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Advanced Ultrasound Techniques for Differentiation of Benign Versus Malignant Thyroid Nodules: A Review. Ultrasound Q 2021; 37:315-323. [PMID: 34855707 DOI: 10.1097/ruq.0000000000000543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT Grayscale ultrasound (US) is decisive in stratifying which thyroid nodules benefit from fine-needle aspiration to evaluate for malignancy. Unfortunately, a significant percentage of nodules remain indeterminate.Herein, we review the clinical considerations and diagnostic accuracy of advanced US, Doppler US, contrast-enhanced US, and US elastography techniques in the evaluation of indeterminate nodules.We conclude that these techniques may be used in combination with grayscale US to improve the assessment of lesion vascularity and tissue property.
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Xie X, Yu Y. Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis. Clinics (Sao Paulo) 2020; 75:e1720. [PMID: 32578824 PMCID: PMC7297523 DOI: 10.6061/clinics/2020/e1720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Ultrasound-guided fine-needle aspiration biopsies are recommended for the detection of suspicious thyroid nodules. However, the best approach regarding suspicious ultrasound features for thyroid nodules is still unclear. This study aimed to evaluate the effect of location and size of thyroid nodules on the diagnostic performance of strain ultrasound elastography. In addition, this study evaluated whether ultrasound elastography predicts malignancy in thyroid nodules. METHODS Data regarding the size, depth, and distance from the carotid artery of nodules, the elasticity contrast index, and the nature of nodules were analyzed. RESULTS There was no significant difference in the depth (p=0.092) and the distance from the carotid artery (p=0.061) between benign and suspicious nodules. Suspicious nodules were smaller than benign nodules (p<0.0001, q=23.84) and had a higher elasticity contrast index (p<0.0001, q=21.05). The depth of nodules and the size of the nodule were not associated with the correct value of the elasticity contrast index (p>0.05 for both). The diagnostic performance of ultrasound elastography was not affected by the distance of the nodules from the carotid artery if they were located ≥15 mm from the carotid artery (p=0.5960). However, if the suspicious nodules were located <15 mm from the carotid artery, the diagnostic accuracy was hampered (p=0.006). CONCLUSIONS The strain ultrasound elastography should be carefully evaluated when small thyroid nodules are located near the carotid artery.
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Affiliation(s)
- Xinxin Xie
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China, 230022
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China, 230022
- *Corresponding author. E-mail:
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Park HS, Kwon H, Kwak DW, Kim MY, Seol HJ, Hong JS, Shim JY, Choi SK, Hwang HS, Oh MJ, Cho GJ, Kim K, Oh SY. Addition of Cervical Elastography May Increase Preterm Delivery Prediction Performance in Pregnant Women with Short Cervix: a Prospective Study. J Korean Med Sci 2019; 34:e68. [PMID: 30863266 PMCID: PMC6406042 DOI: 10.3346/jkms.2019.34.e68] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated whether there is a difference in elastographic parameters between pregnancies with and without spontaneous preterm delivery (sPTD) in women with a short cervix (≤ 25 mm), and examined the ability of elastographic parameters to predict sPTD in those women. METHODS E-CervixTM (WS80A; Samsung Medison, Seoul, Korea) elastography was used to examine the cervical strain. Elastographic parameters were compared between pregnancies with and without sPTD. Diagnostic performance of elastographic parameters to predict sPTD ≤ 37 weeks, both alone and in combination with other parameters, was compared with that of cervical length (CL) using area under receiver operating characteristic curve (AUC) analysis. RESULTS A total of 130 women were included. Median gestational age (GA) at examination was 24.4 weeks (interquartile range, 21.4-28.9), and the prevalence of sPTD was 20.0% (26/130). Both the elastographic parameters and CL did not show statistical difference between those with and without sPTD. However, when only patients with CL ≥ 1.5 cm (n = 110) were included in the analysis, there was a significant difference between two groups in elasticity contrast index (ECI) within 0.5/1.0/1.5 cm from the cervical canal (P < 0.05) which is one of elastographic parameters generated by E-Cervix. When AUC analysis was performed in women with CL ≥ 1.5 cm, the combination of parameters (CL + pre-pregnancy body mass index + GA at exam + ECI within 0.5/1.0/1.5 cm) showed a significantly higher AUC than CL alone (P < 0.05). CONCLUSION An addition of cervical elastography may improve the ability to predict sPTD in women with a short CL between 1.5 and 2.5 cm.
