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Bojunga J, Trimboli P. Thyroid ultrasound and its ancillary techniques. Rev Endocr Metab Disord 2024; 25:161-173. [PMID: 37946091 DOI: 10.1007/s11154-023-09841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Ultrasound (US) of the thyroid has been used as a diagnostic tool since the late 1960s. US is the most important imaging tool for diagnosing thyroid disease. In the majority of cases a correct diagnosis can already be made in synopsis of the sonographic together with clinical findings and basal thyroid hormone parameters. However, the characterization of thyroid nodules by US remains challenging. The introduction of Thyroid Imaging Reporting and Data Systems (TIRADSs) has improved diagnostic accuracy of thyroid cancer significantly. Newer techniques such as elastography, superb microvascular imaging (SMI), contrast enhanced ultrasound (CEUS) and multiparametric ultrasound (MPUS) expand diagnostic options and tools further. In addition, the use of artificial intelligence (AI) is a promising tool to improve and simplify diagnostics of thyroid nodules and there is evidence that AI can exceed the performance of humans. Combining different US techniques with the introduction of new software, the use of AI, FNB as well as molecular markers might pave the way for a completely new area of diagnostic accuracy in thyroid disease. Finally, interventional ultrasound using US-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for benign as well as malignant thyroid diseases.
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Affiliation(s)
- Joerg Bojunga
- Department of Medicine I, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
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2
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Okasha HH, Mansor M, Sheriba N, Abdelfattah Y, Abdelfatah D, Orabi HE, Elebrashy IN, Saif A, Meligi AAE, Elshazli M, Elhadidy KE, Abushady MM, Islam EE, Yosef TM, Salama ASED, Ouf TI, Said SM, Eid YM, Mohsen AA, Rizk MN, Yousief E, Elrawi H, Ahmed TM, Roshdy E, Sedrak HK, Din HGE, Aboulsoud S, El-Sawy SS, El-Feki MA, Alzamzamy A, Elenin SA, Tag-Adeen M, Abdelhameed H, Awad A. Value of TI-RADS and elastography strain ratio in predicting malignant thyroid nodules: experience from a single center in Egypt. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:45. [DOI: https:/doi.org/10.1186/s43162-023-00227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/04/2023] [Indexed: 11/04/2023] Open
Abstract
Abstract
Introduction
Thyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC).
Objective
This study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules.
Material and methods
A total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year.
Results
There were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter < 1, patients with solitary thyroid nodules have 4.5 times to develop malignancy compared to those with multinodular goiter (MNG), nodules with absent halo have 4 times more risk of malignancy. Furthermore, microcalcifications in thyroid nodules increase the risk of malignancy 9 times compared to those without calcifications. SR was found to be an excellent discriminator to differentiate between benign and malignant nodules with P < 0.001. Also, we found that for every unit increase in SR, the risk of malignancy increased by 20%. We reported that the accuracy of ultrasonography in the detection of malignant thyroid nodules had a sensitivity of 89%, specificity of 98%, 70% PPV, and 99.3% NPV, with an overall accuracy of 97.2%.
Conclusion
The application of ultrasonographic non-invasive criteria for thyroid nodules in clinical practice might significantly reduce the number of unnecessary FNAC. Elastography, SR, and TI-RADS classification could be good predictors for malignant thyroid nodules.
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Kurti M, Sabeti S, Robinson KA, Scalise L, Larson NB, Fatemi M, Alizad A. Quantitative Biomarkers Derived from a Novel Contrast-Free Ultrasound High-Definition Microvessel Imaging for Distinguishing Thyroid Nodules. Cancers (Basel) 2023; 15:cancers15061888. [PMID: 36980774 PMCID: PMC10046818 DOI: 10.3390/cancers15061888] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Low specificity in current ultrasound modalities for thyroid cancer detection necessitates the development of new imaging modalities for optimal characterization of thyroid nodules. Herein, the quantitative biomarkers of a new high-definition microvessel imaging (HDMI) were evaluated for discrimination of benign from malignant thyroid nodules. Without the help of contrast agents, this new ultrasound-based quantitative technique utilizes processing methods including clutter filtering, denoising, vessel enhancement filtering, morphological filtering, and vessel segmentation to resolve tumor microvessels at size scales of a few hundred microns and enables the extraction of vessel morphological features as new tumor biomarkers. We evaluated quantitative HDMI on 92 patients with 92 thyroid nodules identified in ultrasound. A total of 12 biomarkers derived from vessel morphological parameters were associated with pathology results. Using the Wilcoxon rank-sum test, six of the twelve biomarkers were significantly different in distribution between the malignant and benign nodules (all p < 0.01). A support vector machine (SVM)-based classification model was trained on these six biomarkers, and the receiver operating characteristic curve (ROC) showed an area under the curve (AUC) of 0.9005 (95% CI: [0.8279,0.9732]) with sensitivity, specificity, and accuracy of 0.7778, 0.9474, and 0.8929, respectively. When additional clinical data, namely TI-RADS, age, and nodule size were added to the features, model performance reached an AUC of 0.9044 (95% CI: [0.8331,0.9757]) with sensitivity, specificity, and accuracy of 0.8750, 0.8235, and 0.8400, respectively. Our findings suggest that tumor vessel morphological features may improve the characterization of thyroid nodules.
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Affiliation(s)
- Melisa Kurti
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Soroosh Sabeti
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Kathryn A Robinson
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Lorenzo Scalise
- Department of Industrial Engineering and Mathematical Science, Polytechnic University of Marchedelle Marche, 60131 Ancona, Italy
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Yoshikawa T, Inui A, Mifune Y, Nishimoto H, Yamaura K, Mukohara S, Shinohara I, Hoshino Y, Matsuishita T, Kuroda R. Assessment of the Ulnar Collateral Ligament of the Elbow Using Ultrasonic Shear Wave Elastography in Professional Baseball Players. Orthop J Sports Med 2022; 10:23259671221138134. [PMID: 36532147 PMCID: PMC9756359 DOI: 10.1177/23259671221138134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Injury to the ulnar collateral ligament (UCL) of the elbow can cause chronic pain and loss of throwing ability. Ultrasonic shear wave elastography (SWE) is a new imaging method that can be used for quantitative assessment of tissue elasticity. PURPOSE To evaluate the properties of the UCL in professional baseball players using SWE. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study included 35 professional baseball players (mean age, 23.0 years) without elbow injuries. Both elbows of each player were examined using ultrasound, and comparisons between the dominant and nondominant arms were conducted. The thickness of the anterior bundle of the UCL at its midportion was measured in the resting position on ultrasound. We also measured the difference in the ulnohumeral joint space with and without gravity stress on the forearm. Tissue elasticity was evaluated using a built-in software program. The relationship between UCL elasticity and ultrasound findings was analyzed using the Pearson correlation coefficient. RESULTS The mean ± SD thickness of the UCL was significantly greater in the dominant arm versus the nondominant arm (6.0 ± 1.4 vs 5.3 ± 1.3 mm; P = .004). The mean joint space difference was significantly wider in the dominant arm as compared with the nondominant arm (0.81 ± 0.42 vs 0.52 ± 0.31 mm; P = .002), and the mean UCL elasticity was lower in the dominant arm than in the nondominant arm (34.9 ± 11.6 vs 43.3 ± 10.6 kPa; P = .002). UCL elasticity was negatively correlated with UCL thickness (r = -0.27; P = .02) and joint space difference (r = -0.34; P = .003). CONCLUSION In professional baseball players, the elbow UCL of the dominant arm demonstrated increased thickness, with a larger joint space gap on gravity stress and lower elasticity in SWE as compared with the nondominant arm. Greater medial joint laxity can be predicted by assessing the elasticity of the UCL using SWE.
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Affiliation(s)
- Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsuishita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Zhu T, Chen J, Zhou Z, Ma X, Huang Y. Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System. Front Oncol 2022; 12:840819. [PMID: 35847847 PMCID: PMC9280912 DOI: 10.3389/fonc.2022.840819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To establish a contrast-enhanced ultrasound (CEUS) diagnostic schedule by CEUS analysis of thyroid nodules of C-TIRADS 4. To establish a CEUS-TIRADS diagnostic model to differentiate thyroid nodules (C-TIRADS 4) by combining CEUS with Chinese thyroid imaging reporting and data system (C-TIRADS). Methods A total of 228 thyroid nodules (C-TIRADS 4) were estimated by CEUS. The arrival time, enhancement degree, enhancement homogeneity, enhancement pattern, enhancement ring, and wash-out time were analyzed in CEUS for all of the nodules. Multivariate factors logistic analysis was performed and a CEUS diagnostic schedule was established. If the nodule had a regular hyper-enhancement ring or got a score of less than 2 in CEUS analysis, CEUS-TIRADS subtracted 1 category. If the nodule got a score of 2 in the CEUS schedule, the CEUS-TIRADS category remained the same as before. If the nodule got a score of more than 2 in the CEUS schedule, CEUS-TIRADS added 1 category. When it reflected an absent enhancement in CEUS, the nodule was judged as CEUS-TIRADS 3. All of the C-TIRADS 4 nodules were re-graded by CEUS-TIRADS. We then compare the diagnosis performance of C-TIRADS, CEUS, and CEUS-TIRADS by sensitivity, specificity, and accuracy. Results Among the 228 C-TIRADS 4 nodules, 69 were determined as C-TIRADS 4a, 114 were C-TIRADS 4b, and 45 were C-TIRADS 4c. The sensitivity, specificity, and accuracy of C-TIRADS were 93.1%, 55.3%, and 74.6% respectively. The area under the curve was 0.753. Later arrival time, hypo-enhancement, heterogeneous enhancement, centripetal enhancement, and rapid washout were risk factors of malignancy in multivariate analysis. The sensitivity, specificity, and accuracy of CEUS were 78.7%, 87.5%, and 83.3% respectively. The area under the curve was 0.803. By CEUS-TIRADS diagnostic model combining CEUS with C-TIRADS, a total of 127 cases were determined as malignancy (111 were malignant and 16 were benign) and 101 were diagnosed as benign ones (5 were malignant and 96 were benign). The sensitivity, specificity, and accuracy of CEUS-TIRADS were 95.7%, 85.7%, and 92.1% respectively. The area under the curve was 0.916. The diagnostic performance of CEUS-TIRADS was significantly better than CEUS and C-TIRADS. The difference was statistically significant (P<0.05). Conclusions The diagnostic schedule of CEUS could get better diagnostic performance than US in the differentiation of thyroid nodules. The CEUS-TIRADS combining CEUS analysis with C-TIRADS could make up for the deficient sensibility of C-TIRADS, showing a better diagnostic performance than US and CEUS.
