1
|
Fan J, Tao L, Zhan W, Li W, Kuang L, Zhao Y, Zhou W. Diagnostic value of qualitative and quantitative parameters of contrast-enhanced ultrasound for differentiating differentiated thyroid carcinomas from benign nodules. Front Endocrinol (Lausanne) 2024; 14:1240615. [PMID: 38250738 PMCID: PMC10797774 DOI: 10.3389/fendo.2023.1240615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
Objective To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) of qualitative and quantitative parameters for differentiating differentiated thyroid cancers from benign nodules. Method A total of 290 thyroid nodules that were pathologically confirmed were enrolled in this study. The univariate analysis was performed for the clinical characteristics and CEUS qualitative and quantitative parameters of the inside and peripheral zone of nodules, including age, gender, nodule size, intensity of enhancement, homogeneity, wash-in and wash-out patterns, margin after CEUS, ring enhancement, peak intensity, sharpness, time to peak(TP), and area under the curve(AUC), and the meaningful indicators in the single-factor analysis were further included in multivariate logistic regression analysis. Results Multivariate analysis showed that there were significant differences in age (p=0.031), nodule size (p<0.001), heterogeneous enhancement (p<0.001), hypo-enhancement (p=0.001), unclear margin after CEUS(p=0.007), inside peak (p<0.001), and outside sharpness(p<0.001) between benign and malignant nodules. However, there were no significant differences in gender, ring enhancement, wash-in, wash-out, outside TP, outside AUC between benign and malignant thyroid nodules (P>0.05, for all). Conclusion CEUS might be useful in the differential diagnosis of differentiated thyroid cancers and benign nodules, which could provide a certain basis for clinical treatment.
Collapse
Affiliation(s)
- Jinfang Fan
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Li
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lijun Kuang
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yingyan Zhao
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
2
|
Wan S, Jin B, Ren B, Boah M, Shen H. Relationship between mild iodine deficiency in pregnant women and thyroid function: A meta-analysis. J Trace Elem Med Biol 2023; 78:127197. [PMID: 37209527 DOI: 10.1016/j.jtemb.2023.127197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Pregnant women are among the key groups in iodine nutrition evaluation. The purpose of the present study was to summarize the evidence supporting the relationship between mild iodine deficiency (UIC: 100-150 μg/L) in pregnant women and levels of thyroid function tests. METHODS This review follows the guidelines for systematic reviews (PRISMA 2020). Three electronic databases (PubMed, Medline, and Embase) were searched for relevant publications in English on the association between mild iodine deficiency in pregnant women and thyroid function. Articles published in Chinese were searched in China's electronic databases (CNKI, WanFang, CBM, and WeiPu). Pooled effects were presented as standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) using fixed or random effect models, respectively. This meta-analysis was registered at www.crd.york.ac.uk/prospero as CRD42019128120. RESULTS We summarized the results from 7 articles with 8261 participants. The overall pooled results showed that the levels of FT3, FT4, and abnormal TgAb (the antibody levels exceeded the upper limit of the reference range) were significantly increased in pregnant women with mild iodine deficiency compared to pregnant women with adequate iodine status (FT3: SMD=0.854, 95% CI: 0.188, 1.520; FT4: SMD=0.550, 95% CI: 0.050, 1.051; TgAb: OR=1.292, 95% CI: 1.095; 1.524). Subgroup analysis was carried out on the sample size, ethnicity, country, and gestation of FT3, FT4, and TSH, but no plausible factor was found. Egger's tests indicated no publication bias.The increase in FT3 and FT4, as well as TgAb levels, in pregnant women is associated with mild iodine deficiency. CONCLUSION Mild iodine deficiency is associated with an increase in FT3,FT4 and TgAb levels in pregnant women. Mild iodine deficiency may increase the risk of thyroid dysfunction in pregnant women.
Collapse
Affiliation(s)
- Siyuan Wan
- Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, Heilongjiang, China.
| | - Baiming Jin
- Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Bingxuan Ren
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Hongmei Shen
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China.
| |
Collapse
|
3
|
Radzina M, Ratniece M, Putrins DS, Saule L, Cantisani V. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers (Basel) 2021; 13:5469. [PMID: 34771632 PMCID: PMC8582579 DOI: 10.3390/cancers13215469] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and "fast-in and slow-out" are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.
Collapse
Affiliation(s)
- Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
| | - Davis Simanis Putrins
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy;
| |
Collapse
|
4
|
Sorrenti S, Dolcetti V, Fresilli D, Del Gaudio G, Pacini P, Huang P, Camponovo C, Leoncini A, D’Andrea V, Pironi D, Frattaroli F, Trimboli P, Radzina M, Cantisani V. The Role of CEUS in the Evaluation of Thyroid Cancer: From Diagnosis to Local Staging. J Clin Med 2021; 10:jcm10194559. [PMID: 34640574 PMCID: PMC8509399 DOI: 10.3390/jcm10194559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022] Open
Abstract
Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting.
Collapse
Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou 310009, China;
- Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Chiara Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
| | - Vito D’Andrea
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Daniele Pironi
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Fabrizio Frattaroli
- Department of Surgery “P. Stefanini”, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia; Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
- Correspondence:
| |
Collapse
|
5
|
Huang S, Cai W, Han S, Lin Y, Wang Y, Chen F, Shao G, Liu Y, Yu X, Cai Z, Zou Z, Yao S, Wang Q, Li Z. Differences in the dielectric properties of various benign and malignant thyroid nodules. Med Phys 2020; 48:760-769. [PMID: 33119125 DOI: 10.1002/mp.14562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/28/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This experiment was conducted to investigate the dielectric properties of different types of thyroid nodules. Our goal was to find a simple and fast method to detect thyroid diseases at different stages from the dielectric properties of thyroid nodules. METHODS We used the open-ended coaxial line method to measure the dielectric permittivities of thyroid tissues from 155 patients at frequencies ranging from 1 to 4000 MHz. Tissues that were investigated included normal thyroid tissue and benign and malignant thyroid nodules (nodular goiter, follicular adenoma, papillary carcinoma, and follicular carcinoma), as determined from pathological reports. Differences in dielectric properties were measured between each nodule and the surrounding 1 cm of tissue. RESULTS The analysis results revealed that the dielectric permittivity and conductivity values were positively correlated with the degree of malignancy of the nodule (normal < benign < malignant; all differences P < 0.05). This was more obvious at frequencies within 20~70 MHz, following the order normal tissue < nodular goiter < follicular adenoma < papillary carcinoma < follicular carcinoma. A significant difference (P < 0.05) in dielectric permittivity and conductivity was found when comparing these nodules with the surrounding 1 cm of tissue. CONCLUSIONS Normal, benign, and malignant nodules were successfully distinguished from one another, and dielectric permittivity was found to be a more sensitive parameter than conductivity. In particular, different disease types can be distinguished at a stimulation frequency of 20~70 MHz, which shows that dielectric properties have application prospects for the detection and diagnosis of cancer. At the same time, the dielectric parameter differences between the surrounding 1 cm of tissue and the diseased nodule can distinguish the tumor and its surrounding tissues in real time during surgery to determine the tumor boundary.
