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甲状腺結節が疑われる場合の不必要な手術は、ひずみ比とエラストグラフィースコアの併用で回避できるか？
Can the unnecessary operations for suspected thyroid nodules be avoided by the combined use of the strain ratio and elastography score?
PMID: 32653346 DOI: 10.1016/j.bjorl.2020.05.017.
抄録
序論:
甲状腺の手術標本のうち、悪性と報告されているのは5～15％に過ぎない。細針吸引生検の結果、悪性を疑って手術を行うことがほとんどであるが、侵襲性、診断不能な結果、再検査の可能性があることが細針吸引生検の欠点である。
INTRODUCTION: Only 5%-15% of thyroid surgical specimens are reported as malignant. Most of the operations are performed due to suspicion of malignancy as a result of fine needle aspiration biopsy but invasiveness, non-diagnostic results and potential repeat biopsies are disadvantages of fine needle aspiration biopsy.
目的:
本研究の目的は、甲状腺結節の鑑別診断にひずみ比と弾性スコアを同時に使用することの有効性を検討するとともに、これら2つの方法の適合性を評価することであった。
OBJECTIVE: The aim of this study was to investigate the effectiveness of simultaneously using both the strain ratio and elasticity score in the differential diagnosis of thyroid nodules, as well as to assess the compatibility of these two methods.
方法:
合計144例の結節を対象とした。最終的な病理組織学的診断を基準とした。ひずみ比とエラストグラフィスコアの曲線下面積の感度、特異度、およびカットオフ値は、受信機動作特性曲線分析を用いて決定した。また、ひずみ比と弾性スコアの互換性と比較も行った。
METHODS: A total of 144 nodules were included in the study. The final histopathologic diagnosis was used as the reference standard. The area under the curve sensitivity, specificity, and cut-off values of the strain ratio and elasticity score were determined using receiver operating characteristic curve analysis. The compatibility and comparison of strain ratio and elasticity score were also performed.
結果:
28個の結節（19.4％）は悪性であった。ひずみ比と弾性スコアの結果は、甲状腺悪性腫瘍の予測に有意に成功していた（両者ともp＜0.001）。さらに、ひずみ比の曲線下面積は0.944、弾性スコアの曲線下面積は0.960であった。弾性スコアの診断精度はひずみ比よりも優れていることがわかったが、その差は統計的に有意ではなかった（p=0.456）。ひずみ比と弾性スコアの適合性を調べたところ、両者の評価は統計的に一致していた（Kappa=0.767; p<0.001）。ひずみ比と弾性スコアを併用した場合、正しい診断の特異度は84.5%から93.1%に上昇した。
RESULTS: Twenty eight nodules (19.4%) were malignant. The strain ratio and elasticity score results were found to be significantly successful in predicting thyroid malignancy (p < 0.001 for both). Moreover, the area under the curve for the strain ratio and elasticity score were found to be 0.944 and 0.960, respectively. The diagnostic accuracy of the elasticity score was found to be superior to that of the strain ratio, but this difference was not statistically significant (p = 0.456). When the compatibility of the strain ratio and elasticity score was examined, the two evaluations were revealed to be statistically consistent with each other (Kappa = 0.767; p < 0.001). When the strain ratio and the elasticity score were used together, the specificity of capturing the correct diagnosis increased from 84.5% to 93.1%.
結論:
甲状腺結節の鑑別診断にひずみ比と弾性スコアを併用すると、より正確な結果が得られた。このように、両法を併用することは、甲状腺結節が疑われる場合に不必要な外科的介入を防ぐために、細針吸引生検に代わる有望な手段となる可能性がある。
CONCLUSION: When the strain ratio an elasticity score were used together for the differential diagnosis of thyroid nodules, more accurate results were obtained. Thus, combining both methods may be a promising alternative to fine needle aspiration biopsy in order to prevent unnecessary surgical interventions for suspected thyroid nodules.
Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.