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Althoff AD, Vance K, Plain M, Reeves RA, Pierce J, Gwathmey FW, Werner BC. Evaluation of Achilles Tendon Stiffness as Measured by Shear Wave Elastography in Female College Athletes Compared With Nonathletes. Sports Health 2024; 16:12-18. [PMID: 36856196 PMCID: PMC10732119 DOI: 10.1177/19417381231153657] [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: 03/02/2023] Open
Abstract
BACKGROUND We sought to utilize a noninvasive technology to assess the effects of activity on Achilles tendon stiffness and define baseline Achilles tendon stiffness in female college athletes compared with nonathletes using tendon shear wave velocity as a marker for tendon stiffness. HYPOTHESIS Training status and exercise may affect Achilles tendon stiffness. STUDY DESIGN LEVEL OF EVIDENCE Level 4. METHODS A total of 32 college-age female athletes were prospectively enrolled (n = 17 varsity athletes and n = 15 nonathletes). Demographic characteristics, activity level, and previous injuries were recorded. Sonographic shear wave elastography (SWE) was used to assess Achilles tendon shear wave velocity bilaterally for all subjects, both at baseline and after 2 minutes of exercise. Student t tests were used to compare the mean elastography measurements between participants stratified by athlete status and pre/postexercise stimulus. Analysis of variance (ANOVA) was used to compare the mean proximal, middle, and distal Achilles tendon elastography measurements. RESULTS As seen by a greater mean shear wave velocity (8.60 ± 1.58 m/s vs 8.25 ± 1.89 m/s; P = 0.02), athletes had stiffer tendons than nonathletes. Exercise stimulus decreased average tendon shear wave velocity (8.57 ± 1.74 m/s vs 8.28 ± 1.72 m/s; P = 0.05). Tendon shear wave velocity was greatest proximally and least distally with significant differences between each region (P < 0.001). In addition, there was a significant 2-way interaction between weekly training status and foot dominance (P = 0.01). Post hoc analysis showed that this result was due to differences in tendon shear wave velocity between the dominant and nondominant lower extremity in nonathletes (7.73 ± 2.00 m/s vs 8.76 ± 1.62 m/s; P < 0.001). CONCLUSION Female varsity collegiate athletes have higher baseline Achilles tendon stiffness as measured by SWE compared with nonathletes. Mean tendon stiffness varies based on Achilles measurement location. SWE is a quick, cost-effective, and noninvasive imaging modality that can be used to evaluate tendon stiffness and elasticity. CLINICAL RELEVANCE SWE is an efficient and noninvasive imaging modality that can evaluate dynamic tendon stiffness and elasticity. SWE may be helpful to assess injuries in female college athletes and may play a role in risk stratification or clinical follow-up. In theory, SWE could be used to identify athletes with increased elasticity as a marker for potential risk for rupture in this population.
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Affiliation(s)
- Alyssa D. Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Kayleigh Vance
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Megan Plain
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Russell A. Reeves
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jennifer Pierce
- Department of Radiology, University of Virginia, Charlottesville, Virginia
| | - Frank W. Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Mena G, Montalvo A, Ubidia M, Olmedo J, Guerrero A, Leon-Rojas JE. Elastography of the thyroid nodule, cut-off points between benign and malignant lesions for strain, 2D shear wave real time and point shear wave: a correlation with pathology, ACR TIRADS and Alpha Score. Front Endocrinol (Lausanne) 2023; 14:1182557. [PMID: 37396172 PMCID: PMC10313103 DOI: 10.3389/fendo.2023.1182557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Objective A prospective cross-sectional investigation of 170 thyroid nodules (TN) between January 2020 and December 2021 at Alpha Imagen was conducted to determine cut-off points (C/O) for elastography measurements and their diagnostic accuracy. Methods Nodules were categorized by ACR TI-RADS, Alpha Score (AS), and Bethesda; all were evaluated using 2D Shear Wave Real Time Elastography (RT-SWE), point Shear Wave (pSWE), and Strain Elastography (SE). Data was assessed with ROC curves, the Shapiro-Wilk test, T test, Chi-square test, and ANOVA. Results C/O were as follows: RTSWE Emax of 115kPa and 6.5 m/s, Emean of 47.5 kPa and 4.1 m/s, pSWE (average) of 52.4 kpa and 4.15 m/s; sensitivity of 81.2% and specificity of 57.6%, with a PPV of 72.4% and NPV of 70.0%. SE Value A had a C/O of 0.20%, with a sensitivity of 84%, specificity of 57%, PPV of 72.4% and NPP of 73.6%. The Strain Ratio nodule/tissue C/O was calculated as 2.69, with a sensitivity of 84%, specificity of 57%, PPV of 72.3%, and NPV of 73.5%. The RLBIndex quality control must be at least 92%; for pSWE, we suggest a mean interquartile ratio of ≤15.7% for kPa and 8.1% for m/s. The recommended depth is between 1.2 and 1.5 cm, and commonly used ROI boxes were 3x3 and 5x5mm. Conclusion 2D-SWE and pSWE with Emax and Emean demonstrated C/O with excellent diagnostic accuracy. To maximize the correct classification of TN, we suggest combining ACR TI-RADS and AS with any of the elastography measurements assessed here.
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Affiliation(s)
- Glenn Mena
- Institute of Radiology and Interventionism, Alpha Imagen, Quito, Ecuador
| | - Alejandro Montalvo
- Institute of Radiology and Interventionism, Alpha Imagen, Quito, Ecuador
| | - Michael Ubidia
- ECVIEW International, Biomedical Engineering Department, Mindray, Quito, Ecuador
| | - Julio Olmedo
- Institute of Radiology and Interventionism, Alpha Imagen, Quito, Ecuador
| | - Ana Guerrero
- Institute of Radiology and Interventionism, Alpha Imagen, Quito, Ecuador
| | - Jose E. Leon-Rojas
- Research Department, Medignosis, Quito, Ecuador
- Medical School, Universidad de las Américas (UDLA), Quito, Ecuador
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Xiao Y, Jin J, Yuan Y, Zhao Y, Li D. A New Estimation Scheme for Improving the Performance of Shear Wave Elasticity Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:289-308. [PMID: 36283938 DOI: 10.1016/j.ultrasmedbio.2022.09.003] [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: 06/04/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
Shear wave velocity (SWV) reconstruction based on time-of-flight (TOF) is widely adopted to realize shear wave elasticity imaging (SWEI). It typically breaks down the reconstruction of a SWV image into many kernels and treats them independently. We hypothesized that information exchange among kernels improves the performance of SWEI. Therefore, we propose the approach of iterative re-weighted least squares based on inter-kernel communication (IKC-IRLS). We also hypothesized that time-to-peak (TTP) is superior to cross-correlation (CC) in visualizing small targets because TTP uses higher shear wave frequencies than CC. To examine the hypotheses, IKC-IRLS was combined with TTP data and compared with four established methods. The five methods were tested by imaging several small-size stiff targets (2.5, 4.0 and 6.4 mm in diameter) using different kernel sizes in the simulation and real experiments. The results indicate that the IKC-IRLS approach can mitigate speckle noise and is robust to TTP outliers. Consequently, the proposed method achieves the highest contrast-to-noise ratio and the lowest mean absolute percentage error of target in almost all tested cases.
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Affiliation(s)
- Yang Xiao
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Jing Jin
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China.
| | - Yu Yuan
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Yue Zhao
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Dandan Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
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Zhou Q, Xu P, Ding H, Wang Y, Fu L, Wang B, Liu D. Application value of gray-scale ultrasound and shear wave elastography in differential diagnosis of thyroid nodules. Technol Health Care 2022; 30:1043-1054. [PMID: 35342061 DOI: 10.3233/thc-213137] [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: 12/07/2022]
Abstract
BACKGROUND The global prevalence of thyroid cancer has increased significantly in recent years. Ultrasonography is the preferred method for differentiating benign and malignant thyroid nodules preoperatively and is recommended by guidelines. OBJECTIVE To assess the application value of gray-scale ultrasound and shear wave elastography in distinguishing small thyroid nodules. METHODS A retrospective analysis of 228 thyroid nodules, all of which were confirmed by pathology after surgery or FNA from January 2019 to January 2020, was carried out. All nodules were divided into a ⩽ 5 mm group and a > 5 mm group according to their maximum size. We compared the differences in the gray scale and elastography of the nodules between the two groups and the accuracy of different diagnostic methods. RESULTS The accuracies of gray-scale ultrasound and shear wave elastography in the ⩽ 5 mm group were found to be lower than those in the > 5 mm group, and the gray-scale accuracy was slightly higher than that of shear wave elastography in both groups (p< 0.05). The largest AUC (area under the curve) of elastic parameters in the ⩽ 5 mm and > 5 mm groups was found for Emax and Esd, respectively. Based on a combination of these two parameters, the accuracies of the two groups were significantly higher than those of the parameters or gray scale alone (p< 0.05) and were 84.62% and 85.48%, respectively. CONCLUSION Shear wave elastography is valuable in the diagnosis of benign and malignant thyroid nodules using ultrasonography. When combining gray-scale ultrasound and shear wave elastography, the diagnostic accuracy is obviously improved, especially for ⩽ 5 mm small thyroid nodules.