Collapse
Affiliation(s)
- Shengyi Huang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Weizhen Cai
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Shuai Han
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Yu Lin
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Yu Wang
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Fei Chen
- Department of Thyroid Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Guoli Shao
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Yonghong Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Xuefei Yu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Zhai Cai
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Zenan Zou
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Shun Yao
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Qiaohui Wang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Zhou Li
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| |
Collapse
|
6
|
Zhang J, Zhang X, Meng Y, Chen Y. Contrast-enhanced ultrasound for the differential diagnosis of thyroid nodules: An updated meta-analysis with comprehensive heterogeneity analysis. PLoS One 2020; 15:e0231775. [PMID: 32310968 PMCID: PMC7170259 DOI: 10.1371/journal.pone.0231775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
The diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for distinguishing malignant thyroid nodules from benign thyroid nodules remains controversial. This meta-analysis was performed to evaluate the overall diagnostic value of CEUS for the characterization of thyroid nodules. Relevant studies were identified by searching PubMed, Embase and the Cochrane Library until August 1th 2019 to assess the overall diagnostic accuracy of CEUS. 37 eligible studies were included in the present meta-analysis. The pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate and diagnostic odds ratio of CEUS were 0.87, 0.83, 5.38, 0.17 and 38.94, respectively, with the AUC of 0.9263. Subgroup analysis showed the heterogeneity was greatly reduced in small nodules group (≤ 1 cm) (I2 = 0.0%), while heterogeneity was still observed in the group of variable sizes group (I2 = 69.5%). However, meta-regression analysis revealed that only diagnostic criterion was the major source of heterogeneity (p = 0.0259). The risk of publication bias was negligible (p = 0.35). CEUS exhibited high accuracy for the identification of thyroid nodules and might provide additional perfusion information for the current US imaging reporting systems.
Collapse
Affiliation(s)
- Juanjuan Zhang
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| | - Xiuting Zhang
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanna Meng
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| | - Yinghong Chen
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| |
Collapse
|
7
|
Rahemi Karizaki S, Alamdaran SA, Bonakdaran S, Morovatdar N, Jafarain AH, Sharifi Hadad A, Hadadzade A. NEW PROPOSED FORMULA OF TI-RADS CLASSIFICATION BASED ON ULTRASOUND FINDINGS. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:199-207. [PMID: 33029237 DOI: 10.4183/aeb.2020.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction The present study aimed to introduce a new formula for classification of nodules in TI-RADS and describe ultrasonography features of benign and malignant thyroid nodules. Methods This study was conducted on thyroid mass in 1033 patients. The incidence of malignancy for thyroid nodules was determined by selecting malignancy coefficients. Then the patients were first classified using conventional TI-RADS classification criteria and once again according to a new proposed formula. Results Among ultrasonography features of thyroid nodules, the irregular shape (46.7%), unclear margin (47.3%), extension to the capsule (irregular and infiltrative margin) (85%), the marked hypo-echoic nodules (63.8%), micro-calcification (49%), and to have vertical axis (74.0%) were associated with high incidence of malignancy. Conclusion According to the proposed new formula for TI-RADS, there are four coefficients of 7, 3, 1 and 0 for incidence of malignancy of each one of ultrasound findings that help to standardization and unifying of TI-RADS classification. The incidence of malignancy in TI-RADS classification according to the new proposed formula was achieved as follows: group 2: 0.0%, group 3: 0.7%, groups 4a, 4b, 4c: 16.7%, 43.4%, 68.5%, and group 5: 95.2%, respectively.
Collapse
Affiliation(s)
- S Rahemi Karizaki
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| | - S A Alamdaran
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| | - S Bonakdaran
- Mashhad University of Medical Sciences, Omid Hospital - Endocrine Research Center-Ghaem Hospital, Mashhad, Iran
| | - N Morovatdar
- Mashhad University of Medical Sciences, Omid Hospital - Social Medicine, Mashhad, Iran
| | - A H Jafarain
- Mashhad University of Medical Sciences, Omid Hospital - Pathology, Mashhad, Iran
| | - A Sharifi Hadad
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| | - A Hadadzade
- Mashhad University of Medical Sciences, Omid Hospital - Radiology - Mashhad, Iran
| |
Collapse
|
8
|
Zhan J, Diao X, Chen Y, Wang W, Ding H. Predicting cervical lymph node metastasis in patients with papillary thyroid cancer (PTC) - Why contrast-enhanced ultrasound (CEUS) was performed before thyroidectomy. Clin Hemorheol Microcirc 2019; 72:61-73. [PMID: 30452407 DOI: 10.3233/ch-180454] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this research was to investigate the clinical value of contrast-enhanced ultrasound (CEUS) for prediction of cervical lymph node metastasis (CLNM) in papillary thyroid cancer (PTC).One hundred and eighty-six patients with PTC confirmed by fine needle aspiration (FNA) were preoperatively performed CEUS.A multivariate analysis was performed to predict CLNM by 15 independent variables. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance.There were totally 37 patients with CLNM confirmed by pathology. Multivariate analysis demonstrated that intensity at peak time, capsule contact and size on CEUS were the three strongest independent predictors for CLNM. ROC analyses of these characteristics showed the areas under the curve (Az), sensitivity, and specificity were 0.650, 48.6 %, 79.8 %; 0.586, 67.6%, 49.7%; and 0.612, 56.8%, 64.4% for intensity at peak time, capsule contact, and size, respectively.The CEUS patterns of PTC are relative to not only the size of PTC but also the possibility of CLNM after thyroidectomy. CEUS seem to be a tool to predict CLNM in PTC patients.
