VALUES OF ELASTOGRAPHY IN DIAGNOSIS OF THYROID CANCERIN DIAGNOSIS OF THYROID CANCER

103 Military Hospital DEPARTMENT OF FUNCTIONAL EXPLORATION VALUES OF ELASTOGRAPHY IN DIAGNOSIS OF THYROID CANCER M.D Nguyen Minh Hai INTRODUCTION - Thyroid nodules are very common hormone disease, only after diabetes - The incidence of nodules through clinical examination is only at 47 % - Ultrasound diagnosis brings up the rate to 19-67% - More than 90% of thyroid nodule is benign and 5-10% is malignant  Need to diagnose early and carry out surgery to patients diagnosed with malignant thyroid nodules PURPOSES OF THE STUDY Evaluated some clinical characteristics, ultrasound and thyroid elastography of tumors 2D Some values thyroid elastography in diagnosis of malignant tumors  OVERVIEW ELASTOGRAPHY TECHNIQUE TIRADS PARAMETERS Kwak (2011) determined TIRADS based on following maglinant suggestive signs: - Solid nodule - Hypoechogenicity or marked hypoechogenicity - Microlobulated or irregular margins - Microcalcifications, with diameter < 0,5mm - Taller-than-wide shape TIRADS: Thyroid image reporting and data system TIRADS 4A 4B 4C Characteristics Mag rate Normal No focal lesions 0% Benign lesions - follicle, spongiform follicle - Nodes with macrocalcification and clear border - Nodes with hyperechogenicity 0% Possibly benign isoechoic or hypoechoic, clear margin, peripheral blood perfusion 1,7 % malignant sign 3,3 % malignant signs 9,2 % or malignant signs 44,4 72,4% All malignant signs or tissue diagnosis or Nodal metastases 87,5 % Low possibility of being malignant Midium possibility of being malignant High possibility of being malignant Very high possibility of being maglinant ELASTOGRAPHY DIAGRAM OF ASTERIA (2008) RESEARCH METHODOLOGY SUBJECTS 72 patients examined or under treatment for thyroid nodules from 10/2015 - 11/2016 Undertook ultrasound scan at the department of functional diagnosis- 103 Military Hospital Tissue diagnosis at the department of Histology –103 Military Hospital RESEARCH METHODOLOGY Research methodology: cross-sectional study RESEARCH CONTENTS • Clinical examination, identify location, density, displacement characteristics of tumors, identify related lympho nodes • 2D ultrasound, color Doppler: Assess echogenicity, border, size, blood circulation • Elastography of tumors: assess the Elastography parameters RESULTS & DISCUSSIONS Figure 1: Distribution of patients with thyroid cancer by gender *Trịnh Thị Thu Hồng: studied 146 patients thyroid multi-nodules: Female/Male: 9/1 *Nguyễn Tài Dũng (2005) studied 32 patients special thyroid cancer: Female 84,4%,; Male 15,6% RESULTS & DISCUSSIONS Figure 2: Distribution of nodules by location on lobes of thyroid *Trần Ngọc Dũng (2010) tumors on right lobe (44,4%), left lobe (37,3%), both lobes (18,3%) Table 2D ultrasound results Lesion structure Structure Echogenicity Shape Calcification Margin n = 72 % Solid 50 69,4 Cyst 4,2 Combination 19 26,4 hypoechogenicity 21 29,2 isoechoic 26 36,1 Heterogeneity 25 34,7 Taller than wide 11,1 Wider than tall 64 88,9 Micro-calcification 10 13,9 Macro-calcification 11 15,3 Irregular 36 50,0 Regular 36 50,0 RESULTS & DISCUSSIONS Figure 3: Distribution of lesion characteristics by 2D echoic pattern * Ng Hữu.Thịnh (2011): studied 44 patients with thyroid nodules, hypoechogenicity nodules: 47,7% * Trần Văn Tuấn (2010): studied 54 patients with thyroid nodules: hypoechogenicity 57,4%, hyperechogenicity 27,8% RESULTS & DISCUSSIONS Figure 