DIAGNOSTIC VALUE OF ELASTOGRAPHY IN NODULAR THYROID DISEASE WITH ADIPOSITY ASSOCIATION
Main Article Content
Keywords
Elastography, Thyroid, Nodules and Adiposity
Abstract
Background/aim: Nodular thyroid disease is widely encountered in the population. It is almost benign and the rate of prevalence differs according to the population, which is gradually increasing, although most of the thyroid nodules are benign. The prevalence of malignancy is 5%-15% and 15%-30% are classified as indeterminate or suspicious for malignancy. A thyroid ultrasonography examination is recommended for the patient had thyroid nodules according to the guidelines of the American Thyroid Association (ATA). Elastography is a recent method used in evaluating thyroid nodules by comparing tissue elasticity. There is still a controversial association between adiposity and thyroid nodules. Aims of this study; highlight the value of elastography to evaluate nodular thyroid disease and find its association with adiposity.
Subject and Methods: This cross-section study was done on 170 patients (65 males and 105 females); they were referred to thyroid elastography examination, from internal medicine, endocrinology, surgery and oncology departments. Anthropometric measurements and imaging of the thyroid nodules were done according to the American College of Radiology (ACR) and Thyroid Imaging Reporting and Data System (TI-RADS). The patients were classified into three groups according to body mass index (BMI); a normal weight group had a BMI ≤ 24.9 kg/m2 (n = 60), an overweight group had a BMI of (25-29.9 kg/m2) (n = 50) and an obese group had a BMI ≥ 30 kg/m2 (n = 60).
Results: The data of this study revealed that qualitative elastography grades could differentiate benign thyroid nodules from malignant; elastography with higher grades was detected within malignant thyroid nodules. Moreover, a Strain’s ratio (SR) cutoff value is >2.3 which could differentiate a malignant nodule from a benign one with a 93 % sensitivity, 81.4 % specificity and 92.4% accuracy. As a greater proportion of patients (64.7%) with thyroid nodules had a BMI of more than 25 kg/m2. The high elastography grade (malignant nodule) was significantly associated with a higher BMI and greater waist circumference (WC). Although the optimal BMI cutoff value was (≥30 kg/m2) for both sexes and the WC cutoff value in males was 105.6 cm with a sensitivity of 69.1% & specificity of 71% & in females was 95.7 cm with a sensitivity of 72.1% and specificity of 58.3%.
Conclusion: The elastography examination is an accurate method to assess thyroid nodules. There is a high association between adiposity and thyroid nodules.
References
2. Hegedus L., Bonnema SJ., Bennedbaek FN. Management of simple nodular goiter. Current status and future perspectives. Endocr Rev. 2013; 24(1):102-32.
3. Haugen BR., Alexander EK., Bible KC. , et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and diffentiated thyroid cancer. The American Thyroid guidelines task force on thyroid nodules and differentiated thyroid cancer. 2016; 26(1):1-133.
4. Russ G., Bonnema J., and Faik M., et al.: European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS Eur. Thyroid. 2017; 6:225-37.
5. Kwak JY., Kim EK. Ultrasound elastography for thyroid nodules. Recent advances. Ultrasonography 2014; 33:33:75-82.
6. Sun CY., Lei KR., Liu BJ. Et al. virtual Touch tissue imaging and quantification (VTIQ) in the evaluation of thyroid nodules. The associated factors leading to misdiagnosis.2017; 7:41958.
7. James BC, Mitchell JM, Jeon HD, Vasilottos N, Grogan RH, Aschebrook-Kilfoy B. An update in international trends in incidence rates of thyroid cancer, 1973–2007. Cancer Causes Control. 2018; 29 (4–5):465–473. Doi: 10.1007/s10552-018-1023-2.
8. Niedziela M.: Thyroid nodules. Best Pract Res Clin Endocrinal Metab 2014; 28:245-77.
9. Eissa MS, Abdellateif MS, Elesawy YF, Shaarawy S and Al-Jarhi UM. Obesity and Waist Circumference are Possible Risk Factors for Thyroid Cancer: Correlation with Different Ultrasonography Criteria. Cancer Management and Research 2020:12 6077–6089.
10. Hiernaux, J, Tanner JM. ‘Growth and physical studies’, In J.S. Weiner, S.A. Lourie (Eds.), Human Biology: A guide to field methods. London: IBP; Oxford, UK: Blackwell Scientific Publications, 1969.
11. Elniel HH, Ibrahim AE, Naglaa MA. Et al. real time ultrasound elastography for the differentiation of benign and malignant thyroid nodules. Open J Med Imaging. 2014; 4:38-47.
12. Davies L,Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg (2014); 140(4):317–22. doi: 10.1001/jamaoto.2014.1
13. Moleti M, Sturniolo G, Di Mauro M, Russo M, Vermiglio F. Female reproductive factors and differentiated thyroid cancer. Front Endocrinol (Lausanne) (2017); 8:111. doi: 10.3389/fendo.2017.00111.
14. Wang Y, Hunt K, Nazareth I, Freemantle N, Petersen I. Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open (2013); 3 (8):e003320. doi: 10.1136/bmjopen-2013-003320.
15. Suteau V, Munier M, Briet C, Rodien P. Sex bias in differentiated thyroid cancer. Int J Mol Sci, 2021; 22(23):12992. doi: 10.3390/ijms222312992.
16. Campanella P, Ianni F, Rota CA, Corsello SM, Pontecorvi A. Quantification of cancer risk of each clinical and ultrasonographic suspicious feature of thyroid nodules: a systematic review and meta-analysis. Eur J Endocrinol 2014; 170(5):R203–211. doi: 10.1530/EJE-13-0995.