Collapse
Affiliation(s)
- Jia Zhan
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuehong Diao
- Ultrasound Department, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Ultrasound Department, Huadong Hospital, Fudan University, Shanghai, China
| | - Wenping Wang
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
9
|
Huang R, Jiang L, Xu Y, Gong Y, Ran H, Wang Z, Sun Y. Comparative Diagnostic Accuracy of Contrast-Enhanced Ultrasound and Shear Wave Elastography in Differentiating Benign and Malignant Lesions: A Network Meta-Analysis. Front Oncol 2019; 9:102. [PMID: 30891425 PMCID: PMC6412152 DOI: 10.3389/fonc.2019.00102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background: We performed a network meta-analysis to compare the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) in differentiating benign and malignant lesions in different body sites. Methods: A computerized literature search of Medline, Embase, SCOPUS, and Web of Science was performed using relevant keywords. Following data extraction, we calculated sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) for CEUS, and SWE compared to histopathology as a reference standard. Statistical analyses were conducted by MetaDiSc (version 1.4) and R software (version 3.4.3). Results: One hundred and fourteen studies (15,926 patients) were pooled in the final analyses. Network meta-analysis showed that CEUS had significantly higher DOR than SWE (DOR = 27.14, 95%CI [2.30, 51.97]) in breast cancer detection. However, there were no significant differences between CEUS and SWE in hepatic (DOR = −6.67, 95%CI [−15.08, 1.74]) and thyroid cancer detection (DOR = 3.79, 95%CI [−3.10, 10.68]). Interestingly, ranking analysis showed that CEUS achieved higher DOR in detecting breast and thyroid cancer, while SWE achieved higher DOR in detecting hepatic cancer. The overall DOR for CEUS in detecting renal cancer was 53.44, 95%CI [29.89, 95.56] with an AUROC of 0.95, while the overall DOR for SWE in detecting prostate cancer was 25.35, 95%CI [7.15, 89.89] with an AUROC of 0.89. Conclusion: Both diagnostic tests showed relatively high sensitivity and specificity in detecting malignant tumors in different organs. Network meta-analysis showed that CEUS had higher diagnostic accuracy than SWE in detecting breast and thyroid cancer, while SWE had higher accuracy in detecting hepatic cancer. However, the results were not statistically significant in hepatic and thyroid malignancies. Further head-to-head comparisons are needed to confirm the optimal imaging technique to differentiate each cancer type.
Collapse
Affiliation(s)
- Rongzhong Huang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Lihong Jiang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Yu Xu
- Chuangxu Institute of Life Science, Chongqing, China
| | - Yuping Gong
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Ran
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhigang Wang
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Sun
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
10
|
Liu Q, Cheng J, Li J, Gao X, Li H. The diagnostic accuracy of contrast-enhanced ultrasound for the differentiation of benign and malignant thyroid nodules: A PRISMA compliant meta-analysis. Medicine (Baltimore) 2018; 97:e13325. [PMID: 30544392 PMCID: PMC6310493 DOI: 10.1097/md.0000000000013325] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a non-invasive method that has been used in the diagnosis of several diseases. Recently, CEUS has been used in the differentiation of benign and malignant thyroid nodules. However, the performance of CEUS in thyroid nodules has not been studied clearly. METHODS The databases of Pubmed, Embase, Cochrane library and the unpublished studies were systematically searched for candidate inclusions, with the use of CEUS in differentiating the benign and malignant thyroid nodules. The quality of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) questionnaire. The pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratio (NLR) were calculated using STATA software version 14.0. RESULTS Totally 33 diagnostic studies were included for further analysis. The quality of included studies was relatively high using QUADAS method. The pooled estimates of sensitivity and specificity were 0.88 (95% CI 0.85, 0.91) and 0.88 (95% CI 0.83, 0.91), respectively. In addition, the DOR, the positive and NLRs were pooled positive LR and the negative LR were 54 (95% CI 33, 89), 7.1% (5.2%, 9.8%), and 0.13% (0.10%, 0.18%). No significant publication bias was observed. CONCLUSIONS Our meta-analysis further indicated that CEUS is a useful tool in differentiating benign and malignant thyroid nodules, with high sensitivity and specificity.
Collapse
Affiliation(s)
| | | | | | | | - Hongbo Li
- Department of General Surgery, People's Hospital of Rizhao, Rizhao, China
| |
Collapse
|
11
|
Abstract
The present study was aimed to compare the application values between 2-dimensional color Doppler ultrasonography (2DUS) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of thyroid malignant nodules.A total of 124 patients suspectedly diagnosed with malignant thyroid nodules under conventional gray-scale ultrasonography were recruited in this study. All enrolled patients were examined by both 2DUS and CEUS.A total of 153 nodules (94.44%) and 45 cases (90.00%) with malignant nodules were detected by the CEUS. No significant differences were noted in nodule detection rates between 2DUS and CEUS (χ = 1.170, P = .279; χ = 0.796, P = .372). The aspect ratio, microcalcification, internal echo, borderline, Vmax, resistance index, and total scores of malignant nodules were higher than those of benign nodules (all P < .05) when diagnosed by 2DUS. The peripheral/internal enhancement time, peak intensity, local enhancement, ring enhancement, and total scores of malignant nodules were significantly higher compared with those of benign nodules (all P < .05) by CEUS. Total score of malignant nodules diagnosed by 2DUS was approximately 3.5 and 2.3 points for CEUS. The diagnostic accuracy of 2DUS as observed by area under the curve was 0.821 with the cut-off value of 3.9, the sensitivity was 82.5%, and the specificity was 85.6%. The diagnostic accuracy of CEUS was 0.862 with the cut-off value of 2.8, the sensitivity was 86.7%, and the specificity was 91.3%.Both 2DUS and CEUS are worthy of application values in the differential diagnosis from benign to malignant thyroid nodules.
Collapse
|
12
|
Gu F, Han L, Yang X, Liu H, Li X, Guo K, Zhao Z, Zhou X, Luo W. Value of time-intensity curve analysis of contrast-enhanced ultrasound in the differential diagnosis of thyroid nodules. Eur J Radiol 2018; 105:182-187. [DOI: 10.1016/j.ejrad.2018.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/13/2022]
|
13
|
Zhan J, Ding H. Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 2018; 37:288-297. [PMID: 30213158 PMCID: PMC6177690 DOI: 10.14366/usg.18019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is widely used to evaluate tumor microcirculation, which is useful in the differential diagnosis between benignity and malignancy. In the last 10 years, the applicability of CEUS to thyroid nodules has greatly improved due to technological refinements and the development of second-generation contrast agents. In this review, we summarize the applications of CEUS for thyroid nodules, focusing on the imaging findings of malignant and benign nodules in the existing literature and the use of those findings to predict malignancies, with an additional brief description of the utilization of CEUS for other thyroid-related diseases.
Collapse
Affiliation(s)
- Jia Zhan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
14
|
Giusti M, Massa B, Balestra M, Calamaro P, Gay S, Schiaffino S, Turtulici G, Zupo S, Monti E, Ansaldo G. Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes. J Zhejiang Univ Sci B 2018; 18:555-566. [PMID: 28681580 DOI: 10.1631/jzus.b1600075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically-treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-to-peak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.