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Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis. Acad Radiol 2022; 29 Suppl 3:S114-S121. [PMID: 29054676 DOI: 10.1016/j.acra.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/03/2017] [Accepted: 09/03/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVE This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. METHODS PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. CONCLUSION Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.
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Swan KZ, Nielsen VE, Bonnema SJ. Evaluation of thyroid nodules by shear wave elastography: a review of current knowledge. J Endocrinol Invest 2021; 44:2043-2056. [PMID: 33864241 DOI: 10.1007/s40618-021-01570-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Shear wave elastography (SWE), as a tool for diagnosing thyroid malignancy, has gathered considerable attention during the past decade. Diverging results exist regarding the diagnostic performance of thyroid SWE. METHODS A comprehensive literature review of thyroid SWE was conducted using the terms "Thyroid" and "shear wave elastography" in PubMed. RESULTS The majority of studies found SWE promising for differentiating malignant and benign thyroid nodules on a group level, whereas results are less convincing on the individual level due to huge overlap in elasticity indices. Further, there is lack of consensus on the optimum outcome reflecting nodule elasticity and the cut-off point predicting thyroid malignancy. While heterogeneity between studies hinders a clinically meaningful meta-analysis, the results are discussed in a clinical perspective with regard to applicability in clinical practice as well as methodological advantages and pitfalls of this technology. CONCLUSION Technological as well as biological hindrances seem to exist for SWE to be clinically reliable in assessing benign and malignant thyroid nodules. Structural heterogeneity of thyroid nodules in combination with operator-dependent factors such as pre-compression and selection of scanning plane are likely explanations for these findings. Standardization and consensus on the SWE acquisition process applied in future studies are needed for SWE to be considered a clinically reliable diagnostic tool for detection of thyroid cancer.
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Affiliation(s)
- K Z Swan
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University , Aarhus, Denmark.
| | - V E Nielsen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - S J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma-A Meta-Analysis. Cancers (Basel) 2021; 13:cancers13050938. [PMID: 33668130 PMCID: PMC7956257 DOI: 10.3390/cancers13050938] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The risk of thyroid malignancy assessment may include certain ultrasound features. The analysis is lacking for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). Our meta-analysis aimed to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. Based on twenty studies describing sonographic features of 10,215 nodules, we found that the most crucial feature associated with an increased risk of FTC were tumor protrusion (odds ratios—OR = 10.19), microcalcifications or mixed type of calcifications: 6.09, irregular margins: 5.11, marked hypoechogenicity: 4.59, and irregular shape: 3.6. Abstract Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of our study was to perform a meta-analysis to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. We searched thirteen databases from January 2006 to December 2020 to find all relevant, full-text journal articles written in English. Analyses assessed the accuracy of malignancy detection in case of follicular lesions, potentially differentiating FTA and FTC included the odds ratio (OR), sensitivity, specificity, positive and negative predictive values. A random-effects model was used to summarize collected data. Twenty studies describing sonographic features of 10,215 nodules met the inclusion criteria. The highest overall ORs to increase the risk of malignancy were calculated for tumor protrusion (OR = 10.19; 95% confidence interval: 2.62–39.71), microcalcifications or mixed type of calcifications (coexisting micro and macrocalcifications): 6.09 (3.22–11.50), irregular margins: 5.11 (2.90–8.99), marked hypoechogenicity: 4.59 (3.23–6.54), and irregular shape: 3.6 (1.19–10.92). The most crucial feature associated with an increased risk of FTC is capsule protrusion, followed by the presence of calcifications, irrespectively of their type.
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Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis. Eur J Radiol 2021; 137:109571. [PMID: 33636489 DOI: 10.1016/j.ejrad.2021.109571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/10/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to assess the diagnostic performance of shear wave elastography (SWE) to assess perinodular stiffness before fine needle aspiration (FNA) of thyroid nodules with a maximum diameter of 1.0 cm. METHOD This retrospective study included 69 thyroid nodules in 68 patients who underwent conventional ultrasound and SWE before ultrasound-guided FNA or surgical excision. The stiffness of perinodular regions was evaluated using wave patterns. Quantitative SWE features were also assessed. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were calculated using conventional ultrasound and conventional ultrasound with SWE. RESULTS Of the 69 nodules, 57(82.6 %)were malignant and 12(17.4 %)were benign. The maximum elastic modulus (Emax) was higher for malignant nodules(P< 0.05). There was no significant difference in mean elastic modulus or minimum elastic modulus between malignant and benign nodules. The Emax≥ 28.2 kPa was the best cut-off value for malignant base on receiver operating curve. Perinodular stiffness was significantly greater for malignant nodules compared with benign nodules according to shear wave patterns. Compared with ultrasound alone, the rate of benign lesions recommended for FNA decreased from 75.0 % (9/12) to 25.0 % (3/12) with conventional ultrasound plus SWE. CONCLUSION SWE provides quantitative and qualitative information when used with conventional ultrasound. SWE has the potential to reduce the number of unnecessary FNA procedures.
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Adamczewski Z, Stasiak M, Stasiak B, Adamczewska M, Lewiński A. Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue. J Clin Med 2021; 10:jcm10020214. [PMID: 33435276 PMCID: PMC7827397 DOI: 10.3390/jcm10020214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 12/24/2022] Open
Abstract
Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane—transverse vs. longitudinal—on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results.
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Affiliation(s)
- Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
| | - Bartłomiej Stasiak
- Institute of Information Technology, Lodz University of Technology, 90-924 Lodz, Poland;
| | - Magdalena Adamczewska
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (Z.A.); (M.S.)
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-271–11-42
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Pengchao ZMS, Liang SMD, Yinyan LMD, Huipeng WMD, Zhiguang CMS, Yumeng LMS, Xuemei WMD. Ultrasound Diagnosis of Primary Squamous Cell Carcinoma of Thyroid Gland: Case Report and Review. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules. J Clin Med 2020; 9:jcm9082495. [PMID: 32756510 PMCID: PMC7464710 DOI: 10.3390/jcm9082495] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022] Open
Abstract
Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1–5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect (“possibly malignant” nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.
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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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Li Y, Polyak D, Johnson E, Yecies D, Shevidi S, de la Zerda A, Gephart MH, Chu S. Difference-Frequency Ultrasound Imaging With Non-Linear Contrast. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1759-1766. [PMID: 31804930 PMCID: PMC8189081 DOI: 10.1109/tmi.2019.2957280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Conventional ultrasound imaging is based on the scattering of sound from inhomogeneities in the density and the speed of sound and is often used in medicine to resolve pathologic compared to normal tissue. Here we demonstrate a difference-frequency ultrasound (dfUS) imaging method that is based on the interaction of two sound pulses that propagate non-collinearly and intersect in space and time. The dfUS signal arises primarily from the second-order non-linear coefficient, a contrast mechanism that differs from linear and harmonic US imaging. The distinct contrast mechanism allows dfUS to image anatomic features that are not identifiable in conventional US images of salmon and pig kidney tissue. Further, dfUS produces enhanced contrast of glioblastoma tumor implanted in the mouse brain, revealing its potential for improving medical diagnosis. Progress towards a real-time system is discussed.
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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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Aghaghazvini L, Maheronnaghsh R, Soltani A, Rouzrokh P, Chavoshi M. Diagnostic value of shear wave sonoelastography in differentiation of benign from malignant thyroid nodules. Eur J Radiol 2020; 126:108926. [PMID: 32171916 DOI: 10.1016/j.ejrad.2020.108926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/27/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To study the efficacy of shear wave elastography (SWE), using both qualitative and quantitative methods, alone and in conjunction with other B-mode features. METHOD 117 patients with 123 nodules were studied both by conventional ultrasonography and SWE. Size, echogenicity, margins, internal calcification (micro- or macro-calcification), composition, shape and color Doppler were assessed for each nodule. The elasticity was assessed both qualitatively and quantitatively. Velocity in the ROI (Region of Interest) was calculated in the stiffest portions for 3 times, and maximum and mean velocity were obtained. ROC curve was analyzed to calculate the best cut-off value of the SWV (Shear Wave Velocity). Univariate logistic regression was used to examine the maximum and mean SWV as discrete variables and the results were compared to key variables of conventional US (Ultrasound) features. RESULT 123 nodules in 117 patients were evaluated. Poor margins, hypoechogenicity, micro-calcification, color Doppler grades III and IV, color map grades IV and V, maximum and minimum velocity had significant correlation with malignancy. The highest Nagelkerke R2 belonged to maximum and mean velocity (R2 = 41.2 and 39 respectively) which propose them as the strongest predictors of malignancy. The best cut-off point for differentiation of benign from malignant nodules was 3.63 m/s for maximum velocity (sensitivity of 90 %, specificity of 78.2 %,) and 3.44 m/s for mean velocity (sensitivity of 90 %, specificity of 76.4 %). CONCLUSION The Real-time SWE is a promising test for the preoperative malignancy risk stratification of patients and maximum velocity has the strongest predictive value for both conventional and elastography variables.
