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Li J, Zhang YR, Ren JY, Li QL, Zhu PS, Du TT, Ge XY, Chen M, Cui XW. Association between diagnostic efficacy of acoustic radiation force impulse for benign and malignant thyroid nodules and the presence or absence of non-papillary thyroid cancer: A meta-analysis. Front Oncol 2023; 13:1007464. [PMID: 36776305 PMCID: PMC9915625 DOI: 10.3389/fonc.2023.1007464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/09/2023] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this study was to investigate the diagnostic efficacy of Acoustic Radiation Force Impulse (ARFI) for benign and malignant thyroid nodules in the presence and absence of non-papillary thyroid cancer (NPTC) and to determine the cut-off values of Shear Wave Velocity (SWV) for the highest diagnostic efficacy of Virtual Touch Quantification (VTQ) and Virtual Touch Tissue Imaging and Quantification (VTIQ). Methods The diagnostic accuracy of ARFI for benign and malignant thyroid nodules was assessed by pooling sensitivity, specificity and area under the curve (AUC) in each group in the presence and absence of both non-papillary thyroid glands, using histology and cytology as the gold standard. All included studies were divided into two groups according to VTQ and VTIQ, and each group was ranked according to the magnitude of the SWV cutoff value to determine the SWV cutoff interval with the highest diagnostic efficacy for VTQ and VTIQ. Results A total of 57 studies were collected on the evaluation of ARFI for the diagnosis of benign and malignant thyroid nodules. The results showed that the presence of non-papillary thyroid carcinoma led to differences in the specificity of VTIQ for the identification of benign and malignant thyroid nodules, and the differences were statistically significant. In addition, the diagnostic efficacy of VTQ was best when the cutoff value of SWV was in the interval of 2.48-2.55 m/s, and the diagnostic efficacy of VTIQ was best when the cutoff value of SWV was in the interval of 3.01-3.15 m/s. Conclusion VTQ and VTIQ have a high diagnostic value for benign and malignant thyroid nodules; however, when the malignant nodules in the study contain non-papillary thyroid carcinoma occupying the thyroid gland, the findings should be viewed in a comprehensive manner.
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Affiliation(s)
- Jun Li
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China,*Correspondence: Jun Li, ; Xin Wu Cui,
| | - Yu-Rui Zhang
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Li Li
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Pei-Shan Zhu
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ting-Ting Du
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xiao-Yan Ge
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ming Chen
- Department of Ultrasound, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Jun Li, ; Xin Wu Cui,
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Lian KM, Lin T. Virtual touch tissue imaging for differential diagnosis in ACR TI-RADS category 3-4 thyroid nodules: Conservative and aggressive methods. Clin Hemorheol Microcirc 2023; 85:123-134. [PMID: 37718784 DOI: 10.3233/ch-231694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
PURPOSE Many Thyroid Imaging Reporting and Data System (TI-RADS) category 3-4 nodules are benign. Our study aimed to add virtual touch tissue imaging (VTI) to TI-RADS using two methods, namely conservative and aggressive, and to explore which method had better diagnostic performance and which method avoided more unnecessary biopsies. METHODS From January 2016 to December 2021, we included 121 thyroid nodules classified as TI-RADS category 3-4 in 115 consecutive patients in this retrospective study. This study used the reference standard for pathological diagnosis by surgical resection or biopsy. The diagnostic performance of the different methods was evaluated and compared by receiver operating characteristic (ROC) and area under the ROC curve (AUC). RESULTS In this study, the aggressive approach had the best diagnostic performance among TI-RADS alone, the conservative approach, and the aggressive approach (AUC: 0.863 versus 0.598, P = 0.0007; 0.863 versus 0.755, P = 0.0067). When we used an aggressive approach, 75.44% (43/57) of the 57 false-positive nodes diagnosed by TI-RADS were appropriately downgraded from TI-RADS category 4 to category 3, avoiding unnecessary biopsies. CONCLUSION VTI improves the diagnostic performance of TI-RADS. The aggressive approach of combining the TI-RADS with VTI would help reduce unnecessary biopsies.