Collapse
Affiliation(s)
- Massimo Giusti
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Barbara Massa
- Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | | | - Paola Calamaro
- Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Stefano Gay
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | | | | | - Simonetta Zupo
- Molecular Diagnostic Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Eleonora Monti
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Gianluca Ansaldo
- Endocrinology Surgery Unit, San Martino University Hospital, I-16100 Genoa, Italy
| |
Collapse
|
15
|
Gyamfi D, Wiafe YA, Danquah KO, Adankwah E, Amissah GA, Odame A. Urinary iodine concentration and thyroid volume of pregnant women attending antenatal care in two selected hospitals in Ashanti Region, Ghana: a comparative cross-sectional study. BMC Pregnancy Childbirth 2018; 18:166. [PMID: 29764405 PMCID: PMC5952633 DOI: 10.1186/s12884-018-1820-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/02/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Iodine deficiency is a major public health problem affecting people worldwide, particularly pregnant women. Iodine requirements increase substantially during pregnancy making pregnant women vulnerable to iodine deficiency and its disorders such as abortions, stillbirths and pregnancy goitre as well as congenital abnormalities, cretinism and mental retardation in their children. The primary aim of this study was to evaluate the prevalence of iodine deficiency and goitre among pregnant women attending antenatal sessions at two selected hospitals in Ashanti region, Ghana. METHODS A cross-sectional study was carried out in 239 pregnant women who attended the antenatal clinic at Kwame Nkrumah University of Science and Technology (KNUST) Hospital or Ejura District Hospital, both in Ashanti Region, Ghana. Socio-demographic data and information related to iodine were captured using a questionnaire. Urinary iodine concentration (UIC) was determined on spot urine samples using the Sandell-Kolthoff reaction with ammonium persulfate as digesting agent. Each woman's thyroid volume was also measured by ultrasonography. RESULTS The overall median UIC was 155.9 μg/L, indicating adequate iodine intake in the study population. However, goitre prevalence in the pregnant women was 11.3%, denoting mild iodine deficiency. The median UIC for pregnant women who attended KNUST Hospital was higher (163.8 μg/L) than that of Ejura District Hospital (149.0 μg/L). The proportion of women who did not consume iodised salt was significantly higher (p < 0.001) in Ejura District Hospital (71.2%) than KNUST Hospital (28.0%). In total, 47.3% of the pregnant women studied had a UIC < 150 μg/L. Only 16.3% knew about the increase in iodine requirement during pregnancy and 21.3% of them had knowledge of the effects of iodine deficiency during pregnancy with most (81.8%) knowing of pregnancy goitre. CONCLUSION There is generally adequate iodine intake among the pregnant women, however, iodine deficiency and goitre still exist among some pregnant women. Thus, assessment and continuous monitoring of iodine nutritional status in pregnant women in the country are warranted. Also, intensification of effective public health campaigns (through radio and television) with regard to iodine utilization and its benefits in pregnancy are still recommended among Ghanaian pregnant women.
Collapse
Affiliation(s)
- Daniel Gyamfi
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Amo Wiafe
- Department of Sonography, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwabena Owusu Danquah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ernest Adankwah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gertrude Akua Amissah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Angela Odame
- Department of Sonography, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
16
|
Wang Y, Lei KR, He YP, Li XL, Ren WW, Zhao CK, Bo XW, Wang D, Sun CY, Xu HX. Malignancy risk stratification of thyroid nodules: comparisons of four ultrasound Thyroid Imaging Reporting and Data Systems in surgically resected nodules. Sci Rep 2017; 7:11560. [PMID: 28912438 PMCID: PMC5599531 DOI: 10.1038/s41598-017-11863-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/30/2017] [Indexed: 01/23/2023] Open
Abstract
To compare the efficiency of four different ultrasound (US) Thyroid Imaging Reporting and Data Systems (TI-RADS) in malignancy risk stratification in surgically resected thyroid nodules (TNs). The study included 547 benign TNs and 464 malignant TNs. US images of the TNs were retrospectively reviewed and categorized according to the TI-RADSs published by Horvath E et al. (TI-RADS H), Park et al. (TI-RADS P), Kwak et al. (TI-RADS K) and Russ et al. (TI-RADS R). The diagnostic performances for the four TI-RADSs were then compared. At multivariate analysis, among the suspicious US features, marked hypoechogenicity was the most significant independent predictor for malignancy (OR: 15.344, 95% CI: 5.313-44.313) (P < 0.05). Higher sensitivity was seen in TI-RADS H, TI-RADS K, TI-RADS R comparing with TI-RADS P (P < 0.05 for all), whereas the specificity, accuracy and area under the ROC curve (Az) of TI-RADS P were the highest (all P < 0.05). Higher specificity, accuracy and Az were seen in TI-RADS K compared with TI-RADS R (P = 0.003). With its higher sensitivity, TI-RADS K, a simple predictive model, is practical and convenient for the management of TNs in clinical practice. The study indicates that there is a good concordance between TI-RADS categories and histopathology.
Collapse
Affiliation(s)
- Ying Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Kai-Rong Lei
- Department of Medical Ultrasound, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Cheng-Yu Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Medical Ultrasound, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
| |
Collapse
|
17
|
Wiesinger I, Kroiss E, Zausig N, Hornung M, Zeman F, Stroszczynski C, Jung EM. Analysis of arterial dynamic micro-vascularization with contrast-enhanced ultrasound (CEUS) in thyroid lesions using external perfusion software: First results. Clin Hemorheol Microcirc 2017; 64:747-755. [PMID: 27792004 DOI: 10.3233/ch-168044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To determine different perfusion characteristics of histo-pathologically proven adenomas and carcinomas of the thyroid gland with CEUS and perfusion software. MATERIAL AND METHODS Retrospective perfusion analysis of 25 patients with carcinomas and 41 cases of adenomas of the thyroid gland (30 males, 36 females; aged 18 - 85 years, mean 56 years). All cases were histologically analyzed. Perfusion analysis was independently performed using external perfusion software (VueBox®). TTP, mTT, Peak and Rise time were calculated. RESULTS Lesions' sizes ranged from 0.2 to 10.2 cm in carcinomas (mean 2.18 cm), and from 0.6 to 5.0 cm in adenomas (mean 2.25 cm). In 20 out of 25 carcinomas that were evaluated with CEUS, a complete wash-out in the late venous phase was found. Adenomas showed wash-out at the border.Perfusion analysis in VueBox® revealed some parameters which tend to show differences between adenomas and carcinomas, however did not reach the level of significance.Median Peak in carcinomas was highest at the margins (2945 rU), and lowest in the surroundings (1110 rU). Mean Transit Time (mTT) values showed no differences between center, margin and surrounding.In adenomas healthy tissue showed higher mTT values compared to the center (24.6 vs. 20.7 sec). Median Peak was highest in the surrounding tissue and lowest in the margins (1999 vs. 1129 rU). No statistical differences could be found in the comparisons. CONCLUSION CEUS with perfusion analysis offers new possibilities for the dynamic evaluation of micro-vascularization in thyroid adenomas and carcinomas. Using VueBox® the perfusion analysis of the arterial phase provides new parameters that help determine a lesion's malignancy or benignity. However a final assessment regarding malignancy and benignity of thyroid lesions using only CEUS and perfusion analysis of the arterial phase is not yet possible.