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Affiliation(s)
- Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Aleahmed Highway, Tehran, Iran.
| | - Radin Maheronnaghsh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Aleahmed Highway, Tehran, Iran.
| | - Akbar Soltani
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Shariati Hospital, Aleahmed Highway, Tehran, Iran.
| | - Pouria Rouzrokh
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Shariati Hospital, Aleahmed Highway, Tehran, Iran.
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Aleahmed Highway, Tehran, Iran.
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16
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Ying ZMD, Yifeng ZMD, Hanxiang WMD, Anqi ZMD, Hui SMD. A Novel Two-dimensional Quantitative Shear Wave Elastography Mode for Differential Diagnosis of Benign and Malignant Thyroid Nodules. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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17
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Zamani M, Skagen K, Russell D, Skjelland M. Response by Zamani et al to Letter Regarding Article, “Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media”. Stroke 2020; 51:e12. [DOI: 10.1161/strokeaha.119.027944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mahtab Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - David Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet
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18
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Tuan PA, Duc NM, An M, Vien MV, Giang BV. The Role of Shear Wave Elastography in the Discrimination Between Malignant and Benign Thyroid Nodules. Acta Inform Med 2020; 28:248-253. [PMID: 33627925 PMCID: PMC7879443 DOI: 10.5455/aim.2020.28.248-253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Grayscale ultrasound (US) is the most common imaging modality for the assessment of thyroid nodules. Objective: This research aimed to assess the value of using the elasticity index (EI), obtained using shear wave elastography (SWE), to discriminate between malignant and benign thyroid nodules. Materials and methods: A total of 86 patients (94 distinct thyroid nodules) were operated on at Vietnam National Cancer Hospital from June 2018 to June 2019. Comparisons of the grayscale ultrasound (US) findings and the EI values between the benign and malignant groups were performed using the Chi-square test and Student’s t-test, respectively. The discrimination abilities of EI were determined through receiver operating characteristic (ROC) curve analysis, with the computation of optimal cut-off points. Results: The EI values of the benign and malignant groups were 37.6 ± 26.1 kPa and 105.4 ± 48.8 kPa, respectively. The area under the ROC curve (AUROC) value for discrimination between groups based on EI values was 0.889 when using an optimal cut-off point of 74.5 kPa, which resulted in a sensitivity of 74.3% and a specificity of 90%. Logistic multivariate regression analysis found that EI and microcalcification were significant factors for the discrimination between groups, with an odds ratio (OR): 1.487 [95% confidence interval (95% CI): 1.124–1.968, p = 0.005] and OR: 12.119 (95% CI: 2.031–72.323, p = 0.006), respectively. Combining grayscale US imaging with SWE can increase the specificity of the diagnosis but does not increase the accuracy. Conclusion: SWE can be helpful for predicting the malignancy of thyroid nodules, although the accuracy of this method is only moderate.
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Affiliation(s)
- Phung Anh Tuan
- Department of Radiology, Vietnam Military Medical University, Hanoi, Vietnam.,Diagnostic Imaging Center, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Mac An
- Radiology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Mai Van Vien
- Department of Thoracic Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Bui Van Giang
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
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19
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Zhang C, Duan L, Liu Q, Zhang W. Application of shear wave elastography and B-mode ultrasound in patellar tendinopathy after extracorporeal shockwave therapy. J Med Ultrason (2001) 2019; 47:469-476. [DOI: 10.1007/s10396-019-00979-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/24/2019] [Indexed: 01/02/2023]
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20
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Lewiński A, Adamczewski Z, Zygmunt A, Markuszewski L, Karbownik-Lewińska M, Stasiak M. Correlations between Molecular Landscape and Sonographic Image of Different Variants of Papillary Thyroid Carcinoma. J Clin Med 2019; 8:jcm8111916. [PMID: 31717363 PMCID: PMC6912205 DOI: 10.3390/jcm8111916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
Papillary thyroid carcinoma (PTC), the most common thyroid cancer, is predominantly driven by mutations in BRAF (primarily p. V600E) and RAS oncogenes. Ultrasound (US) examination provides significant diagnostic data in the management of thyroid nodules, as many sonographic features of thyroid lesions are correlated with the potential risk of thyroid carcinoma. The aim of the study was to analyze the current literature in regard to the potential associations between genetic landscape and sonographic features of PTC. Based on the current literature, sonographic features of PTCs correlate with their molecular drivers, particularly between tumors harboring BRAFV600E versus activating RAS mutations, although many of these findings appear to be dependent on the tumor variant. Suspicious US findings, such as hypoechogenicity, spiculated/microlobulated margins, non-parallel orientation/taller-than-wide shape, and the presence of microcalcifications, are typical for PTC positive for BRAFV600E mutations. On the contrary, tumors with RAS mutations are most frequently hypo- or isoechoic and ovoid-to-round in shape, with smooth margins and without calcifications. There are also some US features typical for PTCs harboring other mutations, including BRAFK601E, RET/PTC rearrangements, PAX8-PPARγ, CTNNB1, and APC. However, further research is necessary, as some rare PTC variants still cannot be reliably analyzed due to the scarce published data.
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Affiliation(s)
- Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
- Correspondence: or ; Tel.: +48-42-271-1141; Fax: +48-42-271-1140
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Arkadiusz Zygmunt
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Leszek Markuszewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Małgorzata Karbownik-Lewińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
- Chair and Department of Oncological Endocrinology, Medical University of Lodz, 90-752 Lodz, Poland
| | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
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21
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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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22
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Marturano I, Russo M, Malandrino P, Buscema M, La Rosa GL, Spadaro A, Manzella L, Sciacca L, L'abbate L, Rizzo L. Combined use of sonographic and elastosonographic parameters can improve the diagnostic accuracy in thyroid nodules at risk of malignancy at cytological examination. MINERVA ENDOCRINOL 2019; 45:3-11. [PMID: 31625708 DOI: 10.23736/s0391-1977.19.02945-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules diagnosed as Thy3B at fine-needle aspiration biopsy have a relevant risk of malignancy (15-30%) and are usually addressed to surgery. However surgery will result unnecessary in most cases. The present study aims at evaluating the possible increase of diagnostic accuracy for predicting malignancy using novel sonographic and elastographic parameters. METHODS In fifty patients undergoing thyroidectomy because of a Thy3B thyroid nodule, sonographic and elastosonographic evaluation was carried out by single operator before surgery. Five sonographic parameters (echogenicity, irregular margins, microcalcifications, intra-nodule blood flow and its irregularity) and two elastosonographic parameters (intra-nodule stiffness and its extension to adjacent tissue) were considered. After obtaining histological diagnosis, diagnostic accuracy was calculated. RESULTS When the two procedures were analyzed separately, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were 100%, 85%, 63% and 100% for ultrasonography and 60%, 92.5%, 67%, 90% for elastrosonography, respectively. The newly introduced evaluation procedures increased sensitivity. When a combined sonographic and elastosonographic evaluation was introduced, diagnostic accuracy was significantly improved: when ≥4 out of the seven parameters indicated were present, the risk of malignancy was very high (sensitivity 100%, specificity 92.55%, PPV 77%, NPV 100%). CONCLUSIONS A novel combined sonographic and elastosonographic parameter evaluation improved diagnostic accuracy for identifying thyroid nodules suspicious of malignancy.
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Affiliation(s)
- Ilenia Marturano
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Marco Russo
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy -
| | - Pasqualino Malandrino
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Massimo Buscema
- Center of Diabetology and Endocrine Diseases, Cannizzaro Hospital, Catania, Italy
| | - Giacomo L La Rosa
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Angela Spadaro
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Livia Manzella
- Center of Experimental Oncology and Hematology, Department of Experimental and Clinical Medicine, Catania University Hospital, Catania, Italy
| | - Laura Sciacca
- Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Luca L'abbate
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
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24
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Dobruch-Sobczak K, Migda B, Krauze A, Mlosek K, Słapa RZ, Wareluk P, Bakuła-Zalewska E, Adamczewski Z, Lewiński A, Jakubowski W, Dedecjus M. Prospective analysis of inter-observer and intra-observer variability in multi ultrasound descriptor assessment of thyroid nodules. J Ultrason 2019; 19:198-206. [PMID: 31807325 PMCID: PMC6856778 DOI: 10.15557/jou.2019.0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/29/2019] [Indexed: 12/31/2022] Open
Abstract
Aim: The aim of this study was to evaluate the inter- and intra-observer variability and accuracy of ultrasound assessment of thyroid nodules using a descriptive lexicon. Materials and methods: A prospective study was performed on complete ultrasound examinations, including sonoelastography and color Doppler ultrasound of 18 patients with 20 thyroid nodules. A total of 20 records of thyroid nodules from these techniques were duplicated, numbered, and randomly arranged. Five radiologists assessed the recordings independently. Cohen Kappa and Fleiss Kappa statistics were used to determine the degree of intra- and inter-observer agreement. Results: Mean accuracy rates for all radiologists, for all ultrasound features, ranged from 82.7 to 87.8%. For B-mode and strain elastography, accuracies ranged from 65.0 to 100% and 47.4 to 86.8%, respectively. Concerning intra-observer variability, three radiologists demonstrated almost perfect agreement (the κ-value ranged from 0.81 to 0.86), and a substantial agreement was noted for the two remaining radiologists. The κ-values for inter-observer agreement ranged from 0.61 for macrocalcifications (substantial agreement) to 0.33 for Asteria four-point elastography scale criteria (fair agreement). Conclusions: The results suggest relatively good inter-observer and excellent intra-observer agreement in the assessment of thyroid nodules using ultrasound, and fair agreement in the case of strain elastography.