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Affiliation(s)
- Kai-Mei Lian
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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DEMİRPOLAT G, TUNA L, KAVUKCU G, ERTAN Y, PAKSOY S, ÇEVİK C. MALİGN VE BENİGN TIROİD NODÜLLERİNİN AYRIMINDA ARFI ELASTOGRAFİ. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1059236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AMAÇ: Malign ve benign tiroid nodüllerini ayırd etmede “Acoustic Radiation Force Impulse” (ARFI) elastografinin “virtual touch tissue elastografi” modunun tanısal performansını değerlendirmek
MATERYAL VE METOD:
Çapı > 5 mm olan ikiyüzdört adet solid ve ağırlıklı solid nodül prospektif olarak ultrasonografi, ARFI elastografinin VTQ modu, ince iğne aspirasyon biyopsisi ve endike olduğunda doku patolojisi ile değerlendirildi. Yüzdoksanaltı nodülde üç makaslama dalgası hızı (shear wave velocity-SWV) ölçümü yapıldı. Her bir nodül için SWV oranı, nodülün SWV'sinin ortalama değerinin komşu parankimin ortalama değerine bölünmesiyle hesaplandı. SWV değeri ve SWV oranının tanısal performansı, ROC analizi ile değerlendirildi.
SONUÇLAR:
Benign ve malign tiroid nodüllerinde normal parankimdeki ortalama SWV değeri sırasıyla 2,13±0,44 m/s, 2,06±0,80 m/s ve 2,06±0,88 m/s idi. SWVoranları benign tiroid nodülleri için 0.97±0.37 ve malign tiroid nodülleri için 1.02±0.40 idi. Ortalama SWV değerleri (t=0,008) (P=0,994) veya SWV oranları (t=0,596; P=0,527) açısından benign ve malign nodüller arasında anlamlı fark yoktu. Maligniteyi öngörmek için herhangi bir cut-off noktası bulunmadı. Alt grup analizinde, SWV ve SWV oranı için AUC'ler, ˂10 mm ve ≥10 mm nodüller arasında önemli ölçüde farklıydı. Bunun dışında herhangi iki grup arasında anlamlı fark saptanmadı (tümü P>0.05). SWV ve SWV oranı için en iyi cut-off noktaları, <10 mm nodüller için sırasıyla SWV için 2.59 m/s ve SWV oranı için 1.0 idi.
SONUÇ: ARFİ görüntülemenin VTQ modu, maligniteyi saptamak için iyi bir tanısal performansa sahip değildir ve gereksiz tiroid biyopsilerinin azaltılmasına katkıda bulunamaz.
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DEMİRPOLAT G, TUNA L, KAVUKCU G, ERTAN Y, PAKSOY S, ÇEVİK C. Malign ve benign tiroid nodüllerinin ayrımında ARFI elastografi. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1167252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: To examine the diagnostic performance of virtual touch tissue quantification (VTQ) mode of Acoustic Radiation Force Impulse (ARFI) elastography imaging in differentiating benign and malignant thyroid nodules.
Materials and Methods: Two hundred four solid and mostly solid nodules >5mm were prospectively evaluated with ultrasonography, VTQ mode of ARFI elastography, fine needle aspiration biopsy, and when indicated with tissue pathology. Three shear-wave velocities (SWV) measurements were done in 196 nodules. The SWV ratio for each nodule was calculated as the mean value of the SWV of the nodule divided by the mean value of the adjacent parenchyma. The diagnostic performance of SWV value and SWV-ratio were assessed by a receiver-operating characteristic (ROC) curve analysis.
Results: The mean SWV value in the normal parenchyma, in benign and malign thyroid nodules, were 2.13±0.44 m/s, 2.06±0.80 m/s, and 2.06±0.88 m/s respectively. The SWV-ratios were 0.97±0.37 for benign thyroid nodules and 1.02±0.40 for malignant thyroid nodules. There was no significant difference between benign and malign nodules in terms of mean SWV values (t=0.008) (P=0.994) or SWV-ratios (t =0.596; P=0.527). No cut-off point was found to predict malignancy. In subgroup analysis, AUCs for the SWV and SWV-ratio were significantly different between nodules ˂10 mm and those ≥10 mm, but not with any other two groups (all P>0.05) (Table-2). The cutoff points for the differential diagnosis were 2.59 m/s for SWV and 1.0 for SWV- ratio respectively for nodules
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Affiliation(s)
- Gülen DEMİRPOLAT
- Department of Radiology Balikesir University Faculty of Medicine Cagıs Yerleskesi, Balıkesir, Türkiye
| | - Lale TUNA
- Kırklareli Training and Research Hospital, Department of Radiology, Kırklareli, Türkiye
| | - Gülgün KAVUKCU
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Yeşim ERTAN
- Department of Pathology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Serpil PAKSOY
- Department of Pathology, Balıkesir University Faculty of Medicine Balikesir University School of Medicine, Cagıs Yerleskesi, Balıkesir, Türkiye
| | - Celalettin ÇEVİK