Collapse
Affiliation(s)
- I Wiesinger
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E Kroiss
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - N Zausig
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - M Hornung
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - F Zeman
- Center of Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
18
|
Wang D, Fu HJ, Xu HX, Guo LH, Li XL, He YP, Bo XW, Zhao CK, Sun LP, Lu F, Zhang K, Wei Q. Comparison of fine needle aspiration and non-aspiration cytology for diagnosis of thyroid nodules: A prospective, randomized, and controlled trial. Clin Hemorheol Microcirc 2017; 66:67-81. [PMID: 28128748 DOI: 10.3233/ch-160222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To compare the sampling efficiency and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) for thyroid nodules. MATERIALS AND METHODS 629 thyroid nodules in 629 cases (477 females, 152 males) were randomly subjected to FNAC or FNNAC from Jun 2014 to Feb 2015. Diagnostic performance was calculated in reference to the histological findings or follow-up results. RESULTS 629 patients (152 men, 477 women) with 629 thyroid nodules were enrolled in the study. Pathological results were obtained in 173 nodules and benign nodules at FNA with more than six months' follow-up were found in 65 nodules. Tumor size for FNAC ranges from 3.0 to 51.0 mm (mean±SD; 10.2±6.9 mm); whereas FNNAC (2.0-43.0 mm; 11.9±7.7 mm). Non-diagnostic results were found in 7.59% (24/316) of FNNAC procedures and 7.59% (25/313) of FNAC (P > 0.05). Determinate and indeterminate results were found in 50.63% (160/316) and 41.77% (132/316) of FNNAC procedures, whereas 58.15% (182/313) and 33.87% (106/313) of FNAC (P < 0.05). In order to obtain determinate cytological results, FNAC might be more suitable than FNNAC for diagnosis of nodules with hypovascularity (51.38% vs. 41.78%, P < 0.05) and macrocalcifications (9.72% vs. 6.50%, P < 0.05). No US and Color-Doppler US characteristics, such as the presence of hypervascularity (P > 0.05), microcalcifications (P > 0.05), internal component (P > 0.05), or size(P > 0.05), were significantly different to obtain determinate cytological results between the FNAC and FNNAC groups. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of FNAC and FNNAC were as follows: 96.67% vs. 100%, 89.74% vs. 96.5%, 87.88% vs. 96.97%, 97.22% vs. 100%, 92.75% vs.98.36%, respectively (all P > 0.05). CONCLUSIONS Both FNAC and FNNAC are effective for diagnosis of thyroid nodules. However, FNAC is more effective than FNNAC to acquire determinate cytological results for nodules which US present hypovascularity and macrocalcifications.
Collapse
Affiliation(s)
- Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Jun Fu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - 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
| | - 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
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - 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
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Ping Sun
- 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
| | - Feng Lu
- 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
| | - Kun 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
| | - Qing Wei
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
19
|
Zhang Y, Luo YK, Zhang MB, Li J, Li J, Tang J. Diagnostic Accuracy of Contrast-Enhanced Ultrasound Enhancement Patterns for Thyroid Nodules. Med Sci Monit 2016; 22:4755-4764. [PMID: 27916971 PMCID: PMC5154710 DOI: 10.12659/msm.899834] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to investigate the accuracy of contrast-enhanced ultrasound (CEUS) enhancement patterns in the assessment of thyroid nodules. Material/Methods A total of 158 patients with suspected thyroid cancer underwent conventional ultrasound (US) and CEUS examinations. The contrast enhancement patterns of the lesions, including the peripheries of the lesions, were assessed by CEUS scans. The relationship between the size of the lesions and the degree of enhancement was also studied. US- and/or CEUS-guided biopsy was used to obtain specimens for histopathological diagnosis. Results The final data included 148 patients with 157 lesions. Seventy-five patients had 82 malignant lesions and 73 patients had 75 benign lesions. Peripheral ring enhancement was seen in 40 lesions. The differences of enhancement patterns and peripheral rings between benign and malignant nodules were significant (p=0.000, 0.000). The diagnostic sensitivity, specificity, and accuracy for malignant were 88%, 65.33%, and 88.32%, respectively, for CEUS, whereas they were 98.33%, 42.67%, and 71.97%, respectively, for TC by conventional US. The misdiagnosis rate by conventional US was 57.33% and 34.67% by CEUS (p=0.005). With regard to the size of lesions, a significant difference was found between low-enhancement, iso-enhancement, high-enhancement, iso-enhancement with no-enhancement area and no-enhancement (p=0.000). Conclusions In patients with suspicious US characteristics, CEUS had high specificity and contributed to establishing the diagnosis. Therefore, CEUS could avoid unnecessary biopsy.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Ming-Bo Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Jie Li
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Junlai Li
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| |
Collapse
|
20
|
Zhang YZ, Xu T, Gong HY, Li CY, Ye XH, Lin HJ, Shen MP, Duan Y, Yang T, Wu XH. Application of high-resolution ultrasound, real-time elastography, and contrast-enhanced ultrasound in differentiating solid thyroid nodules. Medicine (Baltimore) 2016; 95:e5329. [PMID: 27828854 PMCID: PMC5106060 DOI: 10.1097/md.0000000000005329] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
High-resolution ultrasound (HRUS) is a sensitive tool for identifying thyroid nodules. Real-time elastography (RTE) and contrast-enhanced ultrasound (CEUS) are newly developed methods which could measure tissue elasticity and perfusion features. The aim of the present study was to evaluate and compare the diagnostic efficiency of HRUS, RTE, CEUS and their combined use in the differentiation of benign and malignant solid thyroid nodules.In total, 111 consecutive patients with 145 thyroid nodules who were scheduled for surgery were included in the study. All of them underwent HRUS, RTE, and CEUS examination. The independent ultrasound (US) predictors for malignancy were determined and quantified using logistic regression analysis, based on which a risk-scoring model was established for each method. The diagnostic efficiency of each method was assessed by receiver operating characteristic (ROC) curve analysis.HRUS showed the best diagnostic efficiency among the 3 US methods, with 74.6% sensitivity and 87.8% specificity. CEUS had higher sensitivity (85.7%), whereas RTE alone did not show much advantage. Combined use of RTE and HRUS increased the sensitivity (92.1%). The HRUS-RTE-CEUS combination could increase both the sensitivity and specificity (87.3%, 91.5%), with the best AUC (0.935) among all the methods.The overall diagnostic value of HRUS in predicting malignancy is the best among the 3 US methods. Combined use of RTE and CEUS and HRUS could improve the diagnostic efficiency for solid thyroid nodules.
