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Klarich S, White H. Can ultrasound strain elastography (USE) improve management of suspicious thyroid nodules measuring <10 mm? A systematic review. Radiography (Lond) 2023; 29:661-667. [PMID: 37148707 DOI: 10.1016/j.radi.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/08/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Current UK guidelines state that suspicious thyroid nodules <10 mm do not require FNA. These are often followed up with serial ultrasound scans. Ultrasound Strain Elastography (USE) could provide a more accurate alternative and preclude the need for follow-up. Can USE identify nodules at greater risk of malignancy and streamline patient management? METHODS Systematic review methodology used. Inclusion criteria are: - Population: patients with suspicious thyroid nodules <10 mm.- Intervention: USE.- Comparator: Ultrasound features of nodules.- Outcome measure: FNA or surgical removal of nodules. Searches performed on 6 commercial databases, along with grey literature anddissertation databases. The QUADAS-2 diagnostic study checklist used for quality assessment. RESULTS 8 studies included and a narrative analysis performed due to heterogeneity of results. The mean USE sensitivity is 74.3%, mean specificity 80.5%. Mean overall ultrasound sensitivity is 80.4%, specificity 71.0%. Results suggest that USE is not superior to ultrasound for detecting malignancy. Some study limitations, particularly the heterogeneity of reporting the ultrasound features preclude meaningful conclusion from being drawn. CONCLUSION USE is more accurate at identifying benign nodules than ultrasound. Nodules appearing benign on USE could be excluded from serial ultrasound follow-up. No significant difference was found between USE and ultrasound at identifying malignant nodules. IMPLICATIONS FOR PRACTICE As FNA is not recommended for suspicious thyroid nodules <10 mm, these are often followed up with multiple scans and clinician reviews. This increases pressure on healthcare systems and uncertainty for the patient. This review shows that USE is more accurate at identifying benign nodules than ultrasound alone, meaning that these nodules could potentially be excluded from serial follow up. This would streamline patient management, freeing-up vital resources in ENT and ultrasound departments.
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Affiliation(s)
- S Klarich
- Walsall Healthcare NHS Trust, Imaging Department, Walsall Manor Hospital, Moat Road, Walsall, WS2 9PS, United Kingdom.
| | - H White
- Department of Radiography, Birmingham City University, City South Campus, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom.
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Fu Y, Sun Y, Pei Q, Han X, Qin W, Mei F, Tan S, Cui L. Factors Influencing the Sample Adequacy of Ultrasound-Guided Fine-Needle Aspiration from Solid Thyroid Nodules for Liquid-Based Cytology: A Demographic, Sonographic, and Technical Perspective. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111639. [PMID: 36422179 PMCID: PMC9698410 DOI: 10.3390/medicina58111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To identify factors that influence the sample adequacy of solid thyroid nodules based on ultrasound-guided fine-needle aspiration (FNA) with subsequent liquid-based cytology. Materials and Methods: We retrospectively reviewed 855 patients who underwent ultrasound-guided FNA at our hospital between July 2019 and July 2020. The final analysis included 801 solid thyroid nodules in 801 patients. After reviewing the demographic data, ultrasonic features, and FNA technique-related factors, we defined 14 potential variables. For cytological results, the Bethesda categories II−VI were defined as adequate sample results. Univariate and multivariate analyses were performed to identify factors that influenced sample adequacy. Results: The adequate sample rate was 87.1%. The univariate analysis showed that four factors were related to adequate sampling in patients with thyroid FNA. These factors included age (p < 0.001), nodule orientation (p = 0.0232), calcification (p = 0.0034), and operator experience (p = 0.0286). After the multivariate analysis, five independent factors were identified to improve the diagnostic results of FNA for solid thyroid nodules: (1) the presence of Hashimoto’s thyroiditis (odds ratio (OR) = 1.810; 95% confidence interval (CI): 1.076−3.045; p = 0.0254), (2) a taller-than-wide orientation (OR = 2.038; 95% CI: 1.260−3.296; p = 0.0037), (3) the presence of calcification (OR = 1.767; 95% CI: 1.115−2.799; p = 0.0153), (4) four needle passes to obtain material (OR = 1.750; 95% CI: 1.094−2.799; p = 0.0196), and (5) an experienced operator (OR = 0.561; 95% CI: 0.319−0.987; p = 0.0451). Conclusions: A taller-than-wide orientation, the presence of calcification, and the presence of Hashimoto’s thyroiditis were found to affect the sample adequacy of ultrasound-guided FNA with liquid-based cytology. The sample adequacy could be improved when FNA is performed with four needle passes by experienced doctors.
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Affiliation(s)
- Ying Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Qianqian Pei
- Department of Ultrasound, Tongxiang First People’s Hospital, Tongxiang 314500, China
| | - Xiaobo Han
- Department of Ultrasound, Qinhuangdao Third Hospital, Qinhuangdao 066000, China
| | - Wen Qin
- Department of Ultrasound, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
- Correspondence: ; Tel.: +86-13263493931
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Hu M, Zong S, Xu N, Li J, Xia C, Yu F, Zhu Q, Zhao H. The Value of Thyroid Ultrasound Computer-Aided Diagnosis System in the Evaluation of Thyroid Nodules With Concurrent Hashimoto's Thyroiditis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1117-1124. [PMID: 34382688 DOI: 10.1002/jum.15801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/07/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the value of computer-aided diagnosis (CAD) system in assessing thyroid nodules concurrent with Hashimoto's thyroiditis (HT). METHODS Totally 148 patients with 193 thyroid nodules were enrolled. A radiologist assessed the nodules using a thyroid ultrasound CAD system. Additionally, the nodules were evaluated by one experienced radiologist alone, and one training radiologist without and with CAD assistance. The diagnostic performance was compared between the CAD system and the experienced radiologist, and the training radiologist without and with CAD assistance. RESULTS The CAD system demonstrated a similar sensitivity to that of the experienced radiologist in diagnosing thyroid cancers (89.8% versus 92.4%, P > .05). The specificity and accuracy of the CAD system were lower than that of the experienced radiologist in assessing the nodules with diffusedly altered glands (specificity, 60.0% versus 81.7%, P = .007; accuracy, 77.5% versus 88.1%, P = .011). With CAD assistance, the training radiologist had improved sensitivity and accuracy that increased to 87.9% and 86.8% in classifying nodules with sonographically evident HT (both P = .012). CONCLUSION The CAD system has comparable sensitivity, but lower specificity compared with the experienced radiologist in diagnosing thyroid malignancies concurrent with HT. For a radiologist with less experience, the CAD system can help improve the diagnostic performance by increasing sensitivity and accuracy in assessing thyroid nodules with diffusely altered parenchyma.
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Affiliation(s)
- Minxia Hu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Suting Zong
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Ning Xu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Jinzhen Li
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Chunxia Xia
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Fengxia Yu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Qiang Zhu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Hanxue Zhao
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
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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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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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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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