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Affiliation(s)
- Katarzyna Dobruch-Sobczak
- Department of Radiology II, The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.,Department of Ultrasound, Institute of Fundamental Technological Research, PAS, Warsaw, Poland
| | - Bartosz Migda
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Agnieszka Krauze
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Krzysztof Mlosek
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Rafał Z Słapa
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Paweł Wareluk
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Elwira Bakuła-Zalewska
- Department of Pathology The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland.,Polish Mother's Memorial Hospital-Research Institute, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland.,Polish Mother's Memorial Hospital-Research Institute, Poland
| | - Wiesław Jakubowski
- Diagnostic Imaging Department, Medical University of Warsaw, 2nd Faculty of Medicine with the English Division and the Physiotherapy Division, Warsaw, Poland
| | - Marek Dedecjus
- Department of Nuclear Medicine and Endocrine Oncology, The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
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Swan KZ, Bonnema SJ, Jespersen ML, Nielsen VE. Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma. Endocr Connect 2019; 8:1195-1205. [PMID: 31340198 PMCID: PMC6709542 DOI: 10.1530/ec-19-0324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022]
Abstract
Thyroid nodular disease is common, but predicting the risk of malignancy can be difficult. In this prospective study, we aimed to assess the diagnostic accuracy of shear wave elastography (SWE) in predicting thyroid malignancy. Patients with thyroid nodules were enrolled from a surgical tertiary unit. Elasticity index (EI) measured by SWE was registered for seven EI outcomes assessing nodular stiffness and heterogeneity. The diagnosis was determined histologically. In total, 329 patients (mean age: 55 ± 13 years) with 413 thyroid nodules (mean size: 32 ± 13 mm, 88 malignant) were enrolled. Values of SWE region of interest (ROI) for malignant and benign nodules were highly overlapping (ranges for SWE-ROImean: malignant 3-100 kPa; benign 4-182 kPa), and no difference between malignant and benign nodules was found for any other EI outcome investigated (P = 0.13-0.96). There was no association between EI and the histological diagnosis by receiver operating characteristics analysis (area under the curve: 0.51-0.56). Consequently, defining a cut-off point of EI for the prediction of malignancy was not clinically meaningful. Testing our data on previously proposed cut-off points revealed a low accuracy of SWE (56-80%). By regression analysis, factors affecting EI included nodule size >30 mm, heterogeneous echogenicity, micro- or macrocalcifications and solitary nodule. In conclusion, EI, measured by SWE, showed huge overlap between malignant and benign nodules, and low diagnostic accuracy in the prediction of thyroid malignancy. Our study supports that firmness of thyroid nodules, as assessed by SWE, should not be a key feature in the evaluation of such lesions.
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Affiliation(s)
- Kristine Zøylner Swan
- Department of Otorhinolaryngology Head & Neck Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Correspondence should be addressed to K Z Swan:
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark
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Mechanical properties and morphologic features of intrinsic foot muscles and plantar fascia in individuals with hallux valgus. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:282-286. [PMID: 30961928 PMCID: PMC6737510 DOI: 10.1016/j.aott.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/05/2018] [Accepted: 03/17/2019] [Indexed: 12/18/2022]
Abstract
Background The aim of the present study was to investigate the morphologic features and mechanical properties of plantar fascia (PF), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and abductor hallucis (AbH) muscles in individuals with halluks valgus (HV) and to compare the results with individuals without HV. Methods A total of 30 participants (27 female, 3 male) between the ages of 19–58 years with HV deformity and 30 individuals without HV (27 female, 3 male) between the ages of 20–58 years were included in the study. AbH, PF, FHB, and FDB thickness, cross-sectional area and stiffness were measured with an ultrasonography device. For stiffness measurements, Shear Wave Velocity (SWV) of the assessed soft tissues was calculated using a customized software program. Results Mean and standard deviation of SWV of PF, AbH, FHB, FDB, and thickness of PF, AbH, FHB, FDB, and cross-sectional area of AbH, FHB, FDB in individuals with HV were 7.6 ± 1.0 m/sec, 2.8 ± 0.3 m/sec, 2.6 ± 0.4 m/sec, and 3.4 ± 0.2 m/sec, 3.3 ± 0.5 mm, 11.4 ± 2.2 mm, 16.5 ± 1.9 mm, 8.9 ± 1.8 mm, 2.4 ± 0.5 cm2, 2.7 ± 0.5 cm2, 1.9 ± 0.6 cm2, respectively. Mean and standard deviation of SWV of PF, AbH, FHB, FDB and thickness of PF, AbH, FHB, FDB, and cross-sectional area of AbH, FHB, FDB in controls groups were 7.6 ± 1.2 m/sec, 2.3 ± 0.3 m/sec, 2.3 ± 0.4 m/sec, and 3.4 ± 0.4 m/sec, 3.3 ± 0.5 mm, 9.7 ± 2.1 mm, 14.5 ± 1.4 mm, 9.7 ± 1.2 mm, 2.1 ± 0.3 cm2, 2.3 ± 0.4 cm2, 2.1 ± 0.4 cm2, respectively. Individuals with HV had lower AbH and FHB thickness, cross-sectional area and SWV, however FDB thickness and cross-sectional area were higher in individuals with HV compared to that of individuals without HV (p < 0.05). PF thickness (p = 0.273), SWV of PF (p = 0.979) and FDB (p = 0.295) were similar in both groups. Conclusion Our results suggest that individuals with HV had lower AbH and FHB stiffness, however PF and FDB stiffness were similar in HV and control group. In addition, AbH and FHB thickness and cross-sectional area were lower in individuals with HV; however, FDB thickness and cross-sectional area were higher in individuals with HV compared to that of individuals without HV. Level of Evidence Level III, Diagnostic Study.
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Diagnostic Performance of Ultrasound Patterns by K-TIRADS and 2015 ATA Guidelines in Risk Stratification of Thyroid Nodules and Follicular Lesions of Undetermined Significance. AJR Am J Roentgenol 2019; 213:444-450. [PMID: 31039023 DOI: 10.2214/ajr.18.20961] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE. The objective of our study was to assess the malignancy rates of thyroid nodules in the cytologically determined subclass of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) and to assess the diagnostic performance of ultrasound (US) patterns defined by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the 2015 American Thyroid Association (ATA) guidelines for risk stratification of AUS/FLUS nodules. MATERIALS AND METHODS. From January 2010 to December 2016, 1340 thyroid nodules were diagnosed as AUS/FLUS via fine-needle aspiration biopsy. Of these, 683 cytopathologically confirmed nodules were included in this study. Each nodule was assigned to a category and US pattern, as defined by the K-TIRADS and ATA guidelines. US patterns were compared between benign and malignant nodules, and malignancy rates were calculated according to the subclasses of AUS/FLUS nodules and the K-TIRADS and ATA guidelines. Predictors of malignancy were assessed using logistic regression analysis. RESULTS. The overall malignancy rate of AUS/FLUS nodules was 47.4% (324/683). There were significant differences in malignancy risk among the subclasses (p = 0.001). There were significant differences in malignancy rates according to US patterns, K-TIRADS categories, and ATA categories (p < 0.001). The malignancy rates in the K-TIRADS categories of benign, low, intermediate, and high suspicion were 0%, 1.99%, 34.66%, and 89.00%, respectively (p < 0.001). The malignancy rates in the ATA categories of benign, very low, low, intermediate, and high suspicion were 0%, 0%, 3.33%, 33.54%, and 87.67% (p < 0.001). CONCLUSION. AUS/FLUS nodules with a final diagnosis of malignancy had significantly higher rates of suspicious US features and different K-TIRADS and ATA categories than benign nodules. US categories by K-TIRADS and ATA guidelines can be useful in predicting malignancy and risk stratification, and management planning can be adjusted according to US pattern.