Collapse
Affiliation(s)
- Yu-Zhi Zhang
- Department of Endocrinology
- Department of Ultrasound, Affiliated Hospital of Integration Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | | | | | | | | | | | - Mei-Ping Shen
- Department of General Surgery, the First Affiliated Hospital with Nanjing Medical University
| | | | | | - Xiao-Hong Wu
- Department of Endocrinology
- Correspondence: Xiao-Hong Wu, Department of Endocrinology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, China (e-mail: )
| |
Collapse
|
21
|
Chen M, Zhang KQ, Xu YF, Zhang SM, Cao Y, Sun WQ. Shear wave elastography and contrast-enhanced ultrasonography in the diagnosis of thyroid malignant nodules. Mol Clin Oncol 2016; 5:724-730. [PMID: 28101352 PMCID: PMC5228169 DOI: 10.3892/mco.2016.1053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/15/2016] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the value of shear wave elastography (SWE) and contrast-enhanced ultrasonography (CEUS) in the diagnosis of thyroid malignant nodules. A total of 253 patients with 319 thyroid nodules were subjected to two-dimensional ultrasound (2DUS) and CEUS examinations prior to thyroidectomy between March, 2014 and December, 2015. Young's modulus value for each nodule on 2DUS and CEUS images were recorded. The sensitivity, specificity and accuracy of 2DUS, SWE and CEUS in the diagnosis of thyroid malignant nodules were assessed. The results demonstrated that, of the 319 nodules that were pathologically confirmed, 183 were malignant and 136 were benign. The area under the receiver operating characteristic curve as a result of SWE diagnosis was 0.77. When the threshold of the Young's modulus value was ≥27.65 kPa in the diagnosis of malignant thyroid nodules, SWE exhibited a sensitivity of 84.55% (115/136), a specificity of 84.15% (154/183) and an accuracy of 84.32% (269/319). US contrast imaging of malignant thyroid nodules revealed a major tendency for early hypoenhancement and hypoenhancement. CEUS exhibited a sensitivity of 87.5% (119/136), a specificity of 86.33% (158/183) and an accuracy of 86.83% (277/319) in the diagnosis of malignant thyroid nodules. Compared with 2DUS, SWE, CEUS and their combined use exhibited statistically significant differences in the diagnosis of thyroid malignant nodules in terms of sensitivity, specificity and accuracy (χ2=9.220,15.310 and 40.296, respectively; P=0.000); SWE or CEUS did not differ significantly in the diagnosis of thyroid malignant nodules in terms of sensitivity, specificity or accuracy (χ2=0.737;P=0.542); Compared with the use of SWE or CEUS alone, their combination exhibited statistically significant differences in the diagnosis of malignant thyroid nodules in terms of sensitivity, specificity and accuracy (χ2=12.264 and 6.939, respectively; P=0.000,0.005). In conclusion, the high accuracy of the combined use of SWE and CEUS in the diagnosis of malignant thyroid nodules is of great clinical value.
Collapse
Affiliation(s)
- Mei Chen
- Department of Ultrasonography, Ningbo First Hospital, School of Medicine, Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Ke-Qin Zhang
- Department of Endocrinology, The Affiliated Hospital of Tongji University, Shanghai 200065, P.R. China
| | - You-Feng Xu
- Department of Ultrasonography, Ningbo First Hospital, School of Medicine, Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Sheng-Min Zhang
- Department of Ultrasonography, Ningbo First Hospital, School of Medicine, Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Yong Cao
- Department of Ultrasonography, Ningbo First Hospital, School of Medicine, Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Wei-Qun Sun
- Department of Ultrasonography, Ningbo First Hospital, School of Medicine, Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| |
Collapse
|
22
|
Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol 2016; 27:2619-2628. [DOI: 10.1007/s00330-016-4605-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/28/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
|
23
|
Zhang Y, Zhou P, Tian SM, Zhao YF, Li JL, Li L. Usefulness of combined use of contrast-enhanced ultrasound and TI-RADS classification for the differentiation of benign from malignant lesions of thyroid nodules. Eur Radiol 2016; 27:1527-1536. [PMID: 27525973 PMCID: PMC5334375 DOI: 10.1007/s00330-016-4508-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 05/23/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
Abstract
Purpose To study the thyroid image reporting and data system (TI-RADS) classification and the contrast-enhanced ultrasound (CEUS) enhancement pattern of thyroid nodules, and to determine whether combined use of both methods is helpful in the diagnosis of thyroid nodules. Methods A total of 319 thyroid nodules in 246 patients were assessed with TI-RADS, CEUS and a combination of both methods. The diagnostic performance of TI-RADS, CEUS and a combination of both methods was compared. Results The accuracy in the diagnosis of thyroid nodules was 90.3 % for TI-RADS, 90.0 % for CEUS and 96.0 % for a combination of both methods respectively. A statistically significant difference was not observed in the diagnostic accuracy of CEUS and TI-RADS (P > 0.05). However, a significant difference was observed between a combination of both methods and either alone (P < 0.01). A combination of both methods showed high sensitivity, specificity and accuracy for TI-RADS classifications of 4a and 4b thyroid nodules compared with TI-RADS alone (P < 0.01) and a statistically significant difference was not observed for thyroid nodules classified as 2, 3, and 5 (P > 0.05). Conclusions The improved TI-RADS, when combined with CEUS, could significantly improve the diagnostic accuracy for thyroid nodules, especially for TI-RADS class-4 thyroid nodules. Key Points • TI-RADS can be used as the primary diagnostic standard for thyroid nodules • CEUS can be used as an important complement to TI-RADS • The improved TI-RADS can significantly improve the qualitative diagnostic accuracy
Collapse
Affiliation(s)
- Yan Zhang
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China.
| | - Shuang-Ming Tian
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Yong-Feng Zhao
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Jia-Le Li
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Lan Li
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| |
Collapse
|
24
|
Chen HY, Liu WY, Zhu H, Jiang DW, Wang DH, Chen Y, Li W, Pan G. Diagnostic value of contrast-enhanced ultrasound in papillary thyroid microcarcinoma. Exp Ther Med 2016; 11:1555-1562. [PMID: 27168773 PMCID: PMC4840781 DOI: 10.3892/etm.2016.3094] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 11/25/2015] [Indexed: 01/01/2023] Open
Abstract
The aim of the present study was to explore the value and characteristics of contrast-enhanced ultrasound (CEUS) in the diagnosis of papillary thyroid microcarcinoma (PTMC). By analyzing CEUS information of 130 nodules obtained from 106 patients with PTMC, who had been diagnosed by surgery and pathological analysis, CEUS characteristics of PTMC nodules were concluded. Based on the results, the PTMC nodules were divided into three groups as follows: 32 nodules (24.62%) were found to be enhanced earlier than the surrounding normal thyroid tissue, 95 nodules (73.08%) were enhanced at the same time as the normal thyroid tissue and 3 nodules (2.30%) were enhanced later than the normal thyroid tissue. The results also demonstrated that the peak enhancement intensity of the 130 nodules was lower compared with the irregular intensity of the normal parenchyma in corresponding thyroids, and that PTMC enhancement washed out faster than in normal thyroid parenchyma. In conclusion, the PTMC characteristics that CEUS can detect may improve the diagnostic accuracy and provide valuable information for the treatment of the disease.
