ROLE OF ULTRASOUND ELASTOGRAPHY IN CLASSIFICATION OF THYROID NODULE IN COMPARISON WITH HISTOPATHOLOGY

Rihab Ali Toman, Osama Ayad Abdulsattar, Salah Hadi  Kadhim

 

College of Medicine, University of Babylon. Babylon, Iraq.

T

hyroid nodules are distinct lesions and are very easy differentiation from the surrounding thyroid tissues because of their unique characters. A new developmental medical imaging as ultrasound elastography capable to assess the elasticity and stiffness of thyroid nodules.

Purpose. The study aimed to determine the roles of ultrasound elastography in classification of thyroid lesions in patients with thyroid nodules and to compare between ultrasound elastography findings of thyroid nodules in relation to the histopathology.

Materials and methods. A prospective study with total of 30 patients with neck lumps were included during a period from 26th July 2023 to 29th May 2024. Sample composed from 10 males (33.3%) and 20 females (66.7%), who referred to Department of Radiology in private clinic. Participants data, including age, sex and histopathology report were included. All cases underwent FNA of the suspicious nodules, under US guidance. All nodules subjected to B-mode US-Eg (SAMSUNG, MEDISON, KOREA) followed by Doppler. ES scoring was color coded was used.

Results. In this study, the mean age was 46.1±8.61 yrs (median =48 yrs). The mean (median) thyroid nodule size was 14.53±5.59 mm (14.5 mm). Most of nodular masses was solid (22; 73.3%). The majority of lesion had iso-echoic echogenicity (21; 70%). Non-homogeneous lesion noticed in 24 patients (80%). Irregular margin was seen in ten patients (33.3%). The mean (median) volume of nodule detected was 8.39±4.72 cm3 (9 cm3). The results of ES are: Score 1# and 2# recorded in 12 patients which all appeared as benign nodules. Score 4# and 5# recorded in eight cases all appeared as malignant nodules with a high statistical difference (P<0.0001). The results of Strain ratio are the ratio (<1.55) recorded in 17 cases (56.7%) (9 benign and 8 malignant) and ratio (>1.55) recorded in 13 cases (43.3%) (12 benign and 1 malignant), with high statistical difference (P=0.022). As a results, 21 of 30 nodules (70%) appeared as benign and 9 nodules (30%) were malignant. In regard to histopathological diagnosis, benign nodules were documented in 17(56.7%) patients, while malignant nodules were seen nine cases (30%). In addition, four cases appeared as intermediate pattern. The highest sensitivity calculated among Elastography score, Micro-calcifications, volume, Echogenicity and Irregular margin as 92.4%, 91.1%, 88.9%, 85.6% and 80.2%, respectively. The highest specificity calculated among Elastography score, and Echogenicity as 90.8% and 85.7%, respectively. The more accurate test was Elastography score (89.8%). The greater AUC seen in Elastography score (0.976).

Discussion. Dissimilarly, Abdallah et al. reported 40 patients with benign nodules and 10 cases with malignant nodules, moreover, they recorded score 1 and 2 in 29 cases, score 3 in 14 patients and score 4 in seven cases with ratio of 2.5, these due to different in equipment used, large sample size, and early methods of diagnosis. Yang and co-authors, analyzed 265 nodules by US. They found 212 nodules measured >1 cm (patients=178), mean size (2.32 mm), 163 solid, 117 hypoechoic, 138 homogeneous, 106 micro-calcifications, 222 irregular margin, 53 Halo sign and volume (9.51 cm3), which extensively different from our finding because of large number of cases and long-time conducted for study.

Conclusion. Suspicious malignant thyroid nodule characters by solid, iso-echoic echogenicity, non-homogeneous, micro-calcifications, and irregular margin. Elastography Score 1# and 2# recorded for benign nodules. Elastography Score 4# and 5# recorded for malignant nodules. Strain ratio are the ratio (<1.55) recorded for benign and malignant and ratio (>1.55) recorded benign nodules. The highest sensitivity and specificity for distinguish thyroid malignancy calculated in Elastography score 92.4% and 90.8%, respectively. The accuracy of Elastography score is 89.8% with greater AUC (0.976). This study revealed that qualitative Elastography data are able of differentiation between malignant and benign thyroid nodules. The greater elastography score are more reprehensive to malignant lesions versus benign lesions (lower Elastography).

 

 

Keywords: ultrasound elastography, thyroid nodules, elastography score, strain ratio, papillary thyroid carcinoma.

 

Corresponding author: Rihab Ali Toman, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Rihab Ali Toman, Osama Ayad Abdulsattar, Salah Hadi  Kadhim. Role of ultrasound elastography in classification of thyroid nodule in comparison with histopathology. REJR 2024; 14(3):32-44. DOI: 10.21569/2222-7415-2024-14-3-32-44.

Received:        26.07.24 Accepted:       15.09.24