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Affiliation(s)
- Tiantong Zhu
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiahui Chen
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zimo Zhou
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaofen Ma
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Huang
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Ying Huang,
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6
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Li W, Sun Y, Xu H, Shang W, Dong A. Systematic Review and Meta-Analysis of American College of Radiology TI-RADS Inter-Reader Reliability for Risk Stratification of Thyroid Nodules. Front Oncol 2022; 12:840516. [PMID: 35646667 PMCID: PMC9136001 DOI: 10.3389/fonc.2022.840516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the inter-reader agreement of using the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) for risk stratification of thyroid nodules. Methods A literature search of Web of Science, PubMed, Cochrane Library, EMBASE, and Google Scholar was performed to identify eligible articles published from inception until October 31, 2021. We included studies reporting inter-reader agreement of different radiologists who applied ACR TI-RADS for the classification of thyroid nodules. Quality assessment of the included studies was performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool and Guidelines for Reporting Reliability and Agreement Studies. The summary estimates of the inter-reader agreement were pooled with the random-effects model, and multiple subgroup analyses and meta-regression were performed to investigate various clinical settings. Results A total of 13 studies comprising 5,238 nodules were included in the current meta-analysis and systematic review. The pooled inter-reader agreement for overall ACR TI-RADS classification was moderate (κ = 0.51, 95% CI 0.42–0.59). Substantial heterogeneity was presented throughout the studies, and meta-regression analyses suggested that the malignant rate was the significant factor. Regarding the ultrasound (US) features, the best inter-reader agreement was composition (κ = 0.58, 95% CI 0.53–0.63), followed by shape (κ = 0.57, 95% CI 0.41–0.72), echogenicity (κ = 0.50, 95% CI 0.40–0.60), echogenic foci (κ = 0.44, 95% CI 0.36–0.53), and margin (κ = 0.34, 95% CI 0.24–0.44). Conclusions The ACR TI-RADS demonstrated moderate inter-reader agreement between radiologists for the overall classification. However, the US feature of margin only showed fair inter-reader reliability among different observers.
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Affiliation(s)
- Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Yuan Sun
- Department of Burn and Plastic Surgery, Affiliate Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Haibing Xu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Wenwen Shang
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Anding Dong
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
- *Correspondence: Anding Dong,
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7
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Cantisani V, De Silvestri A, Scotti V, Fresilli D, Tarsitano MG, Polti G, Guiban O, Polito E, Pacini P, Durante C, Grani G, Isidori AM, Giannetta E, Sorrenti S, Trimboli P, Catalano C, Cirocchi R, Lauro A, D'Andrea V. US-Elastography With Different Techniques for Thyroid Nodule Characterization: Systematic Review and Meta-analysis. Front Oncol 2022; 12:845549. [PMID: 35371974 PMCID: PMC8966910 DOI: 10.3389/fonc.2022.845549] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background Thyroid nodules are frequent in adult population and thyroid cancer incidence has increased dramatically over the past three decades. The aim of this systematic review and meta-analysis was to evaluate the US-Elastosonography (USE) diagnostic performance in assessing the thyroid nodules malignancy risk. Methods PubMed and Embase databases were searched from January 2011 to July 2021. We extracted data from selected studies and calculated the overall diagnostic accuracy of qualitative USE, semi-quantitative USE and quantitative USE. Summary receiver operating characteristic (ROC) curve was elaborated to show the results. All statistical tests were performed using Metadisc and Medcal software package. Results Finally 72 studies with 13,505 patients and 14,015 thyroid nodules (33% malignant) undergoing elastography were included. The pooled sensitivity, specificity and AUC were 84%, 81%, and 0.89 respectively for qualitative USE; 83%, 80%, and 0.93 for semi-quantitative USE and 78%, 81% and 0.87, for quantitative USE. The qualitative and semiquantitative USE present very similar diagnostic accuracy values and both better than the quantitative USE. Conclusions USE is a useful imaging tool for thyroid nodule characterization. In accordance with recent guidelines and meta-analyses, the USE could be used daily in thyroid nodule malignancy risk stratification. Systematic Review Registration PROSPERO: CRD42021279257.
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Affiliation(s)
- Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Annalisa De Silvestri
- Servizio di Epidemiologia Clinica e Biometria Direzione Scientifica-Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico san Matteo, Pavia, Italy
| | - Valeria Scotti
- Servizio di Epidemiologia Clinica e Biometria Direzione Scientifica-Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico san Matteo, Pavia, Italy
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Tarsitano
- Department of Clinical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
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Chen L, Chen L, Liang Z, Shao Y, Sun X, Liu J. Value of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Papillary Thyroid Carcinoma Invasiveness. Front Oncol 2022; 11:795302. [PMID: 35096595 PMCID: PMC8795613 DOI: 10.3389/fonc.2021.795302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/17/2021] [Indexed: 01/20/2023] Open
Abstract
Objective To evaluate the diagnostic performance of preoperative contrast-enhanced ultrasound (CEUS) in the detection of extracapsular extension (ECE) and cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) and the added value of CEUS in the evaluation of PTC invasiveness to conventional ultrasound (US). Materials and Methods A total of 62 patients were enrolled retrospectively, including 30 patients with invasive PTCs (Group A, ECE or LNM present) and 32 patients with non-invasive PTCs (Group B). All patients underwent US and CEUS examinations before surgery. US and CEUS features of PTCs and lymph nodes were compared between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US, CEUS, and the combination of the two in the detection of ECE and LNM of PTCs were calculated. Logistic regression was used to analyze relationships between variables. Results The PTC size was larger in group A on both US and CEUS (P = 0.001, P = 0.003). More PTCs showed hyper-enhancement in group A (P = 0.013) than in group B. More PTCs had >25% contact between PTC and the thyroid capsule and discontinued capsule on US and CEUS (all P < 0.05) in group A than in group B. More absent hilum and calcification of lymph nodes were observed in group A (both P < 0.05) than in group B on US. More centripetal perfusion and enlarged lymph nodes were observed in group A (both P < 0.05) than in group B on CEUS. CEUS alone and US combined with CEUS manifested higher diagnostic accuracy (79.0%) than US alone (72.6%) in the detection of ECE. The combination of US and CEUS manifested the highest diagnostic accuracy (95.2%) than CEUS alone (90.3%) and US alone (82.2%) in the detection of LNM. Diagnoses of ECE and LNM by the combination of US and CEUS were independent risk factors for PTC invasiveness [odds ratio (OR) = 29.49 and 97.20, respectively; both P = 0.001]. Conclusion CEUS or US combined with CEUS is recommended for the detection of PTC ECE, while the combination of US and CEUS is most recommended for LNM detection. CEUS plays an essential role in the preoperative evaluation of PTC invasiveness.
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Affiliation(s)
- Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Zhenwei Liang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Yuhong Shao
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Xiuming Sun
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Jinghua Liu
- Department of Ultrasound, Peking University First Hospital, Beijing, China
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Abstract
Physicians have used palpation as a diagnostic examination to understand the elastic properties of pathology for a long time since they realized that tissue stiffness is closely related to its biological characteristics. US elastography provided new diagnostic information about elasticity comparing with the morphological feathers of traditional US, and thus expanded the scope of the application in clinic. US elastography is now widely used in the field of diagnosis and differential diagnosis of abnormality, evaluating the degree of fibrosis and assessment of treatment response for a range of diseases. The World Federation of Ultrasound Medicine and Biology divided elastographic techniques into strain elastography (SE), transient elastography and acoustic radiation force impulse (ARFI). The ARFI techniques can be further classified into point shear wave elastography (SWE), 2D SWE, and 3D SWE techniques. The SE measures the strain, while the shear wave-based techniques (including TE and ARFI techniques) measure the speed of shear waves in tissues. In this review, we discuss the various techniques separately based on their basic principles, clinical applications in various organs, and advantages and limitations and which might be most appropriate given that the majority of doctors have access to only one kind of machine.
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Pagano L, Bisceglia A, Riganti F, Garberoglio S, Rossetto R, Bonelli N, Viberti L, Pacchioni D, Papotti M, Ghigo E, Maccario M, Garberoglio R. A Simplified Ultrasonographic Score for the Prediction of Cytologically Suspicious Thyroid Nodules. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:388-394. [PMID: 32126577 DOI: 10.1055/a-1033-1351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The major aim of ultrasound (US)-based risk stratification systems is to reduce unnecessary thyroid biopsies without losing the ability to recognize nodules with clinically significant malignancy. Each of the classic suspicious features of a thyroid nodule detected on US scan (hypoechoic pattern, microcalcifications, irregular margin, taller than wide shape, irregular vascularization) is significantly independently associated with the probability of malignancy, but none of them has good diagnostic accuracy. Thus, we evaluated the predictive value of a binary score simply based on the combination of these US features, regardless of the specific predictive value of each US feature, against the outcome of suspected malignancy at cytological diagnosis (TIR3 to TIR5 categories by SIAPEC-IAP [TIR+]). MATERIALS AND METHODS 1009 thyroid nodules from 1081 patients were considered. The US features of suspicion of all nodules were categorized in 5 binary scores (U1 to U5), each including from 1 to 5 of those features. RESULTS U2 (at least 2 US suspicious features) was the most balanced predictor of TIR+ (PPV 0.48, NPV 0.93, LR+ 3.05 and LR- 0.24). Weighting the predictivity of the single features did not improve the estimate. Using U2 as the criterion to send nodules to FNAC would have reduced the number of biopsies by 60 % (604 patients) and the false negatives would have only accounted for 41 cases out of 237 TIR+ (17 %) with 39 cases of TIR3 and 2 cases of TIR4, including only 6 malignant nodules on histological examination. U2 performed much better than the ATA recommendations for detecting those nodules, resulting in TIR+ at cytology. CONCLUSION This simple and reproducible sonographic score based on 2 US features of suspicion of malignancy has quite a good performance with respect to identifying thyroid lesions categorized by cytology as medium-high risk of malignancy and could allow us to reduce cytology costs for low-risk nodules.
