Ultrasonographic and Color Doppler Ultrasonographic Parameters to Discriminate Thyroid Nodules

Abstract

Objective: To determine parameters that can be used to predict malignant thyroid nodules by using grayscale ultrasonography and color Doppler ultrasonography Materials-methods: Gray-scale ultrasonography and color Doppler ultrasonography findings were retrospectively analyzed in 60 nodules with known histopathology. Of 60 nodules, 12 nodules were malignant. The evaluation criteria for gray-scale ultrasonography were: size, echotexture, internal morphology, contour, presence of microcalcification, and presence of halo sign. The evaluation criteria for color Doppler ultrasonography were: vascular flow pattern and resistive index. Vascular flow patterns were classified as Types I, II, III, and IV. Results: Irregular contour and type IV flow patterns were the most significant independent predictors of malignancy in malignant thyroid nodules. Resistive index was significantly higher in malignant nodules. The cut off value was established as resistive index ≥0.69; 91% sensitivity and 97% specificity were calculated in the identification of malignant nodules. A combination of the absence of a halo sign, type IV flow pattern, and irregular contour had the highest specificity and positive predictive value (66.7% sensitivity, 100% specificity, 100% positive predictive value, 92.3% negative predictive value). Conclusion: We believe that by the integration gray-scale ultrasonography with color Doppler ultrasonography findings, it is possible to determine which nodule is malign/benign without performing fine needle aspiration biopsy (FNAB) and unnecessary operations could be prevented.

Keywords

• Thyroid Nodule
• Ultrasonography
• Doppler Ultrasonography
• Resistive Index
• Vascularization

Tiroid Nodüllerinde Ultrasonografi ve Renkli Doppler Ultrasonografi Bulguları Birlikteliğinde Malignite Saptanması

Abstract

Amaç: Tiroid nodüllerinde ultrasonografi bulgularına ek olarak renkliDoppler ultrasonografi bulguları ile birlikte malign - benign ayrımını yapabilmek. Materyal - Metod: Çalıșmamızda total yada subtotaltiroidektomi sonucunda patolojileri bilinen 60 nodül incelenmiștir. Retrospektif olarak 60 nodülün 12’si malign karakterdeydi. Nodüllerde ultrasonografi bulguları olarak; boyut, ekojenite, natür, kenar yapısı, mikrokalsifikasyon varlığı, periferikhalo varlığı değerlendirilmeye alındı. Renkli Doppler ultrasonografi bulguları olarak kanlanma desenlerine ve rezistif indeks değerlerine bakıldı. Kanlanma desenleri 4 sınıfta gruplandırıldı; tip I, tip II, tip III, tip IV Bulgular: Düzensiz kenar yapısı ve tip IV kanlanma deseni malignnodül saptamada en özgül bağımsız parametreler olarak saptandı. Rezistif indeks değeri malignnodüllerde daha yüksek bulundu. Rezistif indeks için cutoff değeri % 91 duyarlılık ve % 97 özgüllük ile 0,69 olarak hesaplandı. Düzensiz kenar yapısı, periferikhalo kaybı ve tip IV kanlanma deseni kombinasyonu malignnodül saptamada en özgül ve en yüksek pozitif tahmini değere sahip bulgu olarak bulundu (% 66.7 duyarlılık, %100 özgüllük, %100 pozitiftahminideğer, %92.3 negatif tahmini değer). Sonuç: Ultrasonografik ile renkli Doppler ultrasonografi bulguları birlikte malign – benign nodül ayrımı yapılabilir ve gereksiz cerrahi ișlem engellenilebilir.

Keywords

• Tiroid Nodülü
• Ultrasonografi
• Renkli Doppler Ultrasonografi
• Rezistif İndeks
• İnternal Kanlanma

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