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BMC Medical Imaging
Published in: BMC Medical Imaging 1/2021

Open Access 01-12-2021 | Ultrasound | Research article

Analysis of vascularization in thyroid gland nodes with superb microvascular imaging (SMI) and CD34 expression histology: a pilot study

Authors: Thomas Studeny, Wolfgang Kratzer, Julian Schmidberger, Tilmann Graeter, Thomas F. E. Barth, Andreas Hillenbrand

Published in: BMC Medical Imaging | Issue 1/2021

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Abstract

Background

The Doppler sonography technique known as "superb microvascular imaging" (SMI) is advancing sonographic micro vascularization imaging in various disciplines. In this study, we aimed to determine whether SMI could reliably reproduce the blood flow in thyroid nodes and whether malignancy could be diagnosed, based on vascularization properties. Immunhistochemical staining by CD34 and SMI where used to determine the vascularization of nodes in terms of quantified vascularization parameters gained by computational evaluation.

Methods

We used image analysis programs to investigate whether the quantitative value for vascularization strength in the thyroid node, measured with SMI, was correlated with the actual degree of vascularization, determined microscopically. We included 16 patients that underwent thyroid resections. We prepared thyroid gland tissue slices for immunohistochemistry and labelled endothelial cells with CD34 to visualize blood vessels microscopically. We used image analysis programs, ImageJ, to quantify SMI Doppler sonographic measurements and CellProfiler to quantify CD34 expression in histological sections. We evaluated the numeric values for diagnostic value in node differentiation. Furthermore, we compared these values to check for correlations.

Results

Among the 16 nodes studied, three harboured malignant tumours (18.75%): two papillary and one follicular carcinoma. Among the 13 benign lesions (81.25%), four harboured follicular adenomas. Malignant and benign nodes were not significantly different in sonographic (0.88 ± 0.89 vs. 1.13 ± 0.19; p = 0.2790) or immunohistochemical measurements of vascularization strength (0.05 ± 0.05 vs. 0.08 ± 0.06; p = 0.2260).