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Affiliation(s)
- Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alessandro Bisceglia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio Riganti
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sara Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nadia Bonelli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura Viberti
- Candiolo Cancer Institute - FPO, IRCCS, Str. Prov. 142, km 3.95, I-10060, Candiolo (To), Italy
| | - Donatella Pacchioni
- Pathology Unit, City of Health and Science University Hospital, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Maccario
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberto Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
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11
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Qiu Y, Xing Z, Liu J, Peng Y, Zhu J, Su A. Diagnostic reliability of elastography in thyroid nodules reported as indeterminate at prior fine-needle aspiration cytology (FNAC): a systematic review and Bayesian meta-analysis. Eur Radiol 2020; 30:6624-6634. [PMID: 32990793 DOI: 10.1007/s00330-020-07023-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/06/2020] [Accepted: 06/09/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess the diagnostic yields of elastography in thyroid nodules reported as indeterminate in FNAC according to guidelines. METHODS Databases of Medline, Embase, and Cochrane Central were searched till 31 October 2019. Two different reviewers check the studies and extracted the data. The diagnostic accuracy and yield were quantitatively synthesized using Bayesian bivariate model in R. RESULTS Twenty studies with 1734 indeterminate thyroid nodules undergoing elastography were included. The summary estimates of sensitivity and specificity were 0.766 (95% credible interval (CrI), 0.686-0.835) and 0.867 (95% CrI, 0.780-0.931), respectively. The summary estimate for diagnostic odds ratio (DOR) was 25.9 (95% CrI, 12.8-46.2). Summary receiver operating characteristic plots for elastography showed a right-diagonal curvilinear relationship, suggesting a trade-off between sensitivity and specificity, and the estimate of area under curve (AUC) was 0.743. The summary estimates for positive and negative likelihood ratios were 6.6 (95% CrI, 4.2-11.3) and 0.27 (95% CrI, 0.21-0.36), respectively. CONCLUSIONS Elastography had fair diagnostic yields in indeterminate thyroid nodules. Shear wave elastography and strain ratio elastography could be more efficient in diagnosis and should evolve in the next years while combing elastography with ultrasound would contribute more to sensitivity and specificity currently. KEY POINTS • Elastography has fair diagnostic yields in indeterminate thyroid nodules. • Shear wave elastography and strain ratio elastography are more efficient than real-time elastography. • Combining elastography and other ultrasound techniques improves evaluation of indeterminate thyroid nodules.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Jingyan Liu
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Yulan Peng
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan Province, People's Republic of China.
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12
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Cozzolino A, Pozza C, Pofi R, Sbardella E, Faggiano A, Isidori AM, Giannetta E, Pernazza A, Rullo E, Ascoli V, Lenzi A, Gianfrilli D. Predictors of malignancy in high-risk indeterminate (TIR3B) cytopathology thyroid nodules. J Endocrinol Invest 2020; 43:1115-1123. [PMID: 32100197 DOI: 10.1007/s40618-020-01200-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The classification of indeterminate cytopathology at thyroid fine-needle-aspiration (FNA) has been updated to reduce the number of unnecessary surgery; the 2014 Italian classification introduced the low-risk (TIR3A) and high-risk (TIR3B) subcategories. Aim of this study was to identify the ultrasonographic (US), clinical and cytological predictors of malignancy among TIR3B nodules from a single institution. METHODS A prospective observational study including 1844 patients who underwent thyroid FNA from June 2014 to January 2019. Ultrasonographic, clinical and cytological features were recorded. All TIR3B diagnoses were referred to surgery. According to final histology, patients were divided into thyroid cancer (TC) or benign nodules. Chi-square test, or Fisher exact test when appropriate, were used to compare groups and logistic regression analyses were used to determine independent predictors of malignancy. RESULTS Of 1844 FNAs, 96 (5.2%) were TIR3B. Histology report was available in 65. Among them, 25 (38.5%) were TC. Predictors of TC were nodule size < 20 mm [Odds Ratio (OR) = 5.88, 95% CI 1.91-18.11, p = 0.002], absence or weak intralesional flow [OR = 0.3, 95% CI 0.09-0.77, p = 0.015], microcalcifications [OR = 6.5, 95% CI 1.90-21.93, p = 0.003] at US; nuclear inclusions [OR = 25.3, 95% CI 1.34-476.07, p = 0.031] and chromatin clearing [OR = 3.7, 95% CI 1.27-10.99, p = 0.017] at cytopathology. Patients aged < 55 years had a significantly higher risk of TC [OR = 9.7, 95% CI 2.79-34.07, p < 0.001]. In multivariate analysis, age < 55 and nodule size < 20 mm resulted as independent risk factors. CONCLUSIONS Patients < 55 years receiving a diagnosis TIR3B on nodules < 20 mm, with microcalcifications, showing specific nuclear atypia at cytopathology are more likely to have TC. Combining US, cytological and clinical features could help determining which patients with a TIR3B diagnosis should be referred to surgery.
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Affiliation(s)
- A Cozzolino
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - C Pozza
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - R Pofi
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - E Sbardella
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - A Faggiano
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - E Giannetta
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - A Pernazza
- Department of Radiology, Oncology and Pathological Science, "Sapienza" University of Rome, Rome, Italy
| | - E Rullo
- Department of Radiology, Oncology and Pathological Science, "Sapienza" University of Rome, Rome, Italy
| | - V Ascoli
- Department of Radiology, Oncology and Pathological Science, "Sapienza" University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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13
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Yang JR, Song Y, Xue SS, Ruan LT. Suggested amendment of TI-RADS classification of thyroid nodules by shear wave elastography. Acta Radiol 2020; 61:1026-1033. [PMID: 31825762 DOI: 10.1177/0284185119889567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The application of the ultrasound elastography and Thyroid Imaging Reporting and Data System (TI-RADS) classification further expands the scope of ultrasound differential diagnosis between benign and malignant thyroid nodules. PURPOSE To investigate the value of the quantitative parameter of ultrasonic shear waves in optimizing the TI-RADS classification of thyroid nodules. MATERIAL AND METHODS A total of 168 thyroid nodules, initially classified using TI-RADS and scanned by shear wave elastography (SWE), were retrospectively analyzed. All cases were diagnosed by fine needle aspiration and histology following surgery. RESULTS The benign rate of TI-RADS 3 nodules was 76.5%, while the benign rate of TI-RADS 4a nodules was 71.7%. Furthermore, the malignant rate of TI-RADS 4b nodules was 69.7%, while the malignant rate of TI-RADS 4c nodules was 85.7%. In differentiating benign from malignant nodules, the combination of TI-RADS classification and Emean had the largest area under the receiver operating characteristic curve (AUC). Using an Emean value of 42.25 kpa as the cut-off point, the malignant rate of TI-RADS 4a nodules decreased from 28.3% to 23.5%, while the malignant rate of TI-RADS 4b nodules increased from 69.7% to 79.4%. Compared to conventional ultrasound alone, the sensitivity, negative predictive value, and AUC of conventional ultrasound combined with SWE in the diagnosis of benign and malignant thyroid nodules significantly improved (P=0.012, 0.029, 0.001). CONCLUSION The SWE technique can be used to further determine the benign and malignant nature of TI-RADS 4 lesions, providing further reference for the choice of clinical treatment. The TI-RADS classification system corrected by SWE is more significant in the diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Jin-Ru Yang
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
| | - Yan Song
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
| | - Shan-Shan Xue
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
| | - Li-Tao Ruan
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
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14
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Ranjkesh M, Hajibonabi F, Seifar F, Tarzamni MK, Moradi B, Khamnian Z. Diagnostic Value of Elastography, Strain Ratio, and Elasticity to B-Mode Ratio and Color Doppler Ultrasonography in Breast Lesions. Int J Gen Med 2020; 13:215-224. [PMID: 32547163 PMCID: PMC7259450 DOI: 10.2147/ijgm.s247980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/11/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to investigate the sensitivity, specificity, and diagnostic accuracy of sonoelastography (SE), strain ratio (SR), elasticity to B-mode (E/B) ratio, and color Doppler ultrasonography (US) in suspected breast lesions. Materials and Methods This prospective study was conducted on women referred to Alzahra university hospital of Tabriz for annual screening of breast cancer between May 2017 and December 2018. B-mode US, SE, and color Doppler imaging were conducted in females with suspected mammography reports. The lesions in B-mode were classified according to the Breast Imaging Reporting and Data System (B-RADS). The results of SE imaging were graded based on five-grade SE score. SR and E/B ratio of each lesion were also analyzed in SE images. Color Doppler findings were categorized from 0 (no visible vessel) to 2 (> two vessels) based on the vascularity of the tumor. Pathology results were used as the gold standard to measure the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and diagnostic accuracy of each modality. Results One-hundred and ten breast lesions of 104 women aged 42.05±10.33 years were included in the study. Seventy-seven of the lesions were benign and 3 were malignant. Sensitivity and specificity of 97.0% and 77.9% for B-mode US, 93.9% and 87.0% for SE score, 81.8% and 66.2% for color Doppler US, 72.7% and 77.6% for E/B ratio (cutoff: 1.05), and 77.3% and 79.6% for SR (cutoff: 1.90) were obtained, respectively. Addition of SE score to B-mode US increased the sensitivity to 93.9%, specificity to 93.5%, and AUC from 0.95 to 0.97. Cumulative color Doppler US with B-mode US did not enhance the diagnostic accuracy of B-mode US. Conclusion SE was more effective than color Doppler US for distinguishing malignant from benign breast lesion. Among the three different SE features, five-grade SE score was superior to E/B ratio and SR.
