RU2432903C1 - Method of determining indications for invasive examination in case of thyroid nodules - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to ultrasonic diagnostics, and is intended for determination of indications for invasive examination in case of thyroid nodules. Ultrasonic examination of thyroid nodules is carried out. Nodules are classified irrespective of their size by THIRADS scale. In cases if: nodule is hypoechogenic, with clear outline, solid or mixed, possibly with calcites, with expressed vascularisation; or nodule is incapsulated, with irregular contour, hypoechgenic, partly with peripheral vascularisation, at the background of Hashimoto's thyroiditis; or nodule is without a capsule, with irregular contour, isoechogenic, of mixed structure, with solid component, with hyperechogenic inclusions, vascularised, cervical lymph nodes are enlarged; or nodule is with capsule, expressed fluid component, parietal solid excrescences, vascularised; or nodule has expressed capsule, is hyper, iso- or hypoechogenic, contains circular calcinates or microcalcinates, is hypervascularised; if nodule has irregular contour, does not have clear boundary with normal parenchyma, is hypo-, iso- or hyperechogenic, with microcalcites, with presence of structurally changed cervical lymph nodes; or nodule is vertically oriented, without clear contour, hypoechogenic, with microcalcites, is hypovascularised, puncture biopsy is considered indicated. ^ EFFECT: method ensures possibility of determining indications for invasive examination in case of thyroid nodules basing of results of ultrasonic diagnostics. ^ 2 ex, 2 dwg

Description

The invention relates to medicine, namely to ultrasound diagnostics, and can be used to determine the need for invasive diagnostic methods based on the degree of risk of malignancy, determined on the basis of ultrasound data (ultrasound).

Thyroid nodules (SCs) are found in 30–50% of people in a population. Improvement of thyroid ultrasound technique allows detecting thyroid formations with a size of 2-3 mm and biopsy them. However, 90-95% of these MDs are benign, do not have a risk of malignancy and do not require the use of invasive diagnostic methods, namely a puncture biopsy. In this regard, there is a need to determine the indications for invasive diagnosis based on the risk of malignancy of the tumor.

A known classification of breast diseases based on X-ray mammography data and reflecting the degree of cancer risk and the need for further diagnostic measures is BIRADS [American College of Radiology (ACR) Breast Imaging Reporting and Data System Atlas (BI-RADS Atlas). Reston, Va: © American College of Radiology, 2003]. Since X-ray studies are not informative in the diagnosis of thyroid ulcer, their data cannot be used as the basis for the classification of thyroid pathology.

The description of complex ultrasound models of thyroid neoplasms is known, based on the data of ultrasound, puncture biopsy and histological analysis of surgical material [Epstein EV, Matyaschuk SI Thyroid Ultrasound: Atlas Guide. - Kiev, 2004. - 382 p.]. However, this description does not connect ultrasound symptom complexes with indications for further invasive diagnostic procedures, in particular, biopsy.

Based on a comparison of 12,000 ultrasound results and cytological examination of biopsy samples obtained by transdermal fine-needle aspiration biopsy of thyroid thyroid gland, and subsequent statistical analysis, 12 groups were distinguished by an echographic picture of the thyroid gland, which were assigned gradations from 1 to 5, called THIRADS (Thyroid Imaging Reporting and Data Systema). The differentiating sign for the assignment of these gradations was the risk of malignancy in thyroid gland. Indications for invasive diagnostics are determined for each of the gradations.

Thus, the proposed method solves the problem of determining indications for invasive studies in thyroid ulcer based on the risk of malignancy based on the results of ultrasound.

The problem is solved in that the degree of risk of malignancy is determined on the basis of ultrasound examination of nodules of the thyroid gland, which are classified regardless of their size according to the developed THIRADS scale from 1 to 5, depending on the signs given in the table.

Table Echographic characteristics of nodal education Echomorphological type of node Chance of malignancy THIRADS Category Indications for puncture biopsy one 2 3 four 5 UO of the thyroid gland is absent, the normal picture of the thyroid gland 0% THIRADS 1 no Anechoic with hyperechoic inclusion (“comet tail”), non-vascularized Colloidal type 1 node 0% THIRADS 2 no Without capsule, with clear contours, mixed structure, with hyperechoic inclusions, vascularized spongy node Colloidal type 2 node 0% THIRADS 2 no Hyper- or isoechoic, partially encapsulated, with peripheral vascularization, against the background of Hashimoto's thyroiditis Hashimoto type 1 pseudo-node 0% THIRADS 2 no Hypoechoic, with a clear outline, solid or mixed, possibly with calcifications, with pronounced vascularization Colloidal node 3 types 0% THIRADS 2 no Encapsulated, with an uneven contour, hypoechoic, partially with peripheral vascularization, against the background of Hashimoto's thyroiditis Hashimoto type 2 pseudo-node Less than 5% THIRADS 3 Yes

one 2 3 four 5 Without capsule, with an uneven contour, isoechoic, of mixed structure, with a solid component, with hyperechoic inclusions, vascularized, cervical lymph nodes enlarged Colloidal goiter type 4 Less than 5% THIRADS 3 Yes With a capsule, a pronounced liquid component, parietal solid growths, a vascularized node Cystic node 5-10% THIRADS 3 Yes With a pronounced capsule, hyper-, iso- or hypoechoic, containing circular calcifications or microcalcinates, hypervascular Suspicious of malignant 10-80% THIRADS 4a Yes With an uneven contour, without a clear border with the normal parenchyma, hypo-, iso- or hyperechoic, with microcalcifications, the presence of structurally altered cervical lymph nodes Malignant 90% THIRADS 4b Yes Vertically oriented, without a clear contour, hypoechoic, with microcalcifications, hypovascularized Malignant 90% THIRADS 4b Yes A node whose malignancy has been proven by a previous biopsy Malignant one hundred% THIRADS 5 no

if the totality of the signs corresponds to the THIRADS 3, 4 group, the puncture biopsy is considered shown, respectively, if the indicated combination falls into the THIRADS 1, 2 group, there is no risk of malignancy, the biopsy is considered not shown, the combination of the signs belonging to the THIRADS 5 category indicates about unconditional malignancy and does not need verification.