- Department of Public Health Nursing Balikesir University Faculty of Health Science Cagıs Yerleskesi, Balıkesir, Türkiye
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Lian KM, Lin T. Role of color-coded virtual touch tissue imaging in suspected thyroid nodules. Technol Health Care 2022; 30:673-682. [PMID: 34511520 DOI: 10.3233/thc-213156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Conventional ultrasound (US) is the most widely used imaging test for thyroid nodule surveillance. OBJECTIVE We used the color-coded virtual touch tissue imaging (VTI) in the Acoustic Radiation Force Impulse (ARFI) technique to assess the hardness of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) TR3-5 nodules. The ability of color-coded VTI (CV) to discriminate between benign and malignant nodules was investigated. METHODS In this retrospective study, US and CV were performed on 211 TR3-5 thyroid lesions in 181 consecutive patients. All nodules were operated on to obtain pathological results. A multivariate logistic regression model was chosen to integrate the data obtained from the US and CV. RESULTS The area under the receiver operating characteristic (ROC) curve for the model was 0.945 (95% CI, 0.914 to 0.976). The cutoff value of predictive probability for diagnosing malignant thyroid nodules was 10.64%, the sensitivity was 94.43%, and the specificity was 83.12%. Through comparing with US and CV, respectively, it had been observed that the regression model had the best performance (all P< 0.001). However, when the US was compared with CV, the difference was not significant (P= 0.3304). CONCLUSIONS A combination of US and CV should be recommended for suspected malignant thyroid nodules in clinical practice.
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Affiliation(s)
- Kai-Mei Lian
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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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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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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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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Chang N, Zhang X, Wan W, Zhang C, Zhang X. The Preciseness in Diagnosing Thyroid Malignant Nodules Using Shear-Wave Elastography. Med Sci Monit 2018; 24:671-677. [PMID: 29391387 PMCID: PMC5806774 DOI: 10.12659/msm.904703] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Our study aimed to identify more accurate results about the diagnostic role of shear-wave elastography (SWE) for thyroid malignant nodules through a meta-analysis. Potential articles were searched in PubMed, Embase, and the Cochrane Library databases. Overall sensitivity and specificity with 95% confidence intervals (CIs) was used to represent the diagnostic accuracy of SWE. Summary receiver operating characteristic (ROC) curve was constructed to illustrate the results. In addition, χ2 and I2 tests were performed to assess heterogeneity. A value of p≤0.05 indicated significant heterogeneity. All the analysis was conducted in Meta-DiSc version 1.4 software. Twenty studies were included in the analysis. There were a total of 2,907 patients and 3,397 thyroid nodules included in the meta-analysis. Overall sensitivity and specificity were 0.68 (95% CI: 0.66–0.70) and 0.85 (95% CI: 0.84–0.87), respectively. The results showed the area under curve (AUC) was 0.9041, suggesting high accuracy of SWE for differentiating benign and malignant thyroid nodules. SWE showed high accuracy in identifying thyroid malignant nodules, suggesting it could serve as a diagnostic biomarker in thyroid nodules.
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Affiliation(s)
- Na Chang
- Department of Medical Imaging, Shandong University, Jinan, Shandong, China (mainland).,Department of Medical Imaging, Jinan Vocational College of Nursing, Jinan, Shandong, China (mainland)
| | - Xianchao Zhang
- Department of Oncology, Xintai People's Hospital, Xintai, Shandong, China (mainland)
| | - Wenjing Wan
- Department of Nephrology, Xintai People's Hospital, Xintai, Shandong, China (mainland)
| | - Chengqi Zhang
- Department of Medical Imaging, Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Xianqi Zhang
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