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Affiliation(s)
- Mahnaz Ranjkesh
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.,Radiology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Hajibonabi
- Radiology Department, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Seifar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.,Radiology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Moradi
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.,Radiology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zhila Khamnian
- Social Determinant of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Wang HX, Lu F, Xu XH, Zhou P, Du LY, Zhang Y, Ding SS, Shi H, Wang D, Xu HX, Zhang YF. Diagnostic Performance Evaluation of Practice Guidelines, Elastography and Their Combined Results for Thyroid Nodules: A Multicenter Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1916-1927. [PMID: 32451191 DOI: 10.1016/j.ultrasmedbio.2020.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022]
Abstract
The purpose of this multicenter study was to compare the differential diagnostic value of the 2015 American Thyroid Association (ATA) and 2017 American College of Radiology (ACR) practice guidelines and elastography in thyroid nodules. This study also investigated whether the diagnostic value of practice guidelines can be improved, and the unnecessary biopsy rate decreased in combination with elastography. A total of 498 thyroid nodules were evaluated using the ATA and the ACR guidelines. Strain elastography, acoustic radiation force impulse imaging and point-shear wave elastography were used to assess the nodules. The suspicious levels were downgraded or upgraded after combination and unnecessary biopsy rates were calculated, respectively. The diagnostic performance of the practice guidelines was better than that of elastography. The ACR guidelines had a lower unnecessary biopsy rate and similar diagnostic performance compared with the ATA guidelines. The unnecessary biopsy rates significantly decreased when the ACR guidelines were combined with elastography, but the rates did not decrease when the ATA guidelines were combined with elastography.
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Affiliation(s)
- Han-Xiang Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Hong Xu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Guangdong, China
| | - Pei Zhou
- Department of Medical Ultrasound, Central Theater Command General Hospital of the Chinese People`s Liberation Army, Wuhan, China
| | - Lin-Yao Du
- Department of In-patient Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Shi-Si Ding
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Hui Shi
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, China.
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16
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Mauri G, Gitto S, Cantisani V, Vallone G, Schiavone C, Papini E, Sconfienza LM. Use of the Thyroid Imaging Reporting and Data System (TIRADS) in clinical practice: an Italian survey. Endocrine 2020; 68:329-335. [PMID: 31983030 DOI: 10.1007/s12020-020-02199-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/10/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To perform an online survey about the use of Thyroid Imaging Reporting and Data System (TIRADS) classification in Italy. METHODS An online questionnaire was administered to all members of the Italian Society of Medical and Interventional Radiology (Società Italiana di Radiologia Medica ed Interventistica, SIRM) and Italian Society of Ultrasound in Medicine and Biology (Società Italiana di Ultrasonologia in Medicina e Biologia, SIUMB). The survey consisted of 14 questions about demographics, knowledge, and the use of TIRADS classification, current job, expertize in thyroid ultrasound and fine needle aspiration biopsy, and work environment. Descriptive and nonparametric statistics were used, with P < 0.05 indicating statistical significance. RESULTS A total of 1544 answers (9.8% out of 15,836) were received. The participants were 45 (36-59) years old [median (25th-75th percentiles)] and mostly (53.6%) familiar with TIRADS classification. Structured reporting (P < 0.001), expertize in thyroid ultrasound (P = 0.005) and fine needle aspiration biopsy (P < 0.001), and work in a multidisciplinary team (P < 0.001) were associated with the use of TIRADS classification. Physicians working in other fields than radiology were more prone to using TIRADS classification than radiologists and radiologists-in-training (P < 0.001). CONCLUSION Most physicians adopt TIRADS classification when performing thyroid ultrasound. TIRADS classification provides recommendations for the management of thyroid nodules and its use has to be encouraged.
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Affiliation(s)
- Giovanni Mauri
- Divisione di Radiologia Interventistica, IRCCS Istituto Europeo di Oncologia, Milano, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
| | - Vito Cantisani
- Unità operativa di Innovazioni Diagnostiche e Ultrasonografiche, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italy
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-patologiche, Università degli Studi di Roma "La Sapienza", Roma, Italy
| | - Gianfranco Vallone
- Departimento Vita e Salute "V. Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Cosima Schiavone
- Unità operativa di Ecografia Internistica, Policlinico SS. Annunziata, Chieti, Italy
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università degli Studi di Chieti e Pescara "G. D'Annunzio", Chieti, Italy
| | - Enrico Papini
- Dipartimento di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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17
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Hairu L, Yulan P, Yan W, Hong A, Xiaodong Z, Lichun Y, Kun Y, Ying X, Lisha L, Baoming L, Qiang Y, Shuzhen C, Shuangquan J, Xin F, Buyun M, Yi L, Xixi Z, Xue G, Haitao C, Wenying L, Ling T, Xiaoyu L, Xinbao Z, Liang L, Kehong G, Jiawei T. Elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study. BMC Endocr Disord 2020; 20:43. [PMID: 32245458 PMCID: PMC7118939 DOI: 10.1186/s12902-020-0520-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population. METHODS Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy. RESULTS Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4, 60.7, 79.0, 76.3 and 85.5%, respectively, and those of the SR were 81.1, 50.1, 68.9, 65.9 and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1 and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR = 5.290), taller than wide (OR = 12.710), irregular margins (OR = 10.117), extrathyroidal extension (ETE; OR = 6.412), the ES (OR = 3.741) and the SR (OR = 1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those < 1 cm (95.0% vs 90.4, 68.8% vs 56.8, 85.9% vs 74.4, 85.2% vs 69.9, and 87.8% vs 84.2%, respectively). CONCLUSIONS Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.
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Affiliation(s)
- Li Hairu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
| | - Peng Yulan
- Department of Diagnostic Ultrasound and The National Key Discipline of Medical Imaging and Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wang Yan
- Department of Ultrasound, Sixth People's Hospital Affiliated to Shanghai Communication University, Shanghai, China
| | - Ai Hong
- Department of Ultrasound, First Affiliated Hospital of Xi'an Communication University, Xi'an, Shanxi Province, China
| | - Zhou Xiaodong
- Department of Ultrasound, Xijing Hospital Affiliated to The Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Yang Lichun
- Department of Ultrasound, Third Affiliated hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yan Kun
- Department of Ultrasound, Tumor Hospital of Beijing University, Beijing, China
| | - Xiao Ying
- Department of Ultrasound, Xiang-ya Hospital of Centre-south University, Changsha, Hunan Province, China
| | - Liu Lisha
- Department of Ultrasound, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Luo Baoming
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yong Qiang
- Department of Ultrasound, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Cong Shuzhen
- Department of Ultrasound, People's Hospital of Guangdong Province, 106 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Jiang Shuangquan
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
| | - Fu Xin
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
| | - Ma Buyun
- Department of Diagnostic Ultrasound and The National Key Discipline of Medical Imaging and Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Li Yi
- Department of Ultrasound, Sixth People's Hospital Affiliated to Shanghai Communication University, Shanghai, China
| | - Zhang Xixi
- Department of Ultrasound, First Affiliated Hospital of Xi'an Communication University, Xi'an, Shanxi Province, China
| | - Gong Xue
- Department of Ultrasound, Xijing Hospital Affiliated to The Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Chen Haitao
- Department of Ultrasound, Third Affiliated hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Liu Wenying
- Department of Ultrasound, Tumor Hospital of Beijing University, Beijing, China
| | - Tang Ling
- Department of Ultrasound, Xiang-ya Hospital of Centre-south University, Changsha, Hunan Province, China
| | - Lv Xiaoyu
- Department of Ultrasound, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang Province, China
| | - Zhao Xinbao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Li Liang
- Department of Ultrasound, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Gan Kehong
- Department of Ultrasound, People's Hospital of Guangdong Province, 106 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Tian Jiawei
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China.
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Assessment of thyroid gland elasticity with shear-wave elastography in Hashimoto's thyroiditis patients. J Ultrasound 2020; 23:543-551. [PMID: 32185701 DOI: 10.1007/s40477-020-00437-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/15/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We aimed to investigate the use and effectiveness of Shear-Wave Elastography (SWE) in Hashimoto's Thyroiditis (HT) diagnosis and compare the SWE values in HT patients with asymptomatic volunteers. METHODS The thyroid gland parenchyma of 74 patients whose clinical and laboratory findings and ultrasonography (US) features were indicative of HT and 75 healthy, asymptomatic participants with normal laboratory values were examined using SWE. Their thyroid parenchymal echoes and thyroid gland volume were measured using B-mode US examination. Elastographic measurements were made by plotting the boundaries of thyroid gland by hand, using Free Region of Interest (ROI). The quantitative SWE values [meters/second (m/s) and kilopascal (kPa)] were compared betweent the patients and the controls. The correlation analyses between the SWE measurements and the autoantibodies [Anti-thyroid peroxidase antibody (TPOAbs) and anti-thyroglobulin antibodies (TgAbs)], thyroid-stimulating hormone (TSH), freetriiodothyronine (fT3), free-thyroxine (fT4), and thyroglobulin levels were performed. RESULTS The mean thyroid SWE measurement values of HT group were significantly higher than the asymptomatic group (p < 0.001). This study proposes 29.45 kPa or 2.77 m/s as a sensitive-spesific cut-off value for HT. We revealed significant positive association between SWE values and TgAb levels, gland volume, TgAb, TPOAb levels, and a significant negative association between SWE and echogenicity (p < 0.001). CONCLUSION In the assessment of HT, SWE is a highly sensitive imaging method to estimate the degree of fibrosis and to provide objective numerical values.
