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Evaluation of the thyroid nodule with high-resolution ultrasonography and elastography without fine needle aspiration biopsy
Evaluación del nódulo tiroideo con ecografía y elastografía de alta resolución sin la punción-aspiración con aguja fina
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Antonio Ríosa,b,c,
Corresponding author
arzrios@um.es

Corresponding author.
, José Manuel Rodrígueza,b,c, Nuria María Torregrosad, Begoña Torregrosae, Angela Ceperoe, María Dolores Abelláne, Antonio Miguel Hernándezf, Pascual Parrillaa,b,c
a Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, Spain
b Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, Spain
c Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
d Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario Santa Lucía, Servicio Murciano de Salud, Cartagena, Murcia, Spain
e Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, Spain
f Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, Spain
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Received 19 June 2017. Accepted 07 September 2017
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Tables (5)
Table 1. Correlation between the ultrasound variables in mode 2D and the established diagnosis of the thyroid nodule.
Table 2. Correlation between the ultrasound variables in colour and power Doppler mode, and the established diagnosis of the thyroid nodule.
Table 3. Correlation between the elastography variables and the established diagnosis of the thyroid nodule.
Table 4. Multivariate analysis. Variables that are associated with the established diagnosis of the thyroid nodule.
Table 5. Association with benignity of the ultrasound combination including non-hypoechoic and complex echo-structure, no microcalcifications, no chaotic vascularization and type 1 or 2 elastographic patterns.
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Abstract
Introduction

Fine needle aspiration biopsy (FNAB) is the gold standard screening technique used in the diagnostic protocol for thyroid nodules. However, it is not free of complications.

Objective

To identify thyroid nodules in which FNAB could be avoided during the diagnostic process by means of the use of a high-resolution ultrasonography or elastography.

Material and method

A prospective, non-randomized study was carried out. Single thyroid nodules and dominant nodules of multinodular goitre were included. Patients who had undergone thyroid surgery in the past were excluded. All patients underwent a high-resolution ultrasound and elastography, and, subsequently, a FNAB. We analyzed the ultrasound variables in 2D and Doppler, followed by the elastographic variables, and the results of the FNAB according to Bethesda. To correlate the data, the nodules were classified as benign or malignant. Student's t test, the Chi-square test and a logistic regression analysis were applied for the statistical analysis.

Results

A total of 221 thyroid nodules were analyzed, 32 of which were malignant (14%). The most predictive ultrasound findings of malignancy (p<0.05) were a hypoechoic or complex echostructure (OR=11.832), the presence of microcalcifications (OR=9.637) and chaotic vascularization observed in the Doppler (OR=46.464). With regard to the elastography, elastographic patterns I and II were seen to be associated with benignity (p=0.0004 and p<0.0001, respectively). When type 1 or 2 elastography was combined with an ultrasound showing a non-hypoechoic nor complex echostructure, without microcalcifications nor chaotic vascularization in the Doppler ultrasound, 100% of the cases were benign with a specificity of 100% and a sensitivity of 14%.

Conclusions

The combination of a high-resolution ultrasound with an elastography makes it possible to select cases where a FNAB does not have to be performed. Cases susceptible to a periodic follow-up without the use of a FNAB are those without a hypoechoic nor complex structure, no microcalcifications, non-chaotic vascularization and a type 1 or 2 elastography.

Keywords:
Ultrasound
Thyroid nodule
Malignancy
Thyroid carcinoma
Calcifications
Doppler
Elastography
Resumen
Introducción

La punción-aspiración con aguja fina (PAAF) es la técnica diagnóstica gold standard en el protocolo diagnóstico del nódulo tiroideo. Sin embargo, no está exenta de complicaciones.

Objetivo

Establecer los nódulos tiroideos en los que se podría evitar la PAAF en el protocolo diagnóstico con la inclusión de la ecografía de alta definición y la elastografía.

Material y método

Se realiza un estudio prospectivo no aleatorizado. Se incluyen nódulos tiroideos solitarios y los nódulos dominantes del bocio multinodular. Se excluyeron los pacientes con cirugía tiroidea previa. A todos los pacientes se les realiza primero una ecografía de alta resolución y una elastografía, y posteriormente una PAAF. Se analizan las variables ecográficas en 2D y doppler, las elastográficas, y el resultado de la PAAF según Bethesda. Para correlacionar los datos, los nódulos se clasifican como benignos o malignos. Para el análisis estadístico se aplica el test de la t de Student, el test de Chi-cuadrado y un análisis de regresión logística.

Resultados

Se analizan 221 nódulos tiroideos, de los cuales 32 fueron malignos (14%). Los hallazgos ecográficos más predictores de malignidad (p<0,05) son la ecoestructura hipoecoica o compleja (OR=11,832), las microcalcificaciones (OR=9,637) y la vascularización caótica con el doppler (OR=46,464). Respecto a la elastografía, el patrón elastográfico i y ii se asocian a benignidad (p=0,0004 y p<0,0001, respectivamente). Cuando se combina la elastografía tipo i o ii, y la ecografía con ecoestructura no hipoecoica ni compleja, sin microcalcificaciones y sin vascularización caótica en la ecografía doppler, el 100% de los casos eran benignos, con una especificidad del 100% y una sensibilidad del 14%.

Conclusiones

La combinación de la ecografía de alta resolución y la elastografía permite seleccionar casos donde no es necesario realizar una PAAF. Los casos susceptibles de seguimiento periódico sin realización de PAAF son aquellos que no presentan ecoestructura hipoecoica o compleja, que no muestran microcalcificaciones y en los que la vascularización no es caótica, junto con una elastografía tipo i y ii.

Palabras clave:
Ecografía
Nódulo tiroideo
Malignidad
Carcinoma tiroideo
Calcificaciones
Doppler
Elastografía

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