17. Ohtsuru A, Takahashi H, Kamiya K. Incidence of thyroid cancer among children and young adults in fukushima, Japan-reply. JAMA Otolaryngol Head Neck Surg. 2019; 145(8):770. doi: 10.1001/jamaoto.2019.1102.
18. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26(1):1–133. doi: 10.1089/thy.2015.0020.
19. Reginelli A., Urraro F., Di Grezia G., Napolitano G., Maggialetti N., Cappabianca S., et al. conventional ultrasound integrated with elastography and B-flow imaging in the diagnosis of thyroid nodular lesions. Int J Surg. 2014; 12(1):s117-22.
20. Esfahanian F.,Aryan A., Gh ajarzadeh M., et al. application of sonoelastography in differential diagnosis of benign and malignant thyroid nodules. Int. J.Prev. med. 2016; 7:55.
21. Asteria C., Giovanardi A., Pizzocaro A., et al.: US elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid .2008:18:523-31.
22. Rago T., Santini F.,Scutari M., et al.: Elstography: new developments in ultrasound for predicting malignancy in thyroid nodules. The Journal of clinical endocrinology and metabolism. 2007:92(8):2917-22.
23. Gietka Czernel M., Kochman M., Bujalska K. et al.: Real time ultrasound elastography-A new tool for diagnosing thyroid nodules. Endokrynol. Pol.2010:1:652-7.
24. Wang H.L., Zhang S., Xin X.J., et al.: Application of real time ultrasound elastography in diagnosing benign and malignant throid nodules. Cancer Biol. Med. 2012:9:124-7.
25. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”–screening and over diagnosis. N Engl J Med. 2014; 371(19):1765–7. doi: 10.1056/NEJMp1409841.
26. Sado J, Kitamura T, Sobue T, Sawada N, Iwasaki M, Sa sazuki S, Yamaji T, Shimazu T, Tsugane S, Group JS. 2018. Risk of thyroid cancer in relation to height, weight, and body mass index in Japanese individuals: a population based cohort study. Cancer Med. 2018; 7:2200–2210.
27. Miranda-Filho A, Lortet-Tieulent J, Bray F, Cao B, Fran ceschi S, Vaccarella S, Dal Maso L. Thyroid cancer incidence trends by histology in 25 countries: a population based study. Lancet Diabetes Endocrinol. 2021; 9:225–234.
28. Fussey J M, Beaumont RN, Wood AR, Vaidya B., Smith J., and Tyrrell J. Does Obesity Cause Thyroid Cancer? A Mendelian Randomization Study. J Clin Endocrinal Metab. 2020 Jul; 105(7): e2398–e2407.
29. Obradovic M., Sudar-Milovanovic E., Soskic S., Essack M., Arya S., Stewart AJ., Gojobori T., and Isenovic ER. Leptin and Obesity: Role and Clinical Implication. Frontiers in Endocrinology. 2021 May, (12): e 585887.
30. Fryka E., Olaussona J., Mossberga K., Strindberga L., Schmelzc M., Brogrena H., Gand L., Piazzaf S., Provenzanif A., Becattinia B., Lindh L., Solinasa G., Janssona P. Hyperinsulinemia and insulin resistance in the obese may develop as part of a homeostatic response to elevated free fatty acids: A mechanistic case-control and a population-based cohort study. EBioMedicine 65 (2021) 103264.
31. Arduc A, Dogan BA, Tuna MM, et al. Higher body mass index and larger waist circumference may be predictors of thyroid carcinoma in patients with Hürthle-cell lesion/neoplasm fine-needle aspiration diagnosis. Clin Endocrinol (Oxf). 2015; 83(3):405–411. Doi: 10.1111/ cen.12628.
32. Kwon H, Han KD, Park CY. Weight change is significantly associated with risk of thyroid cancer: a nationwide population-based cohort study. Sci Rep. 2019; 9(1):1–8. Doi: 10.1038/s41598-018- 37186-2.
33. Kitahara CM, McCullough ML, Franceschi S, et al. Anthropometric factors and thyroid cancer risk by histological subtype: pooled analysis of 22 prospective studies. Thyroid. 2016; 26(2):306–318. doi:10.1089/thy.2015.0319.
34. Song B, Zuo Z, Tan J, et al. Association of thyroid nodules with adiposity: a community-based cross-sectional study in China. BMC Endocr Disord. 2018; 18(1):3. Doi: 10.1186/s12902-018-0232-8.
35. Zhao S, Jia X, Fan X, et al. Association of obesity with the clinicopathological features of thyroid cancer in a large, operative population: a retrospective case-control study. Medicine. 2019; 98(50):e18213.
36. de Siqueira RA, Rodrigues APDS, Miamae LM, Tomimori EK, Silveira EA. Thyroid nodules in severely obese patients: frequency and risk of malignancy on ultrasonography. Endocr Res. 2020;45 (1):9–16. doi:10.1080/07435800.2019.1625056.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Safenaz Y. El Sherity
Biological Anthropology Department, Medical Research and Clinical Studies Insitute, National Research Centre (Affiliation ID 60014618),
Abbas MH
Internal Medicine Department, Medical Research and Clinical Studies Insitute, National Research Centre
Mohamed Metkees
Biological Anthropology Department, Medical Research and Clinical Studies Insitute, National Research Centre (Affiliation ID 60014618),
Karim G. Moustafa
Reproductive Health department, Medical Research and Clinical Studies Insitute, National Research
Shymaa A. Shalaby
Radiodiagnosis department, Faculty of Medicine, Helwan University, Cairo, Egypt.