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Szczepanek-Parulska E, Klubo-Gwiezdzinska J, Ruchala M. Editorial: Novel Imaging Techniques in the Management of Thyroid Nodules and Autoimmune Thyroid Disease. Front Endocrinol (Lausanne) 2019; 10:804. [PMID: 31824421 PMCID: PMC6879449 DOI: 10.3389/fendo.2019.00804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/04/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Klubo-Gwiezdzinska
- Thyroid Tumors and Functional Thyroid Disorders Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, United States
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Marek Ruchala
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Stangierski A, Wolinski K, Ruchala M. Shear wave elastography in the diagnostics of parathyroid adenomas-new application of the method. Endocrine 2018; 60:240-245. [PMID: 29468557 PMCID: PMC5893658 DOI: 10.1007/s12020-018-1553-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/30/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Shear wave elastography (SWE) was described as valuable tool in the diagnostics of distinct types of thyroid lesions, thyroiditis and several other non-thyroidal conditions, such as liver inflammation and fibrosis or diagnostics of breast lesions. The aim of the current study was to assess the appearance of parathyroid adenomas in SWE and to check prospectively if SWE can be valuable additional tool in the diagnostics of pathologically enlarged parathyroids. METHODS Patients with parathyroid adenomas confirmed by histopathology were included. Subjects with benign thyroid lesions were enrolled to the control group. Elasticity of parathyroid adenomas and benign thyroid nodules was measured and compared. RESULTS Sixty five patients with parathyroid adenomas and 35 patients with 51 benign thyroid nodules were included. Parathyroid adenomas where significantly more elastic than benign thyroid nodules-mean elasticity of the lesion was 5.2 ± 7.2 vs. 24.3 ± 33.8 kPa, respectively. Relative mean elasticity (in comparison with surrounding thyroid tissue) was 0.30 ± 0.36 and 2.8 ± 3.9, respectively. CONCLUSIONS SWE can be useful tool in the diagnostics of parathyroid adenomas. Enlarged parathyroids are significantly more elastic than benign thyroid lesions. Low elasticity of the lesion constitutes feature with high negative prognostic value, allowing for reliable exclusion of suspicion of parathyroid adenomas.
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Affiliation(s)
- Adam Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Kosma Wolinski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Wang F, Chang C, Chen M, Gao Y, Chen YL, Zhou SC, Li JW, Zhi WX. Does Lesion Size Affect the Value of Shear Wave Elastography for Differentiating Between Benign and Malignant Thyroid Nodules? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:601-609. [PMID: 28906009 DOI: 10.1002/jum.14367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We aimed to investigate the diagnostic performance of shear wave elastography (SWE) combined with conventional ultrasonography (US) for differentiating between benign and malignant thyroid nodules of different sizes. METHODS A total of 445 thyroid nodules from 445 patients were divided into 3 groups based on diameter (group 1, ≤ 10 mm; group 2, 10-20 mm; and group 3, > 20 mm). The mean elasticity index of the whole lesion was automatically calculated, and the threshold for differentiation between benign and malignant nodules was constructed by a receiver operating characteristic curve analysis. Diagnostic performances of conventional US and SWE were compared by using pathologic results as reference standards. RESULTS The mean elasticity was significantly higher in malignant versus benign nodules for all size groups. The differences in mean elasticity in the size groups were not statistically significant for malignant or benign nodules. The specificity of US combined with SWE for group 1 was significantly higher than that for groups 2 and 3 (77.8% versus 62.9% and 53.3%; P < .05), and compared with group 1, the sensitivity was significantly higher for groups 2 and 3 (92.4% and 94.3% versus 80.7%; P < .05). When SWE was added, the specificity increased and the sensitivity and diagnostic accuracy decreased for group 1, and the sensitivity increased and the specificity decreased for groups 2 and 3; however, the differences were not significant. CONCLUSIONS Combined with SWE, US yielded higher specificity for nodules of 10 mm and smaller and higher sensitivity for nodules larger than 10 mm.
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Affiliation(s)
- Fen Wang
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Chen
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi Gao
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Ling Chen
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shi-Chong Zhou
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia-Wei Li
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Xiang Zhi
- Departments of Ultrasonography and Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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Clinical Value of 99mTc-3PRGD2 SPECT/CT in Differentiated Thyroid Carcinoma with Negative 131I Whole-Body Scan and Elevated Thyroglobulin Level. Sci Rep 2018; 8:473. [PMID: 29323252 PMCID: PMC5765165 DOI: 10.1038/s41598-017-19036-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to assess the usefulness of integrin imaging with 99mTc-PEG4-E[PEG4-c(RGDfK)]2 (99mTc-3PRGD2) single photon emission computed tomography (SPECT)/computed tomography (CT) in detecting recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg). Thirty-seven patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels were included. 99mTc-3PRGD2 SPECT/CT was performed 1 week after the negative diagnostic 131I WBS. Diagnostic performance indicators, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), for 99mTc-3PRGD2 SPECT/CT was calculated. The correlations between SPECT/CT results and clinic-pathological characteristics were examined. In 30 (81.1%) of the 37 patients, 99mTc-3PRGD2 SPECT/CT showed positive uptake. The sensitivity, specificity, PPV, and NPV of SPECT/CT to detect recurrent disease at follow-up were 96.6%, 75%, 93.3% and 85.7%, respectively. The sensitivity and PPV of SPECT/CT increased with increasing serum Tg levels. 99mTc-3PRGD2 SPECT/CT showed high sensitivity and PPV in the detection of recurrence among DTC patients with higher Tg levels and negative WBS, and the probability of obtaining a positive SPECT/CT result was related with the level of Tg.
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Idiz UO, Aysan E, Elmas L, Yildiz S, Akbulut H. The Place of Elastography in Evaluating the Efficacy of Radiofrequency Ablation of Thyroid Nodules. Am Surg 2017. [DOI: 10.1177/000313481708301124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The usage of radiofrequency ablation (RFA) therapy and elastography to treat thyroid nodules has been increasing recently. Elastography specifically measures the stiffness of tissue using ultra-sonography (US). The aim of the present study was to evaluate the relationship between the elastography values of thyroid nodules and the efficacy of RFA therapy. Ultrasonography was performed on 49 patients who had a thyroid nodule with a diameter of 1 cm or greater before RFA therapy. The RFA was performed under local anesthesia, and elastography was used to measure the stiffness of the normal thyroid tissue, sternocleidomastoid muscle (SCM) and thyroid nodules three months after RFA. The nodule diameter significantly decreased three months after RFA (P < 0.05). According to a cross-evaluation of the mean elastography rates, the thyroid/SCM and nodule/thyroid elastography rates had an inverse relationship (P: 0.009). However, the thyroid/ SCM elastography rates and nodule/SCM elastography rates (P: 0.022) and the thyroid/SCM elastography rates and the rates of reduction (%) of the nodule diameter before and three months after RFA (P: 0.016) had positive relationships. In conclusion, RFA therapy is more effective in patients with thyroid nodules if there are high thyroid tissue/SCM rates in elastography.
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Affiliation(s)
- Ufuk O. Idiz
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Erhan Aysan
- Departments of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Leyla Elmas
- Departments of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Seyma Yildiz
- Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Huseyin Akbulut
- Departments of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7111103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Lima KMME, Costa Júnior JFS, Pereira WCDA, Oliveira LFD. Assessment of the mechanical properties of the muscle-tendon unit by supersonic shear wave imaging elastography: a review. Ultrasonography 2017; 37:3-15. [PMID: 28607322 PMCID: PMC5769952 DOI: 10.14366/usg.17017] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/15/2017] [Accepted: 04/15/2017] [Indexed: 12/25/2022] Open
Abstract
This review aimed to describe the state of the art in muscle-tendon unit (MTU) assessment by supersonic shear wave imaging (SSI) elastography in states of muscle contraction and stretching, during aging, and in response to injury and therapeutic interventions. A consensus exists that MTU elasticity increases during passive stretching or contraction, and decreases after static stretching, electrostimulation, massage, and dry needling. There is currently no agreement regarding changes in the MTU due to aging and injury. Currently, the application of SSI for the purpose of diagnosis, rehabilitation, and physical training remains limited by a number of issues, including the lack of normative value ranges, the lack of consensus regarding the appropriate terminology, and an inadequate understanding of the main technical limitations of this novel technology.