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Cohen J, Riishede I, Carlsen JF, Lambine TL, Dam MS, Petersen MM, Nielsen MB, Ewertsen C. Can Strain Elastography Predict Malignancy of Soft Tissue Tumors in a Tertiary Sarcoma Center? Diagnostics (Basel) 2020; 10:diagnostics10030148. [PMID: 32156078 PMCID: PMC7151207 DOI: 10.3390/diagnostics10030148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
This study aims to investigate the ability of ultrasound strain elastography as an adjunct to predict malignancy in soft tissue tumors suspect of sarcoma or metastasis in a tertiary reference center for sarcoma. A total of 137 patients were included prospectively. Patients were referred on the basis of clinical or radiological suspicion of malignant soft tissue tumor. All patients had previously undergone diagnostic imaging (MRI, CT or PET-CT). After recording strain elastography cine loops, ultrasound guided biopsy was performed. Three investigators, who were blinded to final diagnosis, reviewed all elastograms retrospectively. For each elastogram, a qualitative, visual 5-point score was decided in consensus and a strain ratio was calculated. Final pathology obtained from biopsy or tumor resection served as gold standard. Eighty-one tumors were benign, and 56 were malignant. t-tests showed a significant difference in mean visual score between benign and malignant tumors. There was no significant difference in mean strain ratio between the two groups. Strain elastography may be a valuable adjunct to conventional B-mode ultrasound, perhaps primarily in primary care, when considering whether to refer to a sarcoma center or to biopsy, although biopsies cannot reliably be ruled out based on the current data.
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Affiliation(s)
- Jonathan Cohen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
- University of Copenhagen, Faculty of Health and Medical Sciences, Panum Institute, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Correspondence: ; Tel.: +45-61260782
| | - Iben Riishede
- Department of Obstetrics and Gynaecology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark;
| | - Jonathan Frederik Carlsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Trine-Lise Lambine
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Mikkel Seidelin Dam
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark;
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
| | - Caroline Ewertsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark; (J.F.C.); (T.-L.L.); (M.S.D.); (M.B.N.); (C.E.)
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20
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Dobruch-Sobczak K, Adamczewski Z, Szczepanek-Parulska E, Migda B, Woliński K, Krauze A, Prostko P, Ruchała M, Lewiński A, Jakubowski W, Dedecjus M. Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules-Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region. J Clin Med 2019; 8:jcm8111781. [PMID: 31731455 PMCID: PMC6912671 DOI: 10.3390/jcm8111781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background: To validate the European Thyroid Imaging and Reporting Data System EU-TIRADS classification in a multi-institutional database of thyroid nodules by analyzing the obtained scores and histopathology results. Methods: A total of 842 thyroid lesions (613 benign, 229 malignant) were identified in 428 patients (mean age 62.7 years) and scored according to EU-TIRADS, using ultrasound examination. In all tumors, histopathological verification was performed. Results: In EU-TIRADS 2 (154 nodules) all nodules were benign; in EU-TIRADS 3, only 3/93 malignancies were identified. In EU-TIRADS 4, 12/103 were malignant, and in EU-TIRADS 5 (278 benign vs. 214 malignant). The malignant nodules that would not have qualified for biopsy were: EU-TIRADS 3, 2/3 (67%) malignancies were <20 mm, in EU-TIRADS 4, 7/12 (58%) were <15 mm. In EU-TIRADS 5, 72/214 (34%) were <10 mm; in total, 81/229 (36%) malignant lesions would have been missed. The cutoff between EU-TIRADS 3/4 had sensitivity of 100%, specificity of 25.1%. Using cutoff for EU-TIRADS 5, 93.4%, 54.6%, respectively. Conclusion: The application of EU-TIRADS guidelines allowed us to achieve moderate specificity. The vast majority of malignancies in EU-TIRADS 3, 4, and 5 would not have been recommended for biopsy because having a smaller size than that proposed classification.
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Affiliation(s)
- Katarzyna Dobruch-Sobczak
- Radiology Department II, Maria Sklodowska-Curie Institute- Oncology Center, 15 Wawelska St., 02-034 Warsaw, Poland
- Correspondence:
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 4 Kosciuszki St., 90-419 Lodz, Poland; (Z.A.); (A.L.)
- Department of Endocrinology and Metabolic Diseases, Research Institute, Polish Mother’s Memorial Hospital – Research Institute, 281/289 Rzgowska St., 93-338 Lodz, Poland
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland (M.R.)
| | - Bartosz Migda
- Department of Imaging Diagnostics, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland; (B.M.); (A.K.); (W.J.)
| | - Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland (M.R.)
| | - Agnieszka Krauze
- Department of Imaging Diagnostics, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland; (B.M.); (A.K.); (W.J.)
| | | | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland (M.R.)
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 4 Kosciuszki St., 90-419 Lodz, Poland; (Z.A.); (A.L.)
- Department of Endocrinology and Metabolic Diseases, Research Institute, Polish Mother’s Memorial Hospital – Research Institute, 281/289 Rzgowska St., 93-338 Lodz, Poland
| | - Wiesław Jakubowski
- Department of Imaging Diagnostics, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland; (B.M.); (A.K.); (W.J.)
| | - Marek Dedecjus
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie Institute- Oncology Center, 15 Wawelska St., 02-034 Warsaw, Poland;
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Huang Y, Zhou H, Zhang C, Hong Y, Ye Q, Huang P. Diagnostic Performance of Ultrasound Strain Elastography in Transverse and Longitudinal Views in Predicting Malignant Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2289-2297. [PMID: 31196745 DOI: 10.1016/j.ultrasmedbio.2019.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/12/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
Agreement between ultrasound strain elastography (SE) scores of transverse and longitudinal views of thyroid nodules was investigated, and the diagnostic performance of these scores in predicting thyroid malignancy was assessed. From December 2016 to February 2017, a total of 250 thyroid nodules in 232 patients (62 males and 188 females, mean age: 45 y [20-75 y]) were enrolled. Diagnostic agreement between SE scores obtained in different views was assessed. Sensitivity, specificity, area under the receiver operating characteristic curve (Az) of the SE score in different criteria (criterion 1, SE score ≥4 from any view is defined as suspicious; criterion 2, SE score ≥4 as in only transverse view; and criterion 3, SE score ≥4 only from longitudinal view) were evaluated. Diagnostic agreement between SE scores of different views was fair (κ = 0.227). The Az value for criterion 1 (0.770, 95% confidence interval [CI]: 0.713, 0.820) was the highest among the three criteria, significantly higher than that of criterion 2 (0.692, 95% CI: 0.631, 0.749) (p < 0.001), but not statistically significantly different from that of criterion 3 (0.768, 95% CI: 0.711, 0.819) (p = 0.909). However, the Az value for criterion 3 was higher than that for criterion 2 (p < 0.005). The results indicated that criterion 1 had high sensitivity (80.0%) and criterion 2 had high specificity (68.0%). Our study found that the agreement between SE scores of different views was fair. SE scores ≥4 in either view were most sensitive for predicting malignant thyroid nodules.
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Affiliation(s)
- Yunlin Huang
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Hang Zhou
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Chao Zhang
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yurong Hong
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Pintong Huang
- Department of Ultrasound, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
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Xu T, Wu Y, Wu RX, Zhang YZ, Gu JY, Ye XH, Tang W, Xu SH, Liu C, Wu XH. Validation and comparison of three newly-released Thyroid Imaging Reporting and Data Systems for cancer risk determination. Endocrine 2019; 64:299-307. [PMID: 30474824 DOI: 10.1007/s12020-018-1817-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/12/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE To validate and compare diagnostic value of three newly-released Thyroid Imaging Reporting and Data Systems (TIRADS) for cancer risk determination. METHODS Total 2031 patients with 2465 thyroid nodules were recruited for this study. Ultrasound (US) images were categorized based on three TIRADS editions established by Korean Society of Thyroid Radiology (KSThR), European Thyroid Association (ETA) and American College of Radiology (ACR). ROC curves were established to compare diagnostic value. RESULTS Total 1460 benign and 1005 malignant nodules were enrolled. The malignancy rates of each category in KSThR-TIRADS were 2.8%, 5.1%, 33.7% and 79.6%, respectively. For European-TIRADS, 0, 3.1, 22.8, and 73.5% of nodules categorized as 2 to 5 were malignant. Distribution of carcinomas among ACR-TIRADS categories was 0%, 2.3%, 7.5%, 40.1% and 81.4%, respectively. In terms of diagnostic value, KSThR-TIRADS had highest AUC (0.855) and specificity (87.4%), while lowest (71.4%) sensitivity. ACR-TIRADS showed best sensitivity (96.6%) with lowest specificity (52.9%) and the AUC (0.846) was slightly lower than KSThR-TIRADS. Total 56.1, 45.4, and 37.4% fine-needle aspiration biopsy (FNAB) were recommended by KSThR, ETA and ACR, revealing 42.8%, 44.5% and 53.6% malignant lesions, respectively. The rate of unnecessary FNAB was lowest with the ACR (17.3%), followed by ETA (25.2%) and KSThR (32.1%). CONCLUSION All these US models showed great value in predicting thyroid malignancy. Among them, KSThR-TIRADS showed the most effective diagnostic performance in specificity, while ACR-TIRADS yielded best sensitivity. As for FNAB criteria, ACR-TIRADS showed the lowest rate of unnecessary FNAB and highest rate of malignancy in FNAB.
