 26 – EU-TIRADS 4 (17.3%), 4 – EU-TIRADS 5 (2.7%). On cytological examination 42 tumor nodules were detected. Of these, 6 (14.3%) cases were reported as papillary thyroid carcinoma, 36 (85.7%) as follicular neoplasm, 22 (61%) among the last prove to be follicular carcinoma. Qualitative and quantitative evaluation of elastograms was performed. Benign nodules were colored primarily in blue, while suspicious for malignancy revealed red areas of different size. Elasticity index in benign nodules was 24.3 ± 5.63 kPa for colloid goiter, 27.8 ± 6.35 kPa for cellular goiter; in suspicious for malignancy – 80.9 ± 50.9 kPa for follicular neoplasm, 114 ± 56.8 kPa – for papillary thyroid cancer. The stiffness cutoff value for malignancy indicated with ROC-analysis was estimated as 45.4 kPa. Mean elasticity index (kPa) was significantly higher in suspicious for malignancy nodules than in benign nodules (р < 0.05). Of 120 (80%) nodules, primarily assessed as benign and defined as EU-TIRADS 2 and 3, 18 (12%) nodules after SWE revealed areas of high stiffness exceeding the cutoff value. After that, these nodules were transferred to EU-TIRADS 4 and 5, and these stages require fine-needle aspiration. Of these, 11 (7.3%) cases were reported as follicular neoplasm, 6 (4%) among the last prove to be follicular thyroid carcinoma. Conclusion. Using multiparametric approach with SWE will give the opportunity to classify correctly the nodule according to the EU-TIRADS and to identify greater number of thyroid tumors for fine-needle aspiration. SWE made it possible to increase the specificity of US using the EU-TIRADS system. The characteristics of the SWE score were: sensitivity = 81%, specificity = 90.3%, positive predictive value = 88%, negative predictive value = 91%, and accuracy of comprehensive study = 88.4%.

Highlights

  • To assess the diagnostic efficacy of multiparametric US combining Shear wave elastography (SWE) and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EUTIRADS system for deciding on the need for fine-needle aspiration biopsy

  • Lesions were classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean)

  • After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EUTIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 – EU-TIRADS 3 (28%), 26 – EU-TIRADS 4 (17.3%), 4 – EU-TIRADS 5 (2.7%)

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Summary

Обоснование Цель Материал и методы Результаты

Выводы Ключевые слова: Цитировать: За последние 15 лет появилось множество рекомендаций по тактике ведения пациентов с узловыми образованиями щитовидной железы (ЩЖ), основывающихся на оценке различных ультразвуковых критериев в В-режиме. Определить диагностическую информативность мультипараметрического ультразвукового исследования с использованием цветового доплеровского картирования и эластографии сдвиговой волной в дифференциальной диагностике доброкачественных и злокачественных очаговых образований ЩЖ для определения категории по системе EU-TIRADS и принятия решения о необходимости проведения тонкоигольной аспирационной биопсии. Исследовано 150 узловых образований ЩЖ у 116 пациентов: проведена классификация по системе EU-TIRADS, выполнена эластография сдвиговой волной с оценкой цветовой карты и количественных показателей жесткости (Emean). В 18 (12%) из 120 (80%) образований, отнесенных изначально к «доброкачественным» – EUTIRADS 2 и 3, после эластографии сдвиговой волной обнаружены зоны высокой жесткости, превышающие пороговые значения, что привело к переводу их в категории EU-TIRADS 4 и 5, при которых обязательно выполнение тонкоигольной аспирационной биопсии. Эластография сдвиговой волной позволила повысить специфичность ультразвукового исследования с использованием классификации EU-TIRADS. Received in revised form 21 July 2020.

Conclusion
Число наблюдений
Sensitivity Sensitivity
Папиллярный рак
СВЕДЕНИЯ ОБ АВТОРАХ
Findings
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