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Affiliation(s)
- Kelly Mônica Marinho E Lima
- Laboratory of Biomechanics of the Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Liliam Fernandes de Oliveira
- Laboratory of Biomechanics of the Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Swan KZ, Nielsen VE, Bibby BM, Bonnema SJ. Is the reproducibility of shear wave elastography of thyroid nodules high enough for clinical use? A methodological study. Clin Endocrinol (Oxf) 2017; 86:606-613. [PMID: 28002625 DOI: 10.1111/cen.13295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/04/2016] [Accepted: 12/14/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To systematically assess the reproducibility of thyroid ultrasonographic shear wave elastography (SWE). CONTEXT SWE has been suggested as a potential tool for thyroid nodule evaluation, but assessment of its reproducibility has been insufficiently addressed. DESIGN SWE examinations were performed prospectively by two investigators. PATIENTS Seventy-two patients (male/female: 19/53; mean age: 53 ± 14 years; malignant/benign 17/55) undergoing thyroid surgery were enrolled in the study. MEASUREMENTS Repeated and blinded measurements of elasticity index (EI) in predefined regions of interest (ROI) were collected. The inter- and intrarater agreement, along with the day-to-day agreement, was evaluated in terms of the 95% limits of agreement (LOA). Results are presented as a ratio, by which 1·0 indicates perfect agreement. RESULTS The interrater, intrarater and day-to-day LOA showed ratios between repeated measurements of 1·7-3·6, 1·8-3·7 and 2·2-2·9, respectively. These values reflect a low to moderate degree of agreement for all EI outcomes. The interrater LOA was higher for malignant nodules compared with benign nodules for six of seven EI outcomes (P < 0·001-0·03). The proportion of agreement calculated from the optimum cutoff point for differentiating malignant from benign nodules was 63-88% for the investigated EI outcomes. CONCLUSIONS In this methodological study, EI measured by thyroid SWE seems suboptimal for clinical use, due to a low inter- and intrarater agreement. That EI varies from day to day furthermore jeopardizes the validity of the method. Although the proportion of agreement was acceptable for some EI parameters, it is questionable whether EI assessments can reliably differentiate malignant from benign nodules in the individual patient.
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Affiliation(s)
- Kristine Zøylner Swan
- Department of Otorhinolaryngology and Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Viveque Egsgaard Nielsen
- Department of Otorhinolaryngology and Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Martin Bibby
- Department of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Aarhus, Denmark
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Taş S, Onur MR, Yılmaz S, Soylu AR, Korkusuz F. Shear Wave Elastography Is a Reliable and Repeatable Method for Measuring the Elastic Modulus of the Rectus Femoris Muscle and Patellar Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:565-570. [PMID: 28108983 DOI: 10.7863/ultra.16.03032] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to determine intraobserver, interobserver, and inter-day reliability levels for stiffness measurements of the patellar tendon and rectus femoris muscle using shear wave elastography (SWE). METHODS This study was conducted on 12 healthy male individuals. Two examiners measured mean shear wave velocity values of the patellar tendons and rectus femoris muscles of both extremities using a 9L4 (4-9 MHz) transducer and an Acuson S3000 ultrasound system (Siemens Medical Solutions, Mountain View, CA). The elasticity images were acquired by the Virtual Touch tissue imaging quantification technique (Siemens Medical Solutions). Measurements were repeated 20 minutes and 1 week after the first measurements. The reliability of SWE measurements was assessed by means of the intraclass correlation coefficient (ICC). RESULTS The 12 participants ranged in age from 19 to 33 years (mean age ± SD, 25.33 ± 4.56 years). For the patellar tendon stiffness measurements with SWE, it was found that intraobserver reliability (ICC, 0.91-0.92) and interday reliability (ICC, 0.81-0.83) were excellent, and interobserver reliability (ICC, 0.71) was good. For the rectus femoris muscle stiffness measurements with SWE, it was found that the intraobserver reliability (ICC, 0.93-0.94), interday reliability (ICC, 0.81-0.91), and interobserver reliability (ICC, 0.95) were perfect. CONCLUSIONS Shear wave elastography using the Virtual Touch tissue imaging quantification technique is a reliable and repeatable technique for patellar tendon and rectus femoris stiffness measurements according to intraobserver, interday, and interobserver ICC values.
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Affiliation(s)
- Serkan Taş
- Hacettepe University, Beytepe Hospital, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Seval Yılmaz
- Hacettepe University, Beytepe Hospital, Ankara, Turkey
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Feza Korkusuz
- Department of Sports Medicine, Hacettepe University, School of Medicine, Ankara, Turkey
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Zhou H, Zhou XL, Xu HX, Li DD, Liu BJ, Zhang YF, Xu JM, Bo XW, Li XL, Guo LH, Qu S. Virtual Touch Tissue Imaging and Quantification in the Evaluation of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:251-260. [PMID: 27914177 DOI: 10.7863/ultra.15.12070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of a 2-dimensional shear wave elastographic technique (Virtual Touch tissue imaging and quantification [VTIQ]; Siemens Medical Solutions, Mountain View, CA) for predicting thyroid malignancy. METHODS A total of 302 thyroid nodules underwent conventional sonography and VTIQ before fine-needle aspiration examination or surgery. Compared with histopathologic or cytologic results in combination with follow-up, the diagnostic performance of various shear wave speed (SWS) indices (minimum [SWSmin ], maximum [SWSmax ], and mean [SWSmean ]) on VTIQ as well as conventional sonographic features for predicting thyroid malignancy was evaluated in all of the nodules. RESULTS Sixty-five malignant and 237 benign thyroid nodules were histopathologically or cytologically confirmed. All SWS indices on VTIQ were lower in benign nodules than thyroid malignancy (all P < .001). For discrimination between malignant and benign nodules, all VTIQ SWS indices were better than conventional sonographic features, such as a solid component, a taller-than-wide shape, microcalcification, a poorly defined margin and hypoechogenicity, in predicting thyroid malignancy (all P < .05). By applying a cutoff SWSmean value of 2.60 m/s, VTIQ achieved sensitivity and negative predictive values of 84.6% and 94.3%, respectively, for differentiating nodules. The areas under the receiver operating characteristic curve of SWSmax (0.862 versus 0.717), SWSmin (0.866 versus 0.717), and SWSmean (0.891 versus 0.725) for nodules larger than 10 mm were higher than those for nodules of 10 mm or smaller (all P < .05). Interoperator and intraoperator reproducibility was proven to be excellent, with all interclass correlation coefficient values higher than 0.80 (range, 0.813-0.905) CONCLUSIONS: Virtual Touch tissue imaging and quantification is a useful and reproducible tool for predicting thyroid malignancy.
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Affiliation(s)
- Hang Zhou
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Inpatient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Xian-Li Zhou
- Inpatient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, 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
| | - Dan-Dan 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
| | - 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
| | - Yi-Feng Zhang
- 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
| | - Jun-Mei 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
| | - 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
| | - 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
| | - Le-Hang Guo
- 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
| | - Shen Qu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Taş S, Yılmaz S, Onur MR, Soylu AR, Altuntaş O, Korkusuz F. Patellar tendon mechanical properties change with gender, body mass index and quadriceps femoris muscle strength. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:54-59. [PMID: 28010997 PMCID: PMC6197583 DOI: 10.1016/j.aott.2016.12.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/24/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the effect and correlation of gender, body mass index (BMI) and quadriceps femoris (QF) muscle strength on patellar tendon (PT) thickness and stiffness in healthy sedentary individuals. METHODS This study was carried out with 67 (36 female, 31 male) healthy sedentary individuals between the ages of 18-44 (28.0 ± 7.5 years). The individuals included in the study were divided into two groups according to their gender and BMI (18.5<BMI<25 and 25<BMI). The body composition was determined with Tanita Body Composition Analyser. PT thickness and stiffness was measured with ACUSON S3000 Ultrasonography Device using 9L4 ultrasonography probe. QF concentric muscle strength of the individuals was measured with Biodex® System 4 Dynamometer at 60°/sec angular speed. RESULTS It was found that PT stiffness was higher in males compared to females (p<0.001). It was found that PT stiffness was lower in obese individuals compared to individuals with normal weight (p = 0.017). A negative and weak correlation was found between BMI and PT stiffness (r = -0.26, p = 0.032), whereas a negative and moderate correlation was found between fat percentage and PT stiffness (r = -0.50, p<0.001). A moderate correlation was found between BMI and PT thickness (r = 0.54, p<0.001). It was found that peak torque at 60°/sec angular speed had a moderate correlation with PT stiffness (r = 0.44, p<0.001) and PT thickness (r = 0.45, p<0.001). CONCLUSIONS PT stiffness is correlated and affected by gender, BMI and QF muscle strength whereas PT thickness is correlated and affected only to BMI and QF muscle strength.
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Golu I, Sporea I, Moleriu L, Tudor A, Cornianu M, Vlad A, Timar R, Balas M, Amzar D, Vlad M. 2D-Shear Wave Elastography in the Evaluation of Parathyroid Lesions in Patients with Hyperparathyroidism. Int J Endocrinol 2017; 2017:9092120. [PMID: 28845158 PMCID: PMC5563409 DOI: 10.1155/2017/9092120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS 2D-shear wave elastography (2D-SWE) is a relatively new elastographic technique. The aim of the present study is to determine the values of the elasticity indexes (EI) measured by 2D-SWE in parathyroid benign lesions (adenomas or hyperplasia) and to establish if this investigation is helpful for the preoperative identification of the parathyroid adenoma. MATERIAL AND METHODS The study groups were represented by 22 patients with primary or tertiary hyperparathyroidism, diagnosed by specific tests, and 43 healthy controls, in whom the thyroid parenchyma was evaluated, in order to compare the EI of the thyroid tissue with those of the parathyroid lesions. RESULTS The mean EI measured by 2D-SWE in the parathyroid lesions was 10.2 ± 4.9 kPa, significantly lower than that of the normal thyroid parenchyma (19.5 ± 7.6 kPa; p = 0.007), indicating soft tissue. For a cutoff value of 12.5 kPa, the EI assessed by 2D-SWE had a sensitivity of 93% and a specificity of 86% (AUC = 0.949; p < 0.001) for predicting parathyroid lesions. CONCLUSION A value lower than 12.5 kPa for the mean EI measured by 2D-SWE can be used to confirm that the lesion/nodule is a parathyroid adenoma.