Conclusion

We found a positive, significant correlation (r = 0.55588; p = 0.0254) between SMI (quantitative values for vascularization strength) and immunohistochemistry (CD34 staining) evaluations of thyroid nodes.
Literature
1.
Horvath E, Silva CF, Majlis S, Rodriguez I, Skoknic V, Castro A, et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification. Results in surgically resected thyroid nodules. Eur Radiol. 2017;27:2619–28.CrossRef
2.
Forsberg F; Machado P, Segal S, Okamura Y, Guenette G, Rapp C, et al. Microvascular blood flow in the thyroid. Preliminary results with a novel imaging technique. In: IEEE International Ultrasonics Symposium Proceedings; 2014. p. 2237–40.
3.
Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, 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;22:622–39.CrossRef
4.
De Nicola H, Szejnfeld J, Logullo AF, Wolosker AM, Souza LR, Chiferi V Jr. Flow pattern and vascular resistive index as predictors of malignancy risk in thyroid follicular neoplasms. J Ultrasound Med. 2005;24:897–904.CrossRef
5.
6.
Machado P, Segal S, Lyshchik A, Forsberg F. A novel microvascular flow technique. Initial results in thyroids. Ultrasound Q. 2016;32:67–74.CrossRef
7.
Park SY, Hahn SY, Shin JH, Ko EY, Oh YL. The diagnostic performance of thyroid US in each category of the Bethesda system for reporting thyroid cytopathology. PLoS ONE. 2016;11:e0155898.CrossRef
8.
Park VY, Kim EK, Kwak JY, Yoon JH, Kim MJ, Moon HJ. Thyroid imaging reporting and data system and ultrasound elastography: diagnostic accuracy as a tool in recommending repeat fine-needle aspiration for solid thyroid nodules with non-diagnostic fine-needle aspiration cytology. Ultrasound Med Biol. 2016;42:399–406.CrossRef
9.
Khadra H, Bakeer M, Hauch A, Hu T, Kandil E. Is vascular flow a predictor of malignant thyroid nodules? A meta-analysis Gland Surg. 2016;5:576–82.CrossRef
10.
11.
Russ G. Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS. Description and reflections. Ultrasonography. 2016;35:25–38.CrossRef
12.
Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol. 2013;168:649–55.CrossRef
13.
Götzberger M, Krueger S, Gärtner R, Reincke M, Pichler M, Assmann G, et al. Comparison of color-Doppler and qualitative and quantitative strain-elastography for differentiation of thyroid nodules in daily practice. Hormones (Athens). 2016;15:197–204.CrossRef
14.
Moon HJ, Kwak JY, Kim MJ, Son EJ, Kim EK. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology. 2010;255:260–9.CrossRef
15.
Yoon JH, Kim EK, Kwak JY, Park VY, Moon HJ. Application of various additional imaging techniques for thyroid ultrasound. Direct comparison of combined various elastography and Doppler parameters to gray-scale ultrasound in differential diagnosis of thyroid nodules. Ultrasound Med Biol. 2018;44:1679–86.CrossRef
16.
Yang GCH, Fried KO. Most thyroid cancers detected by sonography lack intranodular vascularity on color doppler imaging: review of the literature and sonographic-pathologic correlations for 698 thyroid neoplasms. J Ultrasound Med. 2017;36:89–94.CrossRef
17.
Nabhan F, Ringel MD. Thyroid nodules and cancer management guidelines: comparisons and controversies. Endocr Relat Cancer. 2017;24:R13–26.CrossRef
18.
Leenhardt L, Erdogan MF, Hegedus L, Mandel SJ, Paschke R, Rago T, 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;2:147–59.CrossRef
19.
Chen L, Zhan J, Diao XH, Liu YC, Shi YX, Chen Y, Zhan WW. Additional value of superb microvascular imaging for thyroid nodule classification with the thyroid imaging reporting and data system. Ultrasound Med Biol. 2019;45:2040–8.CrossRef
20.
Lu R, Meng Y, Zhang Y, Zhao W, Wang X, Jin M, Guo R. Superb microvascular imaging (SMI) compared with conventional ultrasound for evaluating thyroid nodules. BMC Med Imaging. 2017;17:65.CrossRef
21.
Ahn HS, Lee JB, Seo M, Park SH, Choi BI. Distinguishing benign from malignant thyroid nodules using thyroid ultrasonography: utility of adding superb microvascular imaging and elastography. Radiol Med. 2018;123:260–70.CrossRef
22.
Zhu YC, Zhang Y, Deng SH, Jiang Q. A prospective study to compare superb microvascular imaging with grayscale ultrasound and color doppler flow imaging of vascular distribution and morphology in thyroid nodules. Med Sci Monit. 2018;24:9223–31.CrossRef
23.
Cappelli C, Pirola I, Gandossi E, Marini F, Cristiano A, Casella C, et al. Ultrasound microvascular blood flow evaluation: a new tool for the management of thyroid nodule? Int J Endocrinol. 2019;2019:7874890.CrossRef