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Ceyhan Bilgici M, Sağlam D, Delibalta S, Yücel S, Tomak L, Elmalı M. Shear wave velocity of the healthy thyroid gland in children with acoustic radiation force impulse elastography. J Med Ultrason (2001) 2017; 45:75-80. [DOI: 10.1007/s10396-017-0788-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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Liu BJ, Zhao CK, Xu HX, Zhang YF, Xu JM, Li DD, Bo XW, Li XL. Quality measurement on shear wave speed imaging: diagnostic value in differentiation of thyroid malignancy and the associated factors. Oncotarget 2017; 8:4848-4959. [PMID: 28002806 PMCID: PMC5354883 DOI: 10.18632/oncotarget.13996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022] Open
Abstract
To evaluate the associated factors for quality measurement (QM) on shear wave speed (SWS) imaging and the additional value of QM for differentiation of thyroid nodules. A consecutive series of 238 patients with 254 thyroid nodules were enrolled. They were all evaluated by conventional ultrasound and SWS imaging and were finally proven pathologically. QM was used to assess whether SWS propagation was authentic and was classified as high QM and Low QM. Twelve variables were analyzed to evaluate the associated factors for QM using binary logistic regression. Receiver operating characteristic (ROC) curve was plotted on SWS and SWS+QM. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and area under ROC curve (AUC) were calculated. The study included 170 benign thyroid nodules (160 high QM and 10 low QM) and 84 malignant thyroid nodules (56 high QM and 28 low QM) (P < 0.001). The mean SWS of benign and malignant nodules were 2.51 ± 0.47 m/s and 3.43 ± 1.21 m/s respectively (P < 0.001). The sensitivities, specificities, PPVs, NPVs, accuracies and AUCs were 77.4%, 80.0%, 65.7%, 87.7%, 79.1%, 0.82 for SWS alone with SWS ≥ 2.78 m/s; 33.3-34.5%, 91.2-94.1%, 65.9-73.7%, 73.8-74.1%, 72.4-74.0%, 0.63-0.64 for QM alone and 84.5-85.7%, 72.4-75.9%, 60.5-63.4%, 90.8-91.0%, 76.8-78.7%, 0.79-0.80 for SWS+QM. Nodule depth was identified to be the strongest associated factor for QM of SWS, followed by malignancy and SWS. In conclusion, QM for thyroid nodule is associated with nodule depth, malignancy, and SWS. QM improves the specificity in comparison with SWS alone, whereas SWS+QM does not improve the overall diagnostic performance.
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Affiliation(s)
- 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 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 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 Center for Thyroid Diseases, Shanghai 200072, China
| | - Yi-Feng Zhang
- 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 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 Center for Thyroid Diseases, Shanghai 200072, China
| | - Dan-Dan 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 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 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 Center for Thyroid Diseases, Shanghai 200072, China
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The utility of ultrasound elastography in differentiation of endometriomas and hemorrhagic ovarian cysts. J Med Ultrason (2001) 2016; 43:395-400. [PMID: 26880060 DOI: 10.1007/s10396-016-0701-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the feasibility of acoustic radiation force impulse imaging in differentiation of endometriomas and hemorrhagic ovarian cysts. MATERIALS AND METHODS We evaluated 84 ovarian cysts with high internal echogenicity diagnosed in 70 consecutive women. We excluded simple cysts and hemorrhagic cysts containing septations or mural nodules with detectable flow on Doppler ultrasonography. We obtained the elastographic shear wave velocity (SWV) value of the cysts that could be endometriomas or hemorrhagic ovarian cysts. RESULTS Among the 78 ovarian cysts in 70 women without any septation or mural nodule, there were 42 endometriomas and 36 hemorrhagic ovarian cysts. Analysis of median SWV values of the ovarian cysts showed that the endometriomas had considerably higher levels of stiffness compared to the hemorrhagic ovarian cysts [median SWV 4.20 ± 0.42 vs 2.54 ± 1.04 m/s, p < 0.001]. A SWV cutoff value greater than 3.81 m/s yielded sensitivity and specificity values of 82.1 and 79.2 % respectively, for differentiation of endometriomas from hemorrhagic ovarian cysts. CONCLUSION Sonoelastography is a novel imaging technique that enables us to evaluate the stiffness of adnexal lesions. The accurate discrimination of endometriomas and hemorrhagic ovarian cysts is important for avoiding unnecessary surgical procedures. ARFI imaging has a high sensitivity and specificity for distinguishing endometrioma from hemorrhagic ovarian cysts.
