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  • 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
  • | 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged
  • | 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szeged
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Összefoglaló. A pajzsmirigy az első szervek közé tartozik, melyek megjelenítésében, betegségeinek felfedezésében az ultrahang-diagnosztikának fontos szerepe van. A pajzsmirigybetegségek a lakosság jelentős részét érintik, és a technika fejlődésével egyre több pajzsmirigyeltérés, göb kerül felfedezésre. A pajzsmirigy rosszindulatú folyamatainak nincs egy bizonyos specifikus jele, viszont az ultrahangkép alapján meghatározhatók a malignitásra gyanús eltérések. Erre az elmúlt években több összefoglaló rendszer is született. Jelen összefoglaló tanulmányunknak az a célja, hogy bemutassuk a pajzsmirigy ultrahangdiagnosztikájának fejlődését; összehasonlítsuk az egyes leletezési rendszereket, úgymint TIRADS, EU-TIRADS, K-TIRADS, melyek célja a feltehetőleg rosszindulatú göbök kiszűrése, azonosítása a mindennapi rutinmunka során; vizsgáljuk a különböző rendszerek kapcsolatát a patológia által használt Bethesda-pontrendszerrel. Az ultrahangvizsgálat megfelelő értékelése, a pontrendszerek ismerete segíthet a pajzsmirigygöb differenciáldiagnózisában, a követési frekvencia meghatározásában, csökkentheti az aspirációs citológiák számát, ezzel támogatva a klinikai döntéshozatalt. Orv Hetil. 2021; 162(14): 530–541.

Summary. The thyroid gland was one of the first organs, the ultrasound (US) examination of which has played an important role. The thyroid diseases affect a large part of the population, and with the development of imaging technology, more and more thyroid abnormalities, nodules and malignant lesions are being discovered. There are no specific signs of thyroid cancer, but the suspicious signs could be determined by US. In recent years, several systems have been developed. The aim of our review is to demonstrate the development of US diagnostics of the thyroid gland; to compare the different reporting systems, such as TIRADS, EU-TIRADS, K-TIRADS, which should help to identify the questionable lesions in the daily routine work. We examine the relationship between the different US systems and the Bethesda point score used by pathologists. The literature review shows that the US examination supports the clinical decisions, helps to select, who should have a fine-needle biopsy, and allows to determine the frequency of follow-up. The number of unnecessary fine-needle biopsies could be reduced, too. Our paper is part of a bigger research, the ethical license number is 23/2020, University of Szeged. Orv Hetil. 2021; 162(14): 530–541.

  • 1

    Russ G, Leboulleux S, Leenhardt L, et al. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J. 2014; 3: 154–163.

  • 2

    Durante C, Costante G, Lucisano G, et al. The natural history of benign thyroid nodules. JAMA 2015; 313: 926–935.

  • 3

    Durante C, Grani G, Lamartina L, et al. The diagnosis and management of thyroid nodules: a review. JAMA 2018; 319: 914–924.

  • 4

    Győri G, Kocsis-Deák B, Lakatos P. Ultrasound imaging of thyroid nodules. The up-to-date report. [A göbös pajzsmirigy ultrahangvizsgálata – a korszerű ultrahanglelet.] Magy Radiol Online 2018; 92: 11–21. [Hungarian]

  • 5

    Levine RA. Something old and something new: a brief history of thyroid ultrasound technology. Endocr Pract. 2004; 10: 227–233.

  • 6

    Blum M, Weis B, Hernberg J. Evaluation of thyroid nodules by A-mode echoqraphy. Radiology 1971; 101: 651–656.

  • 7

    Walfish PG, Hazani E, Strawbridge HT, et al. Combined ultrasound and needle aspiration cytology in the assessment and management of hypofunctioning thyroid nodule. Ann Intern Med. 1977; 87: 270–274.

  • 8

    Ophir J, Céspedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 1991; 13: 111–134.

  • 9

    Trimboli P, Guglielmi R, Monti S, et al. Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab. 2012; 97: 4524–4530.

  • 10

    Hoang JK, Branstetter BF 4th, Gafton AR, et al. Imaging of thyroid carcinoma with CT and MRI: approaches to common scenarios. Cancer Imaging 2013; 13: 128–139.

  • 11

    Land CE, Kwon D, Hoffman FO, et al. Accounting for shared and unshared dosimetric uncertainties in the dose response for ultrasound-detected thyroid nodules after exposure to radioactive fallout. Radiat Res. 2015; 183: 159–173.

  • 12

    Steiner T, Péter I, Pogány P, et al. Combined presentation of autoimmune thyroiditis, bilateral papillary thyroid carcinoma, cervical thyrolipoma and diabetes mellitus. [Az autoimmun thyreoiditis, a kétoldali papillaris pajzsmirigy-carcinoma, a nyaki thyreolipoma és a diabetes mellitus együttes előfordulása.] Orv Hetil. 2018; 159: 1024–1032. [Hungarian]

  • 13

    Tompa A, Jakab M, Biró A, et al. Genetic and immune-toxicologic studies on abnormal thyroid functions in hospital employees exposed to cytostatic drugs. [Citosztatikus kezelést végző kórházi dolgozók pajzsmirigy-elváltozásainak géntoxikológiai és immuntoxikológiai vonatkozásai.] Orv Hetil. 2015; 156: 60–66. [Hungarian]

  • 14

    Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167–1214. [Erratum: Haugen, BR. Thyroid 2010; 20: 942.] [Erratum: Haugen, BR. Thyroid 2010; 20: 674–675.]