Collapse
Affiliation(s)
- Hong Yan Chen
- Department of Ultrasound in Medicine, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Wei Yan Liu
- Department of Surgery, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Hui Zhu
- Department of Ultrasound in Medicine, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Dao Wen Jiang
- Department of Surgery, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Dong Hua Wang
- Department of Ultrasound in Medicine, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Yongqi Chen
- Department of Pathology, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Weihua Li
- Department of Ultrasound in Medicine, Minhang Central Hospital, Shanghai 201199, P.R. China
| | - Gaofeng Pan
- Department of Surgery, Minhang Central Hospital, Shanghai 201199, P.R. China
| |
Collapse
|
25
|
Ma X, Zhang B, Ling W, Liu R, Jia H, Zhu F, Wang M, Liu H, Huang J, Liu L. Contrast-enhanced sonography for the identification of benign and malignant thyroid nodules: Systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND 2015; 44:199-209. [PMID: 26402325 DOI: 10.1002/jcu.22311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/05/2015] [Accepted: 08/19/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE The use of contrast-enhanced sonography (CEUS) has yielded promising results in the differentiation of thyroid nodules. We conducted this meta-analysis to assess its performance in identifying and distinguishing between benign and malignant thyroid nodules. METHODS PubMed, Medline, Embase, and the Cochrane Library were searched for studies published through the end of December 2013. Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve were calculated. RESULTS A total of 13 studies were included in this meta-analysis. For the diagnosis of malignant thyroid nodules worldwide, the overall mean rates of sensitivity and specificity of CEUS were 90% (95% confidence interval [CI], 88-93%) and 86% (95% CI, 83-89%), respectively. The summary diagnostic odds ratio was 52.83 (95% CI, 21.71-128.55), and the area under the curve for the summary receiver operating characteristic curve was 0.94 (95% CI, 0.90-0.98). CONCLUSIONS This meta-analysis indicates that CEUS may be a valuable supplemental method, with high rates of sensitivity and specificity, to use for identifying and distinguishing between benign and malignant thyroid nodules.
Collapse
Affiliation(s)
- Xuelei Ma
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Binglan Zhang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wenwu Ling
- Department of Sonography, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Rongjun Liu
- Sichuan University, Chengdu, 610041, People's Republic of China
| | - Hongyuan Jia
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Fuping Zhu
- Department of Hepatobiliary Surgery, Ninth People's Hospital of Chongqing, Chongqing, 400700, People's Republic of China
| | - Mengyao Wang
- Sichuan University, Chengdu, 610041, People's Republic of China
| | - Haoqiu Liu
- Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jingwen Huang
- Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lei Liu
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| |
Collapse
|
26
|
Yuan Z, Quan J, Yunxiao Z, Jian C, Zhu HE. Association between real-time contrast-enhanced ultrasound characteristics and thyroid carcinoma size. Mol Clin Oncol 2015; 3:743-746. [PMID: 26171173 DOI: 10.3892/mco.2015.570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/24/2015] [Indexed: 01/17/2023] Open
Abstract
The aim of the present study was to discuss the various appearances of thyroid carcinomas on real-time contrast-enhanced ultrasound (CEUS) in association with tumor size. The appearances of 68 thyroid carcinomas confirmed by pathology were retrospectively analyzed. The lesions were divided into 3 groups by maximum diameter <10, 10-20 and >20 mm, respectively. For each lesion, absolute enhancement beginning time, relative enhancement beginning time, homogeneity, with or without perfusion defect, enhancement order, enhancement intensity and enhancement margin type were evaluated by CEUS. The majority of thyroid carcinomas were enhanced later than the surrounding thyroid gland. The predominant enhancement pattern of all the 68 thyroid carcinomas in the 3 groups was mainly heterogeneous and concentric enhancement, and the lesions mostly showed less clear or poorly defined enhancement margins. There was no significant difference among the 3 groups (P>0.05). Thyroid carcinoma with diameters <10 and 10-20 mm exhibited low enhancement, while thyroid carcinomas with diameters >20 mm showed high enhancement. With the increase of the lesion's maximum diameter, the probability of perfusion defect increased by 28.57, 54.29 and 75.00%, respectively, and there was a significant difference among the 3 groups (P<0.05). CEUS characteristics are associated with tumor size to a certain extent, and can provide valuable information for clinical diagnosis.
Collapse
Affiliation(s)
- Zhang Yuan
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Pudong New Area, Shanghai 200001, P.R. China
| | - Jiang Quan
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Pudong New Area, Shanghai 200001, P.R. China
| | - Zhang Yunxiao
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Pudong New Area, Shanghai 200001, P.R. China
| | - Chen Jian
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Pudong New Area, Shanghai 200001, P.R. China
| | - H E Zhu
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Pudong New Area, Shanghai 200001, P.R. China
| |
Collapse
|
27
|
Thyroid nodule ultrasound: technical advances and future horizons. Insights Imaging 2015; 6:173-88. [PMID: 25736837 PMCID: PMC4376820 DOI: 10.1007/s13244-015-0398-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/28/2015] [Accepted: 02/04/2015] [Indexed: 01/19/2023] Open
Abstract
UNLABELLED Thyroid nodules are extremely common and the vast majority are non-malignant; therefore the accurate discrimination of a benign lesion from malignancy is challenging. Ultrasound (US) characterisation has become the key component of many thyroid nodule guidelines and is primarily based on the detection of key features by high-resolution US. The thyroid imager should be familiar with the strengths and limitations of this modality and understand the technical factors that create and alter the imaging characteristics. Specific advances in high-resolution US are discussed with reference to individual features of thyroid cancer and benign disease. Potential roles for three-dimensional thyroid ultrasound and computer-aided diagnosis are also considered. The second section provides an overview of current evidence regarding thyroid ultrasound elastography (USE). USE is a novel imaging technique that quantifies tissue elasticity (stiffness) non-invasively and has potential utility because cancers cause tissue stiffening. In recent years, there has been much research into the value of thyroid USE for distinguishing benign and malignant nodules. Preliminary findings from multiple pilot studies and meta-analyses are promising and suggest that USE can augment the anatomical detail provided by high-resolution US. However, a definite role remains controversial and is discussed. TEACHING POINTS • High-resolution US characterises thyroid nodules by demonstration of specific anatomical features • Technical advances heavily influence the key US features of thyroid nodules • Most papillary carcinomas appear stiffer than benign thyroid nodules on US elastography (USE) • Thyroid USE is controversial because of variation in the reported accuracies for malignancy • Combined grey-scale US/USE may lower the FNAC rate in benign nodules.