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Affiliation(s)
- Ting Xu
- Department of Endocrinology, Jiangsu Province Official Hospital, Nanjing, China
| | - Ya Wu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Run-Xin Wu
- Nanjing Foreign Languages School, Nanjing, China
| | - Yu-Zhi Zhang
- Department of Ultrasound, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Jing-Yu Gu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xin-Hua Ye
- Department of Ultrasound, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wei Tang
- Department of Endocrinology, Jiangsu Province Official Hospital, Nanjing, China
| | - Shu-Hang Xu
- Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Chao Liu
- Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Xiao-Hong Wu
- Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Du YR, Ji CL, Wu Y, Gu XG. Combination of ultrasound elastography with TI-RADS in the diagnosis of small thyroid nodules (≤10 mm): A new method to increase the diagnostic performance. Eur J Radiol 2018; 109:33-40. [PMID: 30527309 DOI: 10.1016/j.ejrad.2018.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/09/2018] [Accepted: 10/23/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of a new method of combined ultrasound elastography (UE) and thyroid imaging-reporting and data system (TI-RADS) in the differential diagnosis of small thyroid nodules. METHODS Ultrasonography(US), TI-RADS, Elasticity Imaging (EI), Virtual Touch Tissue Imaging (VTI) and Virtual Touch Tissue Quantification (VTQ) features of 142 thyroid nodules (maximum diameter ≤10 mm according to conventional ultrasound measurement) confirmed by surgery or FNA were retrospectively analyzed. Different elastographic methods in small benign and malignant thyroid nodules were compared. The diagnostic efficiency of three adjustment methods of conventional ultrasound TI-RADS classification and ultrasound elastography (VTI and/or VTQ) were compared. RESULTS The pathological examination showed that 70 thyroid nodules were benign and 72 were malignant. The differential ability of UE to diagnose the small benign and malignant thyroid nodules alone is not better than that of conventional ultrasound TI-RADS classification. The sensitivity of conventional ultrasound TI-RADS classification were higher than that of VTI and equal to VTQ(91.67% vs83.33%、91.67%), while the specificity of VTI was much higher than that of TI-RADS and VTQ(91.43% vs 75.71%、60.00%). The diagnostic sensitivity and specificity of TI-RADS classification plus UE (VTI + VTQ) were 94.44% and 87.14% respectively. TI-RADS classification combined with UE (VTI + VTQ) was the highest diagnostic efficiency. CONCLUSION Conventional ultrasound TI-RADS classification is the basis for the diagnosis of small thyroid nodules. The combination of TI-RADS with VTI and VTQ can significantly improve the differential diagnosis of small benign and malignant thyroid nodules. It may provide a new and reliable method for the clinical diagnosis of small thyroid nodules.
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Affiliation(s)
- Yan-Ran Du
- Department of Diagnostic Ultrasound, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 164 Lan Xi Road, Shanghai 200062, China.
| | - Chen-Li Ji
- Department of Diagnostic Ultrasound, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 164 Lan Xi Road, Shanghai 200062, China
| | - Yang Wu
- Department of Diagnostic Ultrasound, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 164 Lan Xi Road, Shanghai 200062, China
| | - Xin-Gang Gu
- Department of Diagnostic Ultrasound, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 164 Lan Xi Road, Shanghai 200062, China.
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Aga H, Hirokawa M, Suzuki A, Ota H, Oshita M, Kudo T, Fukushima M, Kobayashi K, Miyauchi A. Sonographic Evaluation of Nodules Newly Detected in the Neck After Thyroidectomy: Suture Granuloma Versus Recurrent Carcinoma. Ultrasound Int Open 2018; 4:E124-E130. [PMID: 30374470 PMCID: PMC6202953 DOI: 10.1055/a-0749-8688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose This study aimed to clarify the sonographic features of suture granuloma and recurrent carcinoma newly detected after thyroidectomy. Materials and Methods We retrospectively analyzed ultrasound reports with images of 25 cases of suture granuloma and 18 cases of recurrent carcinoma that newly appeared in the resected area after thyroidectomy in our institution. Results Both suture granulomas and recurrent carcinomas more frequently exhibited multiple lesions rather than solitary lesions. Suture granulomas tended to appear in the more superficial areas than the carotid artery, while recurrent carcinomas were more common between the trachea and carotid artery. A total of 10 of the 11 suture granulomas that we followed up decreased in size. Recurrent carcinomas showed irregular shape (55.6%), taller-than-wide shape (38.9%), low internal echogenicity (83.3%), and no punctate microcalcifications. By contrast, suture granulomas were fusiform in shape (56.0%) and showed linear internal echo parallel to the tissue plane on the longitudinal scan (64.0%). The vascular flow sign was mild to none in the majority of both lesions. Conclusion Fusiform shape and linear internal echoes indicate suture granuloma, while irregular shape, taller-than-wide shape, and low echogenicity indicate recurrent carcinoma. Given that the clinical management of suture granuloma differs from that of recurrent carcinoma, it is important to distinguish between these two lesions.
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Affiliation(s)
- Hitomi Aga
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | | | - Ayana Suzuki
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | - Hisashi Ota
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | - Maki Oshita
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | - Takumi Kudo
- Kuma Hospital, Department of Internal Medicine, Kobe, Japan
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Kyriakidou G, Friedrich-Rust M, Bon D, Sircar I, Schrecker C, Bogdanou D, Herrmann E, Bojunga J. Comparison of strain elastography, point shear wave elastography using acoustic radiation force impulse imaging and 2D-shear wave elastography for the differentiation of thyroid nodules. PLoS One 2018; 13:e0204095. [PMID: 30222755 PMCID: PMC6141102 DOI: 10.1371/journal.pone.0204095] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of the study was to compare three different elastography methods, namely Strain Elastography (SE), Point Shear-Wave Elastography (pSWE) using Acoustic Radiation Force Impulse (ARFI)-Imaging and 2D-Shear Wave Elastography (2D-SWE), in the same study population for the differentiation of thyroid nodules. MATERIALS AND METHODS All patients received a conventional ultrasound scan, SE and 2D-SWE, and all patients except for two received ARFI-Imaging. Cytology/histology of thyroid nodules was used as a reference method. SE measures the relative stiffness within the region of interest (ROI) using the surrounding tissue as reference tissue. ARFI mechanically excites the tissue at the ROI using acoustic pulses to generate localized tissue displacements. 2D-SWE measures tissue elasticity using the velocity of many shear waves as they propagate through the tissue. RESULTS 84 nodules (73 benign and 11 malignant) in 62 patients were analyzed. Sensitivity, specificity and NPV of SE were 73%, 70% and 94%, respectively. Sensitivity, specificity and NPV of ARFI and 2D-SWE were 90%, 79%, 98% and 73%, 67%, 94% respectively, using a cut-off value of 1.98m/s for ARFI and 2.65m/s (21.07kPa) for 2D-SWE. The AUROC (Area under the Receiver Operating Characteristic) of SE, ARFI and 2D-SWE for the diagnosis of malignant thyroid nodules were 52%, 86% and 71%, respectively. A significant difference in AUROC was found between SE and ARFI (p = 0.008), while no significant difference was found between ARFI and SWE (86% vs. 71%, p = 0.31), or SWE and SE (71% vs. 52%, p = 0.26). CONCLUSION pSWE using ARFI and 2D-SWE showed comparable results for the differentiation of thyroid nodules. ARFI was superior to elastography using SE.
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Affiliation(s)
- Georgia Kyriakidou
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
- * E-mail:
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
| | - Dimitra Bon
- Institute of Biostatistics and Mathematical Modeling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany
| | - Ishani Sircar
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
| | - Christopher Schrecker
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
| | - Dimitra Bogdanou
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany
| | - Joerg Bojunga
- Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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27
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Zhao CK, Xu HX, Xu JM, Sun CY, Chen W, Liu BJ, Bo XW, Wang D, Qu S. Risk stratification of thyroid nodules with Bethesda category III results on fine-needle aspiration cytology: The additional value of acoustic radiation force impulse elastography. Oncotarget 2018; 8:1580-1592. [PMID: 27906671 PMCID: PMC5352079 DOI: 10.18632/oncotarget.13685] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
To assess the value of conventional ultrasound, conventional strain elastography (CSE) and acoustic radiation force impulse (ARFI) elastography in differentiating likelihood of malignancy for Bethesda category III thyroid nodules. 103 thyroid nodules with Bethesda category III results on fine-needle aspiration cytology (FNAC) in 103 patients were included and all were pathologically confirmed after surgery. Conventional ultrasound, CSE and ARFI elastography including ARFI imaging and point shear wave speed (SWS) measurement were performed. Univariate and multivariate analyses were performed to identify the independent factors associated with malignancy. Area under the receiver operating characteristic curve (Az) was calculated to assess the diagnostic performance. Pathologically, 65 nodules were benign and 38 were malignant. Significant differences were found between benign and malignant nodules in ARFI. The cut-off points were ARFI imaging grade ≥ 4, SWS > 2.94 m/s and SWS ratio > 1.09, respectively. ARFI imaging (Az: 0.861) had the highest diagnostic performance to differentiate malignant from benign nodules, following by conventional ultrasound (Az: 0.606 - 0.744), CSE (Az: 0.660) and point SWS measurement (Az: 0.725 - 0.735). Multivariate logistic regression analysis showed that ARFI imaging grade ≥ 4 was the most significant independent predictor. The combination of ARFI imaging with point SWS measurement significantly improved the specificity (100% vs. 80.0%) and positive predictive value (100 % vs. 72.9%) in comparison with ARFI imaging alone. ARFI elastography is a useful tool in differentiating malignant from benign thyroid nodules with Bethesda category III results on FNAC.
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Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Cheng-Yu Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Wei Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Shen Qu
- Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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28
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Migda B, Migda M, Migda MS, Slapa RZ. Use of the Kwak Thyroid Image Reporting and Data System (K-TIRADS) in differential diagnosis of thyroid nodules: systematic review and meta-analysis. Eur Radiol 2018; 28:2380-2388. [PMID: 29294156 PMCID: PMC5938289 DOI: 10.1007/s00330-017-5230-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic literature review was to assess the usefulness of the Thyroid Image Reporting and Data System (K-TIRADS) classification proposed by Kwak for differentiation of thyroid nodules. MATERIAL AND METHODS Four literature databases were searched for relevant articles through early January 2017. A meta-analysis was performed to calculate pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR). The area under the curve (AUC) from the pooled receiver operating characteristic (ROC) was used to assess the usefulness of this classification for differentiation of thyroid nodules. Meta-analysis was conducted by using meta-analysis software. RESULTS We analysed six publications describing 10,926 nodules. Pooled sensitivity, specificity, LR+, LR-, DOR, and AUC for pooled ROC were 0.983 (95 % CI 0.976-0.989), 0.552 (95 % CI 0.542-0.562), 2.666 (95 % CI 1.692-4.198), 0.05 (95 % CI 0.035-0.072), 51.020 (95 % CI 15.241-170.79) and 0.938, respectively. CONCLUSIONS Kwak TIRADS has high sensitivity and low specificity. Thus, it is very useful to discard the benign cases and to reduce the number of biopsies. KEY POINTS • Routine, adequate standardization of thyroid nodules ultrasound classification is mandatory. • Kwak TIRADS parameters are accurate for differentiating focal thyroid lesions. • Kwak TIRADS system is simple to apply. • Kwak TIRADS system may become a useful diagnostic tool.