New in the claimed method is the use as a differentiating feature of the echographic characteristics of thyroid thyroid gland, regardless of its size, based on the creation of the THIRADS classification and the allocation of gradations from 1 to 5 according to the degree of risk of malignancy.

The method is as follows.

An ultrasound of the thyroid gland is performed in standard modes, when detecting UO, its shape, contours, echogenicity, the presence of a capsule, a liquid component, calcifications are evaluated, and the type of vascularization is determined using Doppler modes. Based on the correlation of the obtained parameters with the characteristics of the groups listed in the table.

If an ultrasound examination of the thyroid gland is not detected, the category THIRADS 1 is assigned, respectively, a puncture biopsy is not shown.

If anechoic with a hyperechoic inclusion of a comet tail, an unvascularized ultrasound, is echographically visualized, it is regarded as a colloidal node of type 1. If UO is determined without a capsule, with clear contours, of a mixed structure, with hyperechoic inclusions, a vascularized, spongy node, it is regarded as a colloidal node of type 2. If thyroid thyroid gland is hyper- or isoechoic, partially encapsulated, with peripheral vascularization, against the background of Hashimoto thyroiditis, it is regarded as a Hashimoto type 1 pseudonode. In cases where the UO is hypoechoic, with a clear outline, solid or mixed, possibly with calcifications, with pronounced vascularization, it is regarded as a type 3 colloidal node. For the listed MA, there is no risk of malignancy, they are assigned a gradation of THIRADS 2 (there is no risk of malignancy), a puncture biopsy is not shown.

If the UO is encapsulated, with an uneven contour, hypoechoic, partially with peripheral vascularization, against the background of Hashimoto's thyroiditis, it is regarded as a Hashimoto type 2 pseudonode. If UO without a capsule, with an uneven contour, isoechoic, of mixed structure, with a solid component, with hyperechoic inclusions, vascularized, cervical lymph nodes are enlarged, it is defined as type 4 colloid goiter. In these cases, the probability of malignancy is 0-5%. If the UO with a capsule, a pronounced liquid component, parietal solid growths, is vascularized, it is regarded as a cystic node, the probability of malignancy of which is 5-10%, a puncture biopsy is considered shown. All these MAs are assigned a THIRADS 3 gradation (low risk of malignancy), a puncture biopsy is indicated.

If UO has a pronounced capsule, is hyper-, iso- or hypoechoic, contains circular calcifications or microcalcinates, is hypervascularized, it is considered suspicious for malignancy with a probability of malignancy of 10-80%, and a grade of THIRADS 4a is assigned (high risk of malignancy). If UO with an uneven contour, without a clear border with a normal parenchyma, hypo-, iso- or hyperechoic, with microcalcifications, the presence of structurally altered cervical lymph nodes, it is regarded as malignant. If the UO is vertically oriented, without a clear contour, hypoechoic, with microcalcinates, is hypovascularized, it is also regarded as malignant. In these cases, THIRADS 4b is assigned (high risk of malignancy - 90%). A puncture biopsy is considered mandatory.

If the malignancy of the node was proved by a previous biopsy, he is assigned a gradation of THIRADS 5, the malignancy is considered verified, a puncture biopsy is not shown.

Example 1. Patient A., 32 years old. When ultrasound: in the right lobe of the thyroid gland is determined anechoic formation of the correct form, with clear contours, homogeneous structure, with hyperechoic inclusion (effect of the “comet tail”) (figure 1). THIRADS 2, puncture biopsy not shown.

Example 2. Patient S., 41 years old. When ultrasound: in the right lobe of the thyroid gland is determined hypoechoic node of irregular shape, with a clear contour, pronounced capsule, heterogeneous structure, with single microcalcifications (figure 2). THIRADS 4a, puncture biopsy is indicated.

Thus, the proposed method, based on the echographic characteristic of the thyroid gland supplemented with the developed THIRADS scale, provides an opportunity to assess the risk of malignancy of a UO with a high degree of reliability, which makes it possible to clearly identify indications for puncture biopsy, to avoid unnecessary invasive interventions without compromising the detection of malignant neoplasms.

Claims (1)

A method for determining indications for invasive examinations for nodular thyroid formations by conducting echomorphological parallels, characterized in that indications for invasive examinations are determined on the basis of data from ultrasound examination of thyroid nodules, which are classified regardless of their size on the THIRADS scale and in cases: if UO hypoechoic, with a clear outline, solid or mixed, possibly with calcifications, with pronounced vascularization; or UO encapsulated, with an uneven contour, hypoechoic, partially with peripheral vascularization, against the background of Hashimoto's thyroiditis; or UO without a capsule, with an uneven contour, isoechoic, of mixed structure, with a solid component, with hyperechoic inclusions, vascularized, cervical lymph nodes are enlarged; or UO with a capsule, a pronounced liquid component, parietal solid growths, vascularized; or UO has a pronounced capsule, hyper-, iso- or hypoechoic, contains circular calcifications or microcalcinates, is hypervascularized; if UO with an uneven contour, without a clear border with a normal parenchyma, hypo-, iso- or hyperechoic, with microcalcifications, the presence of structurally altered cervical lymph nodes; or UO is vertically oriented, without a clear outline, hypoechoic, with microcalcinates, is hypovascularized, a puncture biopsy is considered indicated.

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