International Scientific Surgical Association
Первая международная дистанционная
научно-практическая конференция
"Новые технологии в медицине - 2004"
N.Fukunari, M.Nagahama, K.Sugino, T.Mimura, K.Ito, K.Ito
Clinical evaluation of color-Doppler imaging for the differential diagnosis of thyroid follicular lesions
Department of Surgery and Diagnostic Imaging, Ito hospital
Tokyo, Japan
Abstract
Objects. Ultrasonography of the thyroid gland has recently proved to be a useful clinical diagnostic method, and the newly developed high-resolution ultrasonography with color-Doppler flow mapping function can reveal fine details of the thyroid gland and the hemodynamic features of thyroid neoplasmas. Ultrasonography can yield a diagnostic accuracy of over 90% in thyroid carcinoma, especially papillary carcinoma. However, neither conventional B-mode ultrasound imaging nor aspiration biopsy cytology has delivered satisfactory results for follicular carcinoma. The aim of this study was to evaluate the clinical usefulness of color-Doppler imaging for the differential diagnosis of thyroid follicular lesions
Subjects and Methods. A color-Doppler was performed in 310 patients with a solitary cold nodule, and a combination of B-mode US and color-Doppler findings, including tumor vascularity and results of a FFT analysis were used to create the following diagnostic grading system for differential diagnosis of follicular lesions: Grade 1, benign follicular lesion (no color flow mapping (CFM) inside the nodule); Grade 2, benign peripheral type (CFM only in peripheral area, PI <1.0); Grade 3, suspected follicular carcinoma (penetrating CFM, vascularity moderate); Grade 4, follicular carcinoma (high-velocity penetrating CFM, PI＞1.0). All patients were subjected to surgical resection, and histological examination was used to confirm the diagnosis.
Results. The grades of the177 adenomatous nodules were: Grade 1, 46.9%; Grade 2, 48.0%; Grade 3, 5.1%; and Grade 4, 0%. The corresponding percentages for the 89 follicular adenomas were 16.9%, 49.4%, 30.3%, and 3.4%; and for the 44 follicular carcinomas, 0%, 13.6%, 45.5%, and 40.9%. On the assumption that Grade 1 and 2 lesions are benign and Grade 3 and 4 lesions are malignant, 38 of the 44 follicular carcinomas and 227 of the 266 benign tumors had been accurately diagnosed, yielding a sensitivity of 88.9%, a specificity of 74.2%, and an accuracy of 81.0% for the grading system.
Conclusion. Color-Doppler imaging examination of 310 follicular tumors has revealed that high-velocity pulsative blood flow penetrating the tumor is a characteristic finding of follicular carcinoma, and that yielded a new diagnostic criteria for color-Doppler imaging. The differential diagnostic grading scores for color-Doppler examinations and the results of FFT analysis can show a diagnostic usefulness. Ultrasound with the color-Doppler function can play an important role in the differential diagnosis of thyroid tumors.
Fukunari N., Nagahama M., Sugino K. et al. Clinical evaluation of color-Doppler imaging for the differential diagnosis of thyroid follicular lesions // Новые технологии в медицине: Сб. докл. Первой международной дистанционной науч.-практ. конф., Санкт-Петербург, 15-30 марта 2004 г. СПб, 2004. С. 58-61
E-mail: n-fukunari@ito-hospital.jp