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Affiliation(s)
- Bartosz Migda
- Diagnostic Imaging Department, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland.
| | - Michal Migda
- Clinical Unit of Obstetrics, Women's Disease and Gynaecological Oncology, United District Hospital, Collegium Medicum, University of Nicolaus Copernicus, sw. Jozefa 53-59, 87-100, Torun, Poland
| | - Marian S Migda
- Civis-Vita Health and Medical Centre, Warszawska 20, 87-100, Torun, Poland
| | - Rafal Z Slapa
- Diagnostic Imaging Department, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
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29
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Dietrich CF, Barr RG, Farrokh A, Dighe M, Hocke M, Jenssen C, Dong Y, Saftoiu A, Havre RF. Strain Elastography - How To Do It? Ultrasound Int Open 2017; 3:E137-E149. [PMID: 29226273 DOI: 10.1055/s-0043-119412] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.
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Affiliation(s)
| | - Richard G Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Manjiri Dighe
- Department of Biology, University of Washington, Radiology, Seattle, United States
| | - Michael Hocke
- HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Adrian Saftoiu
- University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
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30
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Color-Doppler ultrasound in the evaluation of oral lesions. J Ultrasound 2017; 20:351-352. [DOI: 10.1007/s40477-017-0273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022] Open
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31
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Qiao J, Li C, Zhang Y, Wang S, Gao S. HBME-1 expression in differentiated thyroid carcinoma and its correlation with the ultrasonic manifestation of thyroid. Oncol Lett 2017; 14:6505-6510. [PMID: 29151906 PMCID: PMC5678245 DOI: 10.3892/ol.2017.6971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/05/2017] [Indexed: 11/05/2022] Open
Abstract
We investigated expression of the protein human bone marrow endothelial cell marker-1 (HBME-1) in differentiated thyroid carcinoma tissues, and analyzed its correlation with ultrasonic manifestation of thyroid. The immunohistochemistry (IHC) staining method was used to measure the expression of HBME-1 in patient with nodular goiter (control group), papillary differentiated thyroid carcinoma (papillary carcinoma group) and follicular differentiated thyroid carcinoma (follicular carcinoma group) to investigate the differences in expression of HBME-1. We further analyzed the correlation of the expression of HBME-1 in the papillary carcinoma group and the follicular carcinoma group with ultrasonic manifestation of thyroid. In both the papillary carcinoma group and the follicular carcinoma group, the levels of HBME-1 in affected tissues and the IHS score of HBME-1 expression were higher than those in the control group (p<0.05). In the papillary carcinoma group, the mean IHS score of HBME-1 expression in affected tissues was higher than in the follicular carcinoma group (p<0.05). There were no statistically significant differences in comparison to HBME-1 expression in affected tissues between the papillary carcinoma group and the follicular carcinoma group (p>0.05). Between the papillary carcinoma group and the follicular carcinoma group, the differences in the comparison of the nodule diameter, echo, shape, boundary, calcification and blood flow signal were statistically significant (p<0.05), but incidence rate of enlargement of cervical lymph nodules between the groups were not statistically significant (p>0.05). Among patients in the papillary carcinoma group, the comparison of the nodule diameter, echo, shape, boundary, calcification and blood flow signal between the HBME-1-positive patients and the HBME-1-negative patients showed no statistical significance (p>0.05), but in the nodules of HBME-1-positive patients, the proportion of blood flow signal was higher than that in the nodules of HBME-1-negative patients. Among patients in the follicular carcinoma group, there was no statistically significant differences in the comparison of ultrasonic manifestation of thyroid (p>0.05). Therefore, there are difference in HBME-1 expression and ultrasonic manifestations of thyroid in patients with papillary carcinoma and follicular differentiated thyroid carcinoma.
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Affiliation(s)
- Jiwei Qiao
- Longnan Hospital of Daqing City, Daqing, Heilongjiang 163453, P.R. China
| | - Chunyu Li
- Longnan Hospital of Daqing City, Daqing, Heilongjiang 163453, P.R. China
| | - Yuying Zhang
- Longnan Hospital of Daqing City, Daqing, Heilongjiang 163453, P.R. China
| | - Shuangyan Wang
- Daqing Hospital of Traditional Chinese Medicine, Daqing, Heilongjiang 163312, P.R. China
| | - Shan Gao
- Longnan Hospital of Daqing City, Daqing, Heilongjiang 163453, P.R. China
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32
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Di Dato C, Gianfrilli D, Greco E, Astolfi M, Canepari S, Lenzi A, Isidori AM, Giannetta E. Profiling of selenium absorption and accumulation in healthy subjects after prolonged L-selenomethionine supplementation. J Endocrinol Invest 2017; 40:1183-1190. [PMID: 28393316 DOI: 10.1007/s40618-017-0663-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/22/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Autoimmune thyroiditis and its complications for the reproductive system are a growing problem. Selenium is a common ingredient in numerous food supplements recommended for thyroiditis and pregnancy. A fast, simple method to measure serum selenium concentration will improve knowledge of its pharmacokinetics and toxicity. AIM To validate a useful method to measure serum selenium concentration and to study selenium absorption and accumulation in a prospective interventional study of prolonged treatment. METHODS Thirty healthy volunteers received a single dose of L-selenomethionine one tablet (83 mcg) (Phase 1), a single dose of two tablets (Phase 2), and two tablets daily for 14 days (Phase 3). Total selenium and selenium time profiles were generated by serial sampling (T0, T3, T6, T12, and T24 hours after ingestion-Phases 1 and 2; and T0 and T24 hours-Phase 3). Selenium concentration was investigated by open-vessel acid digestion of small serum volumes followed by hydride generation atomic fluorescence spectroscopy analysis. RESULTS There was a significant increase in serum selenium concentration (mcg/L) in all treatment phases. Significantly increased levels were reached at T3 in Phase 1 (baseline: 76.5 ± 2.47; T3: 82.8 ± 3.28) and at T6 in Phase 2 (83.8 ± 3.46). They remained significantly increased at T12 in Phase 1 and T24 in Phase 2 (79.03 ± 2.69). There was significant selenium accumulation after prolonged intake (14 days) (102.13 ± 5.61). CONCLUSIONS Prolonged selenomethionine administration increases circulating blood selenium concentration and hydride generation atomic fluorescence spectroscopy enables its accurate quantification.
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Affiliation(s)
- C Di Dato
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - E Greco
- Center for Reproductive Medicine, European Hospital, Rome, Italy
| | - M Astolfi
- Chemistry Department, "Sapienza" University of Rome, Rome, Italy
| | - S Canepari
- Chemistry Department, "Sapienza" University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - E Giannetta
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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33
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Wang Y, Lei KR, He YP, Li XL, Ren WW, Zhao CK, Bo XW, Wang D, Sun CY, Xu HX. Malignancy risk stratification of thyroid nodules: comparisons of four ultrasound Thyroid Imaging Reporting and Data Systems in surgically resected nodules. Sci Rep 2017; 7:11560. [PMID: 28912438 PMCID: PMC5599531 DOI: 10.1038/s41598-017-11863-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/30/2017] [Indexed: 01/23/2023] Open
Abstract
To compare the efficiency of four different ultrasound (US) Thyroid Imaging Reporting and Data Systems (TI-RADS) in malignancy risk stratification in surgically resected thyroid nodules (TNs). The study included 547 benign TNs and 464 malignant TNs. US images of the TNs were retrospectively reviewed and categorized according to the TI-RADSs published by Horvath E et al. (TI-RADS H), Park et al. (TI-RADS P), Kwak et al. (TI-RADS K) and Russ et al. (TI-RADS R). The diagnostic performances for the four TI-RADSs were then compared. At multivariate analysis, among the suspicious US features, marked hypoechogenicity was the most significant independent predictor for malignancy (OR: 15.344, 95% CI: 5.313-44.313) (P < 0.05). Higher sensitivity was seen in TI-RADS H, TI-RADS K, TI-RADS R comparing with TI-RADS P (P < 0.05 for all), whereas the specificity, accuracy and area under the ROC curve (Az) of TI-RADS P were the highest (all P < 0.05). Higher specificity, accuracy and Az were seen in TI-RADS K compared with TI-RADS R (P = 0.003). With its higher sensitivity, TI-RADS K, a simple predictive model, is practical and convenient for the management of TNs in clinical practice. The study indicates that there is a good concordance between TI-RADS categories and histopathology.
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Affiliation(s)
- Ying Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Kai-Rong Lei
- Department of Medical Ultrasound, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Cheng-Yu Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
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34
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He YP, Xu HX, Zhao CK, Sun LP, Li XL, Yue WW, Guo LH, Wang D, Ren WW, Wang Q, Qu S. Cytologically indeterminate thyroid nodules: increased diagnostic performance with combination of US TI-RADS and a new scoring system. Sci Rep 2017; 7:6906. [PMID: 28761147 PMCID: PMC5537223 DOI: 10.1038/s41598-017-07353-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/27/2017] [Indexed: 01/10/2023] Open
Abstract
To investigate the diagnostic performance of combination of ultrasound (US) thyroid imaging reporting and data system (TI-RADS) and a new US scoring system for diagnosing thyroid nodules (TNs) with indeterminate results (Bethesda categories III, IV and V) on fine-needle aspiration (FNA) cytology. 453 patients with 453 cytologically indeterminate TNs were included in this study. Multivariate analyses were performed to construct the scoring system. The diagnostic performances of TI-RADS and the combined method were evaluated and compared. Multivariate analyses revealed that marked hypoechogenicity, taller than wide shape and absence of halo sign were independent predictors for malignancy in cytologically indeterminate TNs. Scoring system was thereafter defined as follows: risk score (RS) = 3.2 x (if marked hypoechogenicity) + 2.8 x (if taller than wide shape) + 1.3 x (if absence of halo sign). Compared with TI-RADS alone, the areas under the receiver operating characteristic curves (AUC), specificity, accuracy and positive predictive value (PPV) of the combined method increased significantly with 0.731 versus 0.569, 48.5% versus 14.1%, 76.2% versus 62.3%, and 70.9% versus 59.9%, respectively (all P < 0.05). The combination of TI-RADS and new US scoring system showed superior diagnostic performances in predicting malignant TNs with indeterminate FNA cytology results in comparison with TI-RADS alone.