4: Distribution of lesion characteristics by calcification images * Ng Hữu.Thịnh (2012) : calcification: 31,8%; * Trịnh Thị Thu Hồng: studied 146 patients with thyroid multi nodular cancer: micro calcification (8,2%), macro-calcification (22,4%), non-calcification (69,4%) RESULTS & DISCUSSIONS Grade 4: 12 patients (16,6%) Figure 5: TIRADS classification - TIRADS - included 60 patients (83,3%), have not found images suggesting malignant sign - 12 patients (16,6%) had to malignant signs of TIRADS (These patients was referred for FNA) RESULTS & DISCUSSIONS Table Results of sample of tumor elastography Elasticity classification n = 72 Percentage (%) ES (soft) 5,6 ES (soft – hard) 35 48,6 ES (hard) 28 38,9 ES (very hard) 6,9 The results showed, 33/72 patients (45,8%) have hard and very hard tumors (ES3ES4), all of these case are suggested to be malignant tumors However, these are only qualitative parameter, diagnostic value is not high RESULTS & DISCUSSIONS Figure 6: Distribution of elastography of lesions by colour diagram The results showed: 33/72 patients (45,8%) have hard and very hard tumors (ES3ES4), all of these case are suggested to be malignant tumors However, these are only qualitative parameter, diagnostic value is not high RESULTS & DISCUSSIONS Table Parameters of elasticity Parameters N = 72 Min Max E1 1,19 ± 0,54 0,6 3,3 E2 2,6 ± 0,98 1,0 4,6 SR (E2/E1) 2,51 ±1,18 0,6 5,7 SR ≥ 2,5 23 patients (31,9 %) < 2,5 49 patients (68,1%) - Sahin et al (2014) SR > 2,45 suggests thyroid cancer on elastography RESULTS & DISCUSSIONS Table Sensitivity, Specificity by elastography GPB Malignant Benign Total 10 13 23 47 49 12 60 72 Elastography ES3 -ES4 (hard tumor Malignant) ES1-ES2 (soft benign) Total tumor- - Sensitivity: 83,3% - Specificity: 78,3% - Accuracy level: 79,1% RESULTS & DISCUSSION Table Sensitivity level, specification by SR elasticity ratio GPB Malignan t Benign Total SR ≥ 2,5 ( Malignant ) 11 12 23 SR < 2,5 ( Benign ) 48 49 12 60 72 SR elasticity ratio Total - Sensitivity: 91,6% - Specificity: 80% - Accuracy level: 81,9% Sahin et al (2014) SR > 2,45 is diagnostic sign of thyroid cancer on elastography Sensitivity level: 73,9% and Specificity: 73% RESULTS & DISCUSSION Table Sensitivity level, Specification according TIRADS, ES and SR elasticity ratio Pathology parenchyma 2D ultrasound+ elasticity Malign ant Benign Total 11 12 59 60 TIRADS + ES 3,4+ SR ≥ 2.5 (Malignant) TIRADS 2-3+ES 2,3+ SR < 2.5 (benign ) Sensitivity level: 91,7% Specification: 98,3% Accuracy level:60 98,3% 12 72 Total Gilles Russ (2013): 2D ultrasound, TIRADS if combined with tissue ultrasound elastography will increase the sensitivity level of thyroid cancer diagnosis up to 98,5% CONCLUSIONS Studying on 72 patients with thyroid nodules by thyroid elastography, we have concluded that: 1.Clinical characteristics, 2D ultrasound and elastography -Clinical characteristics : Density of hard, solid, less moving tumors: 41,7% One nodule: 56,9% Cervical lymph node: 8,3% -2D ultrasound parameters: Irregular margin: 50% Hypoechogenicity: 29,2% Taller than wide shape: 11,1% Micro-calcification nodes: 13,9% -Elastography parameters: Colour codes ES3 - ES4 (hard and very hard tumors): 45,8% CONCLUSIONS Technical values of elastography in thyroid cancer diagnosis - Elastography values: Sensitivity level 83,3% Specification 78,3% - Elastography combined with 2D ultrasound and TIRADS classification: Sensitivity level 91,7% Specificity: 98,3% Accuracy: 98,3%