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Affiliation(s)
- Ioana Golu
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioan Sporea
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Lavinia Moleriu
- Department of Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Tudor
- Department of Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Marioara Cornianu
- Department of Pathology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Vlad
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Diabetes and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- *Adrian Vlad:
| | - Romulus Timar
- Department of Diabetes and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Melania Balas
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniela Amzar
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihaela Vlad
- Department of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Elastography Center, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Colakoglu B, Yildirim D, Alis D, Ucar G, Samanci C, Ustabasioglu FE, Bakir A, Ulusoy OL. Elastography in Distinguishing Benign from Malignant Thyroid Nodules. J Clin Imaging Sci 2016; 6:51. [PMID: 28123841 PMCID: PMC5209857 DOI: 10.4103/2156-7514.197074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/30/2016] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this study is to test the diagnostic success of strain elastography in distinguishing benign from malignant thyroid nodules. MATERIALS AND METHODS The size, echogenicity, and halo integrity of 293 thyroid nodules and the presence of microcalcification in these nodules were evaluated on gray-scale examination. Doppler characteristics and elastography patterns were also evaluated and recorded. Nodules were classified in four categories (patterns 1-4) based on elastographic examination. RESULTS According to the cytopathological findings, 222 nodules were benign, and 71 nodules were malignant. The risk of a nodule to be malignant was 3.8 times increased by hypoechogenicity, 7.7 times increased by the presence of microcalcification, and 11.5 times increased by the absence of halo. On Doppler patterns, the presence of central vascularity increased the malignancy risk of a nodule by 5.8 times. According to the receiver operating characteristic analysis, patterns 3 and 4 were malignant, and patterns 1 and 2 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of elastography were 100%, 80.2%, 61.7%, 100%, and 85%, respectively. CONCLUSION Strain elastography can be used as a noninvasive method in distinguishing benign from malignant thyroid nodules and in identifying the patients who would undergo surgery.
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Affiliation(s)
- Bulent Colakoglu
- Department of Radiology, Vehbi Koç Foundation American Hospital, Istanbul, Turkey
| | - Duzgun Yildirim
- Department of Radiology, Acıbadem Taksim Hospital, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gokhan Ucar
- Department of Radiology, Vehbi Koç Foundation American Hospital, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Alev Bakir
- Department of Biostatistics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Onur Levent Ulusoy
- Department of Radiology, Florence Nightingale Hospital, Istanbul, Turkey
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Yuan S, Magarik M, Lex AM, Fleischer AC. Clinical applications of sonoelastography. Expert Rev Med Devices 2016; 13:1107-1117. [DOI: 10.1080/17434440.2016.1257938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Seong M, Shin JH, Hahn SY. Ultrasound Strain Elastography for Circumscribed Solid Thyroid Nodules without Malignant Features Categorized as Indeterminate by B-Mode Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2383-2390. [PMID: 27451050 DOI: 10.1016/j.ultrasmedbio.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/31/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to evaluate the diagnostic performance of ultrasound strain elastography (USE) for circumscribed solid thyroid nodules without malignant or benign features seen on US. This retrospective study included 197 thyroid nodules in 196 patients who underwent USE with color mapping and strain ratio measurement between 2010 and 2014. Of the 197 nodules, 24 (12.2%) were malignant. No significant differences in color mapping or strain ratio were observed between benign and malignant nodules. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 29.2% (95% confidence interval [CI]: 13.8%-49.4%), 77.5% (95% CI: 75.3%-80.3%), 15.2% (95% CI: 7.2%-25.8%), 88.7% (95% CI: 86.3%-92.0%), and 71.6% (95% CI: 67.8%-76.5%) for color mapping and 50.0% (95% CI: 30.%-69.5%), 57.2% (95% CI: 54.5%-59.9%), 14.0% (95% CI: 8.5%-18.4%), 89.2% (95% CI: 85.0%-93.4%) and 56.3% (95% CI: 51.6%-61.1%) for strain ratio measurement, respectively. USE with color mapping and strain ratio measurement has a limited ability to differentiate benign from malignant nodules for circumscribed solid thyroid nodules without definite malignant features categorized as indeterminate by B-mode US.
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Affiliation(s)
- Minjung Seong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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The usefulness of fluorine-18 fluorodeoxyglucose PET in the detection of recurrence in patients with differentiated thyroid cancer with elevated thyroglobulin and negative radioiodine whole-body scan. Nucl Med Commun 2016; 37:935-8. [DOI: 10.1097/mnm.0000000000000563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Park SY, Hahn SY, Shin JH, Ko EY, Oh YL. The Diagnostic Performance of Thyroid US in Each Category of the Bethesda System for Reporting Thyroid Cytopathology. PLoS One 2016; 11:e0155898. [PMID: 27348515 PMCID: PMC4922578 DOI: 10.1371/journal.pone.0155898] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
We aimed to evaluate the diagnostic performance of thyroid ultrasonography (US) in each category of the Bethesda system and analyze false positive/negative findings using US. This retrospective study included 622 thyroid nodules in 592 patients. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of US in each category of the Bethesda system were evaluated. False positive/negative cases of US were analyzed. Out of the 622 total thyroid FNAs, 179 (28.8%) were malignant. The malignancy rates for the 6 categories were as follows: I (nondiagnostic): 9.7%, II (benign): 2.5%, III (atypia/follicular lesion of undetermined significance): 37.5%, IV (suspicious for follicular neoplasm): 5.7%, V (suspicious for malignancy): 100%, and VI (malignancy): 100%. The accuracies of US for the 6 categories were 92.5%, 95.6%, 70.8%, 94.3%, 95%, and 92.4% in category order. US showed the lowest sensitivity (50%) in Category IV. Category III demonstrated relatively low sensitivity (66.7%) and specificity (73.3%) due to a high incidence of follicular variant of papillary thyroid carcinoma and a low number of category III nodules. The most optimal performance of US was revealed in Category I with 88.9% sensitivity and 92.9% specificity. In 22 US false positive cases, the most frequent finding was associated with marked hypoechogenicity and the least finding was noncircumscribed margin. The most common US features of 19 false negative cases were circumscribed iso or hypoechoic nodules. These results highlight the excellent diagnostic performance of US in category I of the Bethesda system and the lowest sensitivity of US in category IV. Awareness of US interpreters regarding these pitfalls can minimize false positive/negative diagnoses and prevent unnecessary interventions.
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Affiliation(s)
- So Yoon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Comparison of diagnostic yield of core-needle and fine-needle aspiration biopsies of thyroid lesions: Systematic review and meta-analysis. Eur Radiol 2016; 27:431-436. [PMID: 27090114 PMCID: PMC5127867 DOI: 10.1007/s00330-016-4356-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/26/2016] [Accepted: 04/05/2016] [Indexed: 12/16/2022]
Abstract
Objectives Thyroid nodular disease is one of the most commonly observed medical conditions. Cytological evaluation of the specimens obtained with fine-needle aspiration biopsy (FNAB) is the most accurate tool for selecting nodules which should be further surgically removed. A major limitation of this method is the high occurrence of non-diagnostic results. This indicates the need for improvement of the thyroid biopsy technique. The aim of this meta-analysis was to compare the diagnostic value of thyroid core-needle biopsies (CNBs) and FNABs. Materials and methods PubMed/MEDLINE, Cochrane Library, Scopus, Cinahl, Academic Search Complete, Web of Knowledge, PubMed Central, PubMed Central Canada and Clinical Key databases were searched. Risk ratios (RRs) of non-diagnostic results were meta-analysed using the random-effects model. Results Eleven studies were included in the quantitative analysis. CNB yielded significantly more diagnostic results – the pooled risk ratio (RR) of gaining a non-diagnostic result was 0.27 (p<0.0001). For lesions with one previous non-diagnostic FNAB, RR was 0.22 (p<0.0001). Conclusions CNB seems to be a valuable diagnostic technique yielding a higher proportion of diagnostic results than conventional FNAB. It is also significantly more effective in case of nodules with a prior non-diagnostic result of FNAB results than repeated FNABs. Key Points • Core-needle biopsy yields a higher proportion of diagnostic results than fine-needle biopsy. • Core-needle biopsies may decrease the amount of unnecessary thyroidectomies. • Probability of gaining non-diagnostic result using core-needle biopsy is almost four times lower.