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Affiliation(s)
- Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China. .,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China. .,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.,Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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35
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He YP, Xu HX, Wang D, Li XL, Ren WW, Zhao CK, Bo XW, Liu BJ, Yue WW. First experience of comparisons between two different shear wave speed imaging systems in differentiating malignant from benign thyroid nodules. Clin Hemorheol Microcirc 2017; 65:349-361. [PMID: 27983544 DOI: 10.3233/ch-16197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Research Center for Thyroid Diseases, Shanghai, China
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36
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Cosgrove D, Barr R, Bojunga J, Cantisani V, Chammas MC, Dighe M, Vinayak S, Xu JM, Dietrich CF. WFUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography: Part 4. Thyroid. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:4-26. [PMID: 27570210 DOI: 10.1016/j.ultrasmedbio.2016.06.022] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced guidelines for the use of elastography techniques including basic science, breast and liver. Here we present elastography in thyroid diseases. For each available technique, procedure, reproducibility, results and limitations are analyzed and recommendations are given. Finally, recommendations are given based on the level of evidence of the published literature and on the WFUMB expert group's consensus. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of thyroid diseases.
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Affiliation(s)
- David Cosgrove
- Division of Radiology, Imperial and Kings Colleges, London, UK
| | - Richard Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Joerg Bojunga
- Department of Internal Medicine 1, Endocrinology and Diabetology, Goethe University Hospital, Frankfurt am Main, Germany
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Ultrasound Division, Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sudhir Vinayak
- Department of Imaging and Diagnostic Radiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, China
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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37
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Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol 2016; 27:2619-2628. [DOI: 10.1007/s00330-016-4605-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/28/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
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Abstract
PURPOSE OF REVIEW Elastography is a novel noninvasive diagnostic tool that is helpful in the evaluation of thyroid nodules. The purpose of this review is to provide a comprehensive summary of the use of elastography in the clinical thyroid setting. RECENT FINDINGS Initial and subsequent studies show that elastography has both a sensitivity and specificity that approaches 100% for the determination of thyroid cancer within a thyroid nodule. In addition, the technique also has a very high negative predictive value and thus, may also be helpful in identification of thyroid nodules that do not need further diagnostic evaluation, including fine-needle aspiration biopsy. These characteristics also apply to both strain and shear wave elastography. However, as both the extent of tissue compression and the operator's classification of a nodule using a qualitative color code are subjective, intra and interobserver variability is an important reason for some conflicting findings. SUMMARY Elasticity within a thyroid nodule, as evaluated by elastography, offers diagnostic results that are equal to or sometimes even greater than that of conventional ultrasonography for the determination of thyroid malignancy. The integration of both techniques in the clinical work-up of thyroid nodules can thus significantly improve the accuracy of the diagnosis of thyroid nodules.
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Affiliation(s)
- Flavia Magri
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri, IRCCS; University of Pavia, Pavia, Italy
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Topaloglu O, Baser H, Cuhaci FN, Sungu N, Yalcin A, Ersoy R, Cakir B. Malignancy is associated with microcalcification and higher AP/T ratio in ultrasonography, but not with Hashimoto's thyroiditis in histopathology in patients with thyroid nodules evaluated as Bethesda Category III (AUS/FLUS) in cytology. Endocrine 2016; 54:156-168. [PMID: 27172917 DOI: 10.1007/s12020-016-0982-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/03/2016] [Indexed: 01/08/2023]
Abstract
The predictors of malignancy are important for the decision of appropriate management in nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). Our aim was to determine the ultrasonographical, clinical, and biochemical predictors of malignancy in these patients. A total of 427 patients with cytologically Bethesda Category III (AUS/FLUS) thyroid nodules were included in this retrospective study. We divided the nodules into two subgroups according to the histopathology as benign and malignant, and compared the preoperative ultrasonographical, clinical, and biochemical findings. In overall, 427 patients with 449 AUS/FLUS nodules who had undergone surgery, the rate of malignancy was 23.4 % (105/449). When evaluated separately, the rate of malignancy was 25.8 % in nodules with AUS (82/318) and 17.6 % in nodules with FLUS (23/131) (p = 0.061). The vast majority of malignant specimens in histopathology consisted of papillary thyroid carcinoma (PTC) (n = 91, 86.7 %). Preoperative ultrasonographic features of 105 malignant nodules in histopathology were compared with the 344 benign nodules in histopathology. Anteroposterior/Transverse (AP/T) ratio was significantly higher in malignant group compared to benign group (p = 0.013). In multiple logistic analysis, we found that higher AP/T ratio and microcalcification were independently associated with malignancy (p < 0.05). The malignancy-associated cut-off value of AP/T ratio at maximum sensitivity and specificity was ≥0.81. We did not find any correlation between malignancy and Hashimoto's thyroiditis in histopathology in multivariate analysis (p > 0.05). In Bethesda Category III nodules with higher AP/T ratio and microcalcification, surgery might be considered as a first therapeutic option instead of repeat fine-needle aspiration biopsy or observation.
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Affiliation(s)
- Oya Topaloglu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey.
| | - Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Fatma Neslihan Cuhaci
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Nuran Sungu
- Department of Pathology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Abdussamed Yalcin
- Department of General Surgery, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
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40
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Pozza C, Gianfrilli D, Fattorini G, Giannetta E, Barbagallo F, Nicolai E, Cristini C, Di Pierro GB, Franco G, Lenzi A, Sidhu PS, Cantisani V, Isidori AM. Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non-palpable testicular lesions. Andrology 2016; 4:1193-1203. [PMID: 27565451 PMCID: PMC5108442 DOI: 10.1111/andr.12260] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/11/2016] [Accepted: 07/10/2016] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to evaluate prospectively the accuracy of qualitative and strain ratio elastography (SE) in the differential diagnosis of non‐palpable testicular lesions. The local review board approved the protocol and all patients gave their consent. One hundred and six patients with non‐palpable testicular lesions were consecutively enrolled. Baseline ultrasonography (US) and SE were correlated with clinical and histological features and ROC curves developed for diagnostic accuracy. The non‐palpable lesions were all ≤1.5 cm; 37/106 (34.9%) were malignant, 38 (35.9%) were benign, and 31 (29.2%) were non‐neoplastic. Independent risk factors for malignancy were as follows: size (OR 17.788; p = 0.002), microlithiasis (OR 17.673, p < 0.001), intralesional vascularization (OR 9.207, p = 0.006), and hypoechogenicity (OR, 11.509, p = 0.036). Baseline US had 89.2% sensitivity (95% CI 74.6–97.0) and 85.5% specificity (95% CI 75.0–92.8) in identifying malignancies, and 94.6% sensitivity (95% CI 86.9–98.5) and 87.1% specificity (95% CI 70.2–96.4) in discriminating neoplasms from non‐neoplastic lesions. An elasticity score (ES) of 3 out of 3 (ES3, maximum hardness) was recorded in 30/37 (81.1%) malignant lesions (p < 0.001). An intermediate score of 2 (ES2) was recorded in 19/38 (36.8%) benign neoplastic lesions and in 22/31 (71%) non‐neoplastic lesions (p = 0.005 and p = 0.001 vs. malignancies). None of the non‐neoplastic lesions scored ES3. Logistic regression analysis revealed a significant association between ES3 and malignancy (χ2 = 42.212, p < 0.001). ES1 and ES2 were predictors of benignity (p < 0.01). Overall, SE was 81.8% sensitive (95% CI 64.8–92.0) and 79.1% specific (95% CI 68.3–88.4) in identifying malignancies, and 58.6% sensitive (95% CI 46.7–69.9) and 100% specific (95% CI 88.8–100) in discriminating non‐neoplastic lesions. Strain ratio measurement did not improve the accuracy of qualitative elastography. Strain ratio measurement offers no improvement over elastographic qualitative assessment of testicular lesions; testicular SE may support conventional US in identifying non‐neoplastic lesions when findings are controversial, but its added value in clinical practice remains to be proven.
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Affiliation(s)
- C Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Fattorini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Barbagallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - C Cristini
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - G B Di Pierro
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - G Franco
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, England
| | - V Cantisani
- Department of Radiologic Science, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Quantitative assessment of rotator cuff muscle elasticity: Reliability and feasibility of shear wave elastography. J Biomech 2015; 48:3853-8. [PMID: 26472309 DOI: 10.1016/j.jbiomech.2015.09.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 12/18/2022]
Abstract
Ultrasound imaging has been used to evaluate various shoulder pathologies, whereas, quantification of the rotator cuff muscle stiffness using shear wave elastography (SWE) has not been verified. The purpose of this study was to investigate the reliability and feasibility of SWE measurements for the quantification of supraspinatus (SSP) muscle elasticity. Thirty cadaveric shoulders (18 intact and 12 with torn rotator cuff) were used. Intra- and inter-observer reliability was evaluated on an established SWE technique for measuring the SSP muscle elasticity. To assess the effect of overlying soft tissues above the SSP muscle, SWE values were measured with the transducer placed on the skin, on the subcutaneous fat after removing the skin, on the trapezius muscle after removing the subcutaneous fat, and directly on the SSP muscle. In addition, SWE measurements on 4 shoulder positions (0°, 30°, 60°, and 90° abduction) were compared in those with/without rotator cuff tears. Intra- and inter-observer reliability of SWE measurements were excellent for all regions in SSP muscle. Also, removing the overlying soft tissue showed no significant difference on SWE values measured in the SSP muscle. The SSP muscle with 0° abduction showed large SWE values, whereas, shoulders with large-massive tear showed smaller variation throughout the adduction-abduction positions. SWE is a reliable and feasible tool for quantitatively assessing the SSP muscle elasticity. This study also presented SWE measurements on the SSP muscle under various shoulder abduction positions which might help characterize patterns in accordance to the size of rotator cuff tears.
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