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Affiliation(s)
- Hyun Soo Park
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hayan Kwon
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong Wook Kwak
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Ajou University Hospotal, Ajou University School of Medicine, Suwon, Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Kyung Choi
- Department of Obstetrics and Gynecology, The Catholic University of Korea Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Min Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kunwoo Kim
- Department of Obstetrics and Gynecology, Hamchoon Women's Clinic, Seoul, Korea
| | - Soo-young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tumino D, Grani G, Di Stefano M, Di Mauro M, Scutari M, Rago T, Fugazzola L, Castagna MG, Maino F. Nodular Thyroid Disease in the Era of Precision Medicine. Front Endocrinol (Lausanne) 2019; 10:907. [PMID: 32038482 PMCID: PMC6989479 DOI: 10.3389/fendo.2019.00907] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/12/2019] [Indexed: 12/31/2022] Open
Abstract
Management of thyroid nodules in the era of precision medicine is continuously changing. Neck ultrasound plays a pivotal role in the diagnosis and several ultrasound stratification systems have been proposed in order to predict malignancy and help clinicians in therapeutic and follow-up decision. Ultrasound elastosonography is another powerful diagnostic technique and can be an added value to stratify the risk of malignancy of thyroid nodules. Moreover, the development of new techniques in the era of "Deep Learning," has led to a creation of machine-learning algorithms based on ultrasound examinations that showed similar accuracy to that obtained by expert radiologists. Despite new technologies in thyroid imaging, diagnostic surgery in 50-70% of patients with indeterminate cytology is still performed. Molecular tests can increase accuracy in diagnosis when performed on "indeterminate" nodules. However, the more updated tools that can be used to this purpose in order to "rule out" (Afirma GSC) or "rule in" (Thyroseq v3) malignancy, have a main limitation: the high costs. In the last years various image-guided procedures have been proposed as alternative and less invasive approaches to surgery for symptomatic thyroid nodules. These minimally invasive techniques (laser and radio-frequency ablation, high intensity focused ultrasound and percutaneous microwave ablation) results in nodule shrinkage and improvement of local symptoms, with a lower risk of complications and minor costs compared to surgery. Finally, ultrasound-guided ablation therapy was introduced with promising results as a feasible treatment for low-risk papillary thyroid microcarcinoma or cervical lymph node metastases.
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Affiliation(s)
- Dario Tumino
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Di Stefano
- Division of Endocrine and Metabolic Diseases, Department of Clinical Sciences and Community Health, IRCCS Istituto Auxologico Italiano, Università degli Studi di Milano, Milan, Italy
| | - Maria Di Mauro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Scutari
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresa Rago
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Department of Clinical Sciences and Community Health, IRCCS Istituto Auxologico Italiano, Università degli Studi di Milano, Milan, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- *Correspondence: Fabio Maino
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Gregory A, Bayat M, Kumar V, Denis M, Kim BH, Webb J, Meixner DD, Ryder M, Knudsen JM, Chen S, Fatemi M, Alizad A. Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography: A Preliminary Two-plane View Study. Acad Radiol 2018; 25:1388-1397. [PMID: 29573939 DOI: 10.1016/j.acra.2018.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 02/28/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. MATERIALS AND METHODS A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5-68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. RESULTS Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. CONCLUSIONS The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P < .0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.
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Zhao CK, Xu HX. Ultrasound elastography of the thyroid: principles and current status. Ultrasonography 2018; 38:106-124. [PMID: 30690960 PMCID: PMC6443591 DOI: 10.14366/usg.18037] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Ultrasound (US) elastography has been introduced as a non-invasive technique for evaluating thyroid diseases. This paper presents a detailed description of the technical principles, peculiarities, and limitations of US elastography techniques, including strain elastography and shear-wave elastography. This review was conducted from a clinical perspective, and aimed to assess the usefulness of US elastography for thyroid diseases in specific clinical scenarios. Although its main focus is on thyroid nodules, the applications of US elastography for other thyroid diseases, such as diffuse thyroid diseases and thyroiditis, are also presented. Furthermore, unresolved questions and directions for future research are also discussed.
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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, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai 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 Center for Thyroid Diseases, Shanghai, China
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Hahn SY, Shin JH, Ko EY, Bae JM, Choi JS, Park KW. Complementary Role of Elastography Using Carotid Artery Pulsation in the Ultrasonographic Assessment of Thyroid Nodules: A Prospective Study. Korean J Radiol 2018; 19:992-999. [PMID: 30174489 PMCID: PMC6082762 DOI: 10.3348/kjr.2018.19.5.992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022] Open
Abstract
Objective The aim of this study was to evaluate the diagnostic performance of gray-scale ultrasonography (US), Doppler scan, and elastography using carotid artery pulsation in the diagnosis of thyroid nodules and to find a complementary role of elastography. Materials and Methods A total 197 thyroid nodules with 91 malignant and 106 benign pathologic results from 187 patients (41 males and 146 females; age range, 20-83 years; mean age, 49.4 years) were included in this prospective study. The gray-scale, Doppler US images, elastography with elasticity contrast index (ECI), and stiffness color were assessed. The diagnostic performances of each dataset were assessed in order to differentiate benign from malignant thyroid nodules. Results The optimal cut-off value of the ECI was 1.71. The area under receiver operating characteristic curve (Az value) was 0.821 for gray-scale US, 0.661 for the ECI, 0.592 for stiffness color, and 0.539 for Doppler US. The Az value for a combined assessment of gray-scale US and the ECI was higher than that for the gray-scale US alone; however, there was no statistical difference between the two (p = 0.219). The median ECI values of follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FVPTC) were significantly lower than those of the other malignant lesions (p = 0.005). Meanwhile, the diffuse sclerosing variant of PTC and a metastatic nodule showed the two highest median values of the ECI. Conclusion For differentiating thyroid nodules, the diagnostic performances of the combination of gray-scale US and elastography with the ECI were similar to, but not superior, to those of gray-scale US alone. FVPTC and FTC have a significantly lower ECI value than those of the other malignant lesions.
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Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Min Bae
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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