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Duan SB, Yu J, Li X, Han ZY, Zhai HY, Liang P. Diagnostic value of two-dimensional shear wave elastography in papillary thyroid microcarcinoma. Onco Targets Ther 2016; 9:1311-7. [PMID: 27022286 PMCID: PMC4790519 DOI: 10.2147/ott.s98583] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study was to evaluate the predictability of two-dimensional shear wave elastography (2D-SWE) for papillary thyroid microcarcinoma (PTMC). Materials and methods One hundred and eighteen patients with 137 thyroid nodules (46 benign nodules, 91 malignant nodules) were included in this study who received conventional ultrasound (US) and 2D-SWE before fine-needle aspiration or surgery. The diagnostic performance was compared between US findings only and the combined use of US findings with 2D-SWE, which were correlated with pathology results. Results Receiver-operating characteristic curve analysis was performed to assess the diagnostic performance of 2D-SWE. Conventional US findings and 2D-SWE values were analyzed and compared between benign and malignant thyroid nodules. The mean values of SWE_mean, SWE_min, and SWE_max were 46.6±16.7, 26.2±9.5, and 73.6±18.1 kPa, respectively, in PTMC, which were significantly higher than those in benign tumors (27.8±12.4, 15.8±8.6, and 50.3±22.6 kPa, P<0.001). The optimal cut-off values of SWE_mean, SWE_min, and SWE_max for predicting malignancy were 34.5, 21.8, and 53.2 kPa, respectively. Taller than wide, micro-calcification, and SWE_mean were found to be independent risk factors for predicting PTMC. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of combined conventional US features with 2D-SWE parameters were 95.7%, 94.5%, 94.9%, 89.8%, and 97.7%, respectively; these were superior to those of conventional US (89.1%, 90.1%, 89.9%, 82.0%, and 93.2%). Conclusion The study indicates that the quantitative parameters of 2D-SWE are an independent predictive factor for diagnosing PTMC, which could provide valuable information when conventional US cannot give determinate results.
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Affiliation(s)
- Shao-Bo Duan
- Department of Interventional Ultrasound, Medical Center Tsinghua University, Beijing, People's Republic of China; Department of Interventional Ultrasound, PLA General Hospital, Beijing, People's Republic of China
| | - Jie Yu
- Department of Interventional Ultrasound, PLA General Hospital, Beijing, People's Republic of China
| | - Xin Li
- Department of Interventional Ultrasound, PLA General Hospital, Beijing, People's Republic of China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, PLA General Hospital, Beijing, People's Republic of China
| | - Hong-Yan Zhai
- Department of Interventional Ultrasound, PLA General Hospital, Beijing, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, PLA General Hospital, Beijing, People's Republic of China
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Woliński K, Stangierski A, Szczepanek-Parulska E, Gurgul E, Budny B, Wrotkowska E, Biczysko M, Ruchala M. VEGF-C Is a Thyroid Marker of Malignancy Superior to VEGF-A in the Differential Diagnostics of Thyroid Lesions. PLoS One 2016; 11:e0150124. [PMID: 26900960 PMCID: PMC4762679 DOI: 10.1371/journal.pone.0150124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/09/2016] [Indexed: 12/26/2022] Open
Abstract
Introduction Thyroid nodular goiter is one of the most common medical conditions affecting even over a half of adult population. The risk of malignancy is rather small but noticeable–estimated by numerous studies to be about 3–10%. The definite differentiation between benign and malignant ones is a vital issue in endocrine practice. The aim of the current study was to assess the expression of vascular endothelial growth factor A (VEGF-A) and VEGF-C on the mRNA level in FNAB washouts in case of benign and malignant thyroid nodules and to evaluate the diagnostic value of these markers of malignancy. Materials and Methods Patients undergoing fine-needle aspiration biopsy (FNAB) in our department between January 2013 and May 2014 were included. In case of all patients who gave the written consent, after ultrasonography (US) and fine-needle aspiration biopsy (FNAB) performed as routine medical procedure the needle was flushed with RNA Later solution, the washouts were frozen in -80 Celsius degrees. Expression of VEGF-A and VEGF-C and GADPH (reference gene) was assessed in washouts on the mRNA level using the real-time PCR technique. Probes of patients who underwent subsequent thyroidectomy and were diagnosed with differentiated thyroid cancer (DTC; proved by post-surgical histopathology) were analyzed. Similar number of patients with benign cytology were randomly selected to be a control group. Results Thirty one DTCs and 28 benign thyroid lesions were analyzed. Expression of VEGF-A was insignificantly higher in patients with DTCs (p = 0.13). Expression of VEGF-C was significantly higher in patients with DTC. The relative expression of VEGF-C (in comparison with GAPDH) was 0.0049 for DTCs and 0.00070 for benign lesions, medians – 0.0036 and 0.000024 respectively (p<0.0001). Conclusions Measurement of expression VEGF-C on the mRNA level in washouts from FNAB is more useful than more commonly investigated VEGF-A. Measurement of VEGF-C in FNAB washouts do not allow for fully reliable differentiation of benign and malignant thyroid nodules and should be interpreted carefully. Further studies on larger groups are indicated. However, measurement of VEGF-C on mRNA level can bring important information without exposing patient for additional risk and invasive procedures.
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Affiliation(s)
- Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
| | - Adam Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Edyta Gurgul
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Budny
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Elzbieta Wrotkowska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Biczysko
- Department of General, Gastroenterological and Endocrine Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Tian W, Hao S, Gao B, Jiang Y, Zhang S, Guo L, Luo D. Comparison of Diagnostic Accuracy of Real-Time Elastography and Shear Wave Elastography in Differentiation Malignant From Benign Thyroid Nodules. Medicine (Baltimore) 2015; 94:e2312. [PMID: 26717367 PMCID: PMC5291608 DOI: 10.1097/md.0000000000002312] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Thyroid nodules are relatively more prevalent in iodine-deficiency area, and the incidence increased sharply in the past decade in these areas. Workup of malignant from benign nodules in clinic was the main problem for managing thyroid nodules.An overall search for the articles about the diagnostic performance of real-time elastography (RTE) and shear wave elastography (SWE) before April 2015 in the databases of PubMed, Embase, and Google scholar. The pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curve were obtained from individual studies with a random-effects model. Subgroup and meta-regression analysis were also performed.Fifty-six studies involved in 2621 malignant nodules and 7380 benign nodules were contained in our meta-analysis. The pooled sensitivity and specificity of RTE was 83.0% and 81.2%, which is higher than SWE (sensitivity: 78.7%, specificity: 80.5%). The areas under the SROC curve of RTE and SWE were 0.885 and 0.842 respectively. RTE had higher diagnostic value for Caucasians than Asians. Stran ratio (SR) assessment had higher diagnostic performance than elasticity score (ES) system. Similarly, it had higher diagnostic value when malignant nodules were more than 50.In summary, the results revealed that RTE had higher diagnostic performance than SWE in differentiating malignant from benign nodules. However, future international multicenter studies in the region of thyroid risk need to further assess the diagnostic performance of RTE.
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Affiliation(s)
- Wuguo Tian
- From the Department of Breast, Thyroid, and Vascular Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
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Samir AE, Dhyani M, Anvari A, Prescott J, Halpern EF, Faquin WC, Stephen A. Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane. Radiology 2015; 277:565-73. [PMID: 25955578 DOI: 10.1148/radiol.2015141627] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate the diagnostic accuracy of shear-wave elastography (SWE) for the diagnosis of malignancy in follicular lesions and to identify the optimal SWE measurement plane. MATERIALS AND METHODS The institutional review board approved this HIPAA-compliant, single-institution, prospective pilot study. Subjects scheduled for surgery after a previous fine-needle aspiration report of "atypia of undetermined significance" or "follicular lesion of undetermined significance," "suspicion for follicular neoplasm," or "suspicion for Hurthle cell neoplasm," were enrolled after obtaining informed consent. Subjects underwent conventional ultrasonography (US), Doppler evaluation, and SWE preoperatively, and their predictive value for thyroid malignancy was evaluated relative to the reference standard of surgical pathologic findings. RESULTS Thirty-five patients (12 men, 23 women) with a mean age of 55 years (range, 23-85 years) and a fine-needle aspiration diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (n = 16), suspicion for follicular neoplasm (n = 14), and suspicion for Hurthle cell neoplasm (n = 5) were enrolled in the study. Male sex was a statistically significant (P = .02) predictor of malignancy, but age was not. No sonographic morphologic parameter, including nodule size, microcalcification, macrocalcification, halo sign, taller than wide dimension, or hypoechogenicity, was associated with malignancy. Similarly, no Doppler feature, including intranodular vascularity, pulsatility index, resistive index, or peak-systolic velocity, was associated with malignancy. Higher median SWE tissue Young modulus estimates from the transverse insonation plane were associated with malignancy, yielding an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.62, 1.00) for differentiation of malignant from benign nodules. At a cutoff value of 22.3 kPa, sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 88%, 75%, and 91%, respectively, were observed. CONCLUSION This prospective pilot study indicates that SWE may be a valuable tool in preoperative malignancy risk assessment of follicular-patterned thyroid nodules.
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Affiliation(s)
- Anthony E Samir
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Manish Dhyani
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Arash Anvari
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Jason Prescott
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Elkan F Halpern
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - William C Faquin
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
| | - Antonia Stephen
- From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.)
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