24.
Kong J, Li JC, Wang HY, Wang YH, Zhao RN, Zhang Y, et al. Role of superb micro-vascular imaging in the preoperative evaluation of thyroid nodules. Comparison with power Doppler flow imaging. J Ultrasound Med. 2017;36:1329–37.CrossRef
25.
Folkman J. Tumor angiogenesis factor. Cancer Res. 1974;34:2109–13.PubMed
26.
Shin HJ, Kim EK, Moon HJ, Yoon JH, Han KH, Kwak JY. Can increased tumoral vascularity be a quantitative predicting factor of lymph node metastasis in papillary thyroid microcarcinoma? Endocrine. 2014;47:273–82.CrossRef
27.
De la Torre NG, Buley I, Wass JA, Turner HE. Angiogenesis and lymphangiogenesis in thyroid proliferative lesions: relationship to type and tumour behaviour. Endocr Relat Cancer. 2006;13:931–44.CrossRef
28.
Skuletic V, Radosavljevic GD, Pantic J, Markovic BS, Jovanovic I, Jankovic N, et al. Angiogenic and lymphangiogenic profiles in histological variants of papillary thyroid carcinoma. Pol Arch Intern Med. 2017;127:429–37.PubMed
29.
Zhan J, Diao XH, Jin JM, Chen L, Chen Y. Superb Microvascular Imaging-A new vascular detecting ultrasonographic technique for avascular breast masses: a preliminary study. Eur J Radiol. 2016;85:915–21.CrossRef
30.
Yongfeng Z, Ping Z, Wengang L, Yang S, Shuangming T. Application of a novel microvascular imaging technique in breast lesion evaluation. Ultrasound Med Biol. 2016;42:2097–105.CrossRef
31.
Lee DH, Lee JY, Han JK. Superb microvascular imaging technology for ultrasound examinations: Initial experiences for hepatic tumors. Eur J Radiol. 2016;85:2090–5.CrossRef
32.
Lee YS, Kim MJ, Han SW, Lee HS, Im YJ, Shin HJ, et al. Superb microvascular imaging for the detection of parenchymal perfusion in normal and undescended testes in young children. Eur J Radiol. 2016;85:649–56.CrossRef
33.
Brogan PT, Henning H, Stout TA, de Ruijter-Villani M. Relationship between colour flow Doppler sonographic assessment of corpus luteum activity and progesterone concentrations in mares after embryo transfer. Anim Reprod Sci. 2016;166:22–7.CrossRef
34.
Wilson WD, Valet AS, Andreotti RF, Green-Jarvis B, Lyshchik A, Fleischer AC. Sonographic quantification of ovarian tumor vascularity. J Ultrasound Med. 2006;25:1577–81.CrossRef
35.
Wu MH, Chen CN, Chen KY, Ho MC, Tai HC, Chung YC, et al. Quantitative analysis of dynamic power Doppler sonograms for patients with thyroid nodules. Ultrasound Med Biol. 2013;39:1543–51.CrossRef
36.
Sakano R, Saito K, Kamishima T, Nishida M, Horie T, Noguchi A, et al. Power Doppler signal calibration in the finger joint between two models of ultrasound machine. A pilot study using a phantom and joints in patients with rheumatoid arthritis. Acta Radiol. 2017;58:1238–44.CrossRef
37.
Jiang J, Shang X, Zhang H, Ma W, Xu Y, Zhou Q, et al. Correlation between maximum intensity and microvessel density for differentiation of malignant from benign thyroid nodules on contrast-enhanced sonography. J Ultrasound Med. 2014;33:1257–63.CrossRef
38.
Wong NA, Willott J, Kendall MJ, Sheffield EA. Measurement of vascularity as a diagnostic and prognostic tool for well differentiated thyroid tumours. Comparison of different methods of assessing vascularity. J Clin Pathol. 1999;52:593–7.CrossRef
39.
Sancak S, Hardt A, Gärtner R, Eszlinger M, Aslan A, Eren FT, et al. Comparison of Color Flow Doppler Sonography (CFDS) and immunohistologic detection of microvessels for the assessment of the malignancy of thyroid nodules. Horm Metab Res. 2010;42:670–6.CrossRef
40.
Bojunga J. Ultrasound of thyroid nodules. Ultraschall Med. 2018;39:488–511.CrossRef
41.
Ma BY, Jin Y, Suntdar PS, Zhao HN, Jiang Y, Zhou JH. Contrast-enhanced ultrasonography findings for papillary thyroid carcinoma and its pathological bases. Sichuan Da Xue Xue Bao Yi Xue Ban. 2014;45:997–1000.PubMed
42.
Zhou Q, Jiang J, Shang X, Zhang HL, Ma WQ, Xu YB, et al. Correlation of contrast-enhanced ultrasonographic features with microvessel density in papillary thyroid carcinomas. Asian Pac J Cancer Prev. 2014;15:7449–52.CrossRef
Metadata
Title
Analysis of vascularization in thyroid gland nodes with superb microvascular imaging (SMI) and CD34 expression histology: a pilot study
Authors
Thomas Studeny
Wolfgang Kratzer
Julian Schmidberger
Tilmann Graeter
Thomas F. E. Barth
Andreas Hillenbrand
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2021
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-021-00690-5

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