  • 15

    Hircsu I, Gazdag A, Bodor M, et al. Multiple endocrine neoplasia type 2A in a family. [A multiplex endokrin neoplasia-2A szindrómáról egy család kapcsán.] Orv Hetil. 2020; 161: 75–79. [Hungarian]

  • 16

    Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010; 43: 229–238.

  • 17

    Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract. 2016; 22(Suppl 1): 622–639.

  • 18

    Russ G, Bonnema SJ, Erdogan MF, et al. European Thyroid Association Guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J. 2017; 6: 225–237.

  • 19

    Smayra T, Charara Z, Sleilaty G, et al. Classification and regression tree (CART) model of sonographic signs in predicting thyroid nodules malignancy. Eur J Radiol Open 2019; 6: 343–349.

  • 20

    Grant EG, Tessler FN, Hoang JK, et al. Thyroid ultrasound reporting lexicon: white paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol. 2015; 12: 1272–1279.

  • 21

    Fagin JA, Mitsiades N. Molecular pathology of thyroid cancer: diagnostic and clinical implications. Best Pract Res Clin Endocrinol Metab. 2008; 22: 955–969.

  • 22

    Rumack CM, Wilson SR, Charboneau JW, et al. (eds.) Diagnostic ultrasound, 4th edition. Elsevier-Mosby, Philadelphia, PA, 2014.

  • 23

    Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2009; 132: 658–665.

  • 24

    Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2017; 27: 1341–1346.

  • 25

    Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2014; 99: 1253–1263.

  • 26

    Zhan J, Ding H. Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 2018; 37: 288–297.

  • 27

    Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260: 892–899.

  • 28

    Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009; 94: 1748–1751.

  • 29

    Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 2016; 17: 370–395.

  • 30

    Xu T, Wu Y, Wu RX, et al. Validation and comparison of three newly-released thyroid imaging reporting and data systems for cancer risk determination. Endocrine 2019; 64: 299–307.

  • 31

    Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am J Roentgenol.  2002; 178: 687–691.

  • 32

    Wang CC, Friedman L, Kennedy GC, et al. A large multicenter correlation study of thyroid nodule cytopathology and histopathology. Thyroid 2011; 21: 243–251.

  • 33

    Kessler A, Gavriel H, Zahav S, et al. Accuracy and consistency of fine-needle aspiration biopsy in the diagnosis and management of solitary thyroid nodules. Isr Med Assoc J. 2005; 7: 371–373.

  • 34

    Kocsis-Deák B, Balla B, Árvai K, et al. Genetic testing of thyroid nodules using a gene panel developed on a new generation sequencing platform. [A pajzsmirigygöbök genetikai vizsgálata újgenerációs szekvenáláson alapuló platformon kifejlesztett génpanel segítségével.] Orv Hetil. 2019; 160: 1417–1425. [Hungarian]

  • 35

    Filetti S, Durante C, Torlontano M. Nonsurgical approaches to the management of thyroid nodules. Nat Clin Pract Endocrinol Metab. 2006; 2: 384–394.

  • 36

    Ha SM, Baek JH, Choi YJ, et al. Malignancy risk of initially benign thyroid nodules: validation with various thyroid imaging reporting and data system guidelines. Eur Radiol. 2019; 29: 133–140.

  • 37

    van der Molen AJ, Thomsen HS, Morcos SK, et al. Effect of iodinated contrast media on thyroid function in adults. Eur Radiol. 2004; 14: 902–907.

  • 38

    Razek AA, Sadek AG, Kombar OR, et al. Role of apparent diffusion coefficient values in differentiation between malignant and benign solitary thyroid nodules. Am J Neuroradiol. 2008; 29: 563–568.

  • 39

    Johnson PT, Horton KM, Megibow AJ, et al. Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol. 2011; 8: 762–767.

  • 40

    Yoon DY, Chang SK, Choi CS, et al. The prevalence and significance of incidental thyroid nodules identified on computed tomography. J Comput Assist Tomogr. 2008; 32: 810–815.

  • 41

    Hoang JK, Raduazo P, Yousem DM, et al. What to do with incidental thyroid nodules on imaging? An approach for the radiologist. Semin Ultrasound CT MR 2012; 33: 150–157.

  • 42

    Nguyen XV, Choudhury KR, Eastwood JD, et al. Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules. Am J Neuroradiol. 2013; 34: 1812–1817.

  • 43

    Leenhardt L, Erdogan MF, Hegedűs L, et al. 2013 European Thyroid Association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J. 2013; 2: 147–159.

  • 44

    Kumbhar SS, O’Malley RB, Robinson TJ, et al. Why thyroid surgeons are frustrated with radiologists: lessons learned from pre- and postoperative US. Radiographics 2016; 36: 2141–2153.

  • 45

    Nam IC, Park JO, Joo YH, et al. Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck 2013; 35: 40–45.

  • 46

    Zhao CK, Xu HX. Ultrasound elastography of the thyroid: principles and current status. Ultrasonography 2019; 38: 106–124.

  • 47

    Fekete M, Erdei M, Dienes A, et al. Ultrasound elastographic examination of the thyroid gland: a twin study. [A pajzsmirigy ultrahang-elasztográfiás vizsgálata ikreken.] Magy Radiol Online 2019; 93: 15–24. [Hungarian]

  • 48

    Bojunga J, Herrmann E, Meyer G, et al. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 2010; 20: 1145–1150.

  • 49

    Song J, Chai YJ, Masuoka H, et al. Ultrasound image analysis using deep learning algorithm for the diagnosis of thyroid nodules. Medicine (Baltimore) 2019; 98: e15133.

  • 50

    Wildman-Tobriner B, Buda M, Hoang JK, et al. Using artificial intelligence to revise ACR TI-RADS risk stratification of thyroid nodules: diagnostic accuracy and utility. Radiology 2019; 292: 112–119.

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