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Liu BJ, Lu F, Xu HX, Guo LH, Li DD, Bo XW, Li XL, Zhang YF, Xu JM, Xu XH, Qu S. The diagnosis value of acoustic radiation force impulse (ARFI) elastography for thyroid malignancy without highly suspicious features on conventional ultrasound. Int J Clin Exp Med 2015; 8:15362-15372. [PMID: 26629025 PMCID: PMC4658914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the potential diagnostic performance of acoustic radiation force impulse (ARFI) elastography in identifying malignancy in nodules that do not appear highly suspicious on conventional ultrasound (US). METHODS 330 pathologically confirmed thyroid nodules (40 malignant and 290 benign; mean size, 22.0±11.6 mm) not suspicious of malignancy on conventional US in 330 patients (mean age 52.8±11.7 years) underwent ARFI elastography before surgery. ARFI elastography included qualitative ARFI-induced strain elastography (SE) and quantitative point shear wave elastography (p-SWE). ARFI-induced SE image was assessed by SE score, while p-SWE was denoted with shear wave velocity (SWV, m/s). The diagnostic performance of four criteria sets was evaluated: criteria set 1 (ARFI-induced SE), criteria set 2 (p-SWE), criteria set 3 (either set 1 or 2), criteria set 4 (both set 1 and 2). Receiver operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance. RESULTS SE score ≥4 was more frequently found in malignant nodules (32/40) than in benign nodules (30/290, P<0.001). The mean SWV of malignant nodules (3.64±2.23 m/s) was significantly higher than that of benign nodules (2.02±0.69 m/s) (P<0.001). ARFI-induced SE (set 1) had a sensitivity of 80.0% (32/40) and a specificity of 89.7% (260/290) with a cut-off point of SE score ≥4; p-SWE (set 2) had a sensitivity of 80.0% (32/40) and a specificity of 57.9% (168/290) with a cut-off point of SWV ≥2.15 m/s. When ARFI-induced SE and p-SWE were combined, set 3 had the highest sensitivity (92.5%, 37/40) while set 4 had the highest specificity (95.2%, 276/290). CONCLUSION ARFI elastography can be used for differential diagnosis of malignant thyroid nodules without highly suspicious features on US. The combination of ARFI-induced SE and p-SWE leads to improved sensitivity and specificity.
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Affiliation(s)
- Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Feng Lu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
- Department of Ultrasound, Guangdong Medical College Affiliated HospitalZhanjiang 524001, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Xiao-Hong Xu
- Department of Ultrasound, Guangdong Medical College Affiliated HospitalZhanjiang 524001, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
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Huang X, Guo LH, Xu HX, Gong XH, Liu BJ, Xu JM, Zhang YF, Li XL, Li DD, Qu S, Fang L. Acoustic radiation force impulse induced strain elastography and point shear wave elastography for evaluation of thyroid nodules. Int J Clin Exp Med 2015; 8:10956-10963. [PMID: 26379890 PMCID: PMC4565273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/15/2015] [Indexed: 06/05/2023]
Abstract
The aim of the study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) induced strain elastography (SE), point shear wave elastography (p-SWE), and their combined use in differentiating thyroid nodules. This retrospective study included 155 thyroid nodules (94 benign and 61 malignant) in 136 patients. Ultrasound, ARFI-induced SE and p-SWE were performed on each nodule. Receiver operating characteristic curve (ROC) analyses were performed to assess the diagnostic efficacy of ARFI-induced SE, p-SWE and their combined use to distinguish benign from malignant thyroid nodules with histological results used as the reference standard. The areas under the ROC for ARFI-induced SE, p-SWE, and their combined use were 0.828, 0.829, and 0.840, respectively (both P > 0.05). The specificity of ARFI-induced SE was higher than that of p-SWE as well as their combined use (both P < 0.05). The combination of the two methods significantly improved the diagnostic sensitivity and NPV compared with either ARFI-induced SE or p-SWE alone (both P < 0.05). For nodules ≤ 10 mm, the combination of the two methods significantly improved the diagnostic sensitivity only. For nodules > 10 mm, there were no significant differences in sensitivity and NPV among the three methods in differentiating thyroid nodules (all P > 0.05). In conclusions, ARFI-induced SE and p-SWE are both valuable tools for detecting malignant thyroid nodules. The combined use of ARFI-induced SE and p-SWE improves the diagnostic sensitivity and NPV significantly whereas ARFI-induced SE alone achieves the highest specificity.
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Affiliation(s)
- Xian Huang
- Department of Ultrasound, Shenzhen Second People’s Hospital, First Hospital Affiliated to Shenzhen UniversityShenzhen 518035, China
- Clinical School of Shenzhen Second People’s Hospital, Anhui Medical UniversityHefei 230032, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
- Department of Ultrasound, Guangdong Medical College Affiliated HospitalZhanjiang 524001, China
| | - Xue-Hao Gong
- Department of Ultrasound, Shenzhen Second People’s Hospital, First Hospital Affiliated to Shenzhen UniversityShenzhen 518035, China
- Clinical School of Shenzhen Second People’s Hospital, Anhui Medical UniversityHefei 230032, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Lin Fang
- Thyroid Institute, Tongji University School of MedicineShanghai 200072, China
- Department of Thyroid and Breast Surgery, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
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