Collapse
|
28
|
Jiang J, Shang X, Wang H, Xu YB, Gao Y, Zhou Q. Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification. Kaohsiung J Med Sci 2015; 31:138-44. [PMID: 25744236 DOI: 10.1016/j.kjms.2014.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/24/2014] [Accepted: 07/04/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to investigate the diagnostic values of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in benign and malignant thyroid nodules with calcification. Conventional ultrasound and CEUS were performed in 122 patients with thyroid nodules with calcification. The thyroid nodules were characterized as benign or malignant by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of the two imaging methods were determined. The area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic values of the two imaging methods. In 122 cases of thyroid nodules with calcification, 73 benign nodules and 49 malignant nodules were verified by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of conventional ultrasound were 50%, 77%, 59%, 69%, and 66%, respectively, and those of CEUS were 90%, 92%, 88%, 93%, and 91%, respectively. There were significant differences between the two imaging methods. AUCs of conventional ultrasound and CEUS were 0.628 ± 0.052 and 0.908 ± 0.031, suggesting low and high diagnostic values, respectively. CEUS has high diagnostic values, being significantly greater than those of conventional ultrasound, in differential diagnosis of benign and malignant thyroid nodules with calcification.
Collapse
Affiliation(s)
- Jue Jiang
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Xu Shang
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Hua Wang
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Yong-Bo Xu
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Ya Gao
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China.
| | - Qi Zhou
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China.
| |
Collapse
|
29
|
Hong YR, Yan CX, Mo GQ, Luo ZY, Zhang Y, Wang Y, Huang PT. Conventional US, elastography, and contrast enhanced US features of papillary thyroid microcarcinoma predict central compartment lymph node metastases. Sci Rep 2015; 5:7748. [PMID: 25582862 PMCID: PMC4291568 DOI: 10.1038/srep07748] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/08/2014] [Indexed: 12/13/2022] Open
Abstract
Lymph node metastases at the time of diagnosis have a major impact on both therapeutic strategy and tumor recurrence for patients with papillary thyroid microcarcinoma (PTMC). Our objective was to evaluate the usefulness of PTMC characteristics on ultrasonography for predicting central compartment lymph node metastases (CCLNM) of PTMC. One hundred twenty seven patients who underwent surgery for PTMC were enrolled in this study. The relationship between the CCLNM and the characteristics on conventional US, elastographic, and contrast enhanced ultrasound (CEUS) were investigated. Univariate analysis indicated that PTMCs with CCLNM were more often nodule irregular shape, microcalcifications, hyperenhancing or isoenhancing parametric maps, and peak index ≥1 at preoperative US and CEUS than those without CCLNM (P< 0.01, 0.05, 0.01 and 0.05 respectively). Multivariate analysis showed that microcalcification (OR:2.378, 95% CI: 1.096–5.158) and hyperenhancement or isoenhancement (OR:2.8, 95% CI: 1.287–6.094) were predictive for the presence of CCLNM. Elastography score was not significantly different between the groups. Our study indicated that preoperative thyroid nodule characteristics on conventional US and CEUS may serve as a useful tool to predict central compartment lymph node metastases in PTMC.
Collapse
Affiliation(s)
- Yu-Rong Hong
- Department of Ultrasound, Second Affiliated Hospital Zhejiang University College of Medicine
| | - Cao-Xin Yan
- Department of Ultrasound, Second Affiliated Hospital Zhejiang University College of Medicine
| | - Guo-Qaing Mo
- Department of Ultrasound, Second Affiliated Hospital Zhejiang University College of Medicine
| | - Zhi-Yan Luo
- Department of Ultrasound, Second Affiliated Hospital Zhejiang University College of Medicine
| | - Ying Zhang
- Department of Ultrasound, Second Affiliated Hospital Zhejiang University College of Medicine
| | - Yong Wang
- Department of Surgery, Second Affiliated Hospital Zhejiang University College of Medicine
| | - Pin-Tong Huang
- Department of Ultrasound, Second Affiliated Hospital Zhejiang University College of Medicine
| |
Collapse
|
30
|
Giusti M, Campomenosi C, Gay S, Massa B, Silvestri E, Monti E, Turtulici G. The use of semi-quantitative ultrasound elastosonography in combination with conventional ultrasonography and contrast-enhanced ultrasonography in the assessment of malignancy risk of thyroid nodules with indeterminate cytology. Thyroid Res 2014; 7:9. [PMID: 25506397 PMCID: PMC4264546 DOI: 10.1186/s13044-014-0009-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background The pre-surgical selection of thyroid nodules with indeterminate cytology (Thy 3 according to British Thyroid Association) after fine-needle aspiration biopsy (FNAB) is currently required in order to reduce unnecessary total thyroidectomy. The objective of our study was to use a surgical series of Thy 3 nodules to evaluate the predictive role of ultrasound elastosonography (USE) and contrast-enhanced ultrasonography (CEUS) in pre-surgical diagnoses of malignancy. Subjects and methods We enrolled 63 patients with Thy 3 nodules in which cytological–histological correlation was available. The ELX 2/1 strain index was obtained by means of semi-quantitative USE, which was performed before surgery in addition to conventional ultrasonography (US) and contrast-enhanced US (CEUS) on the Thy 3 nodules. The ELX 2/1 strain index, a five-item US score and both peak (P) index and time to peak (TTP) index from CEUS were correlated with the histological results. After surgical diagnosis, the data were analysed by using a receiver-operating characteristic (ROC) curve. Results Histology was benign in 50 and malignant in 13 Thy 3 nodules. No difference in maximal diameter was noted between benign (22.8 ± 1.6 mm) and malignant (18.9 ± 2.9 mm) nodules. Significant correlations were found between histology and cumulative US findings (p=0.005), ELX 2/1 index (p=0.002), P index (p=0.01) and TTP index (p=0.02). On analysing data from US, USE and CEUS, significant ROC areas under the curve were observed (p<0.0001). A cut-off value was set for US (>2), ELX 2/1 (>0.95), P index (<0.99) and TTP index (>0.98) scores. The diagnostic power of the cumulative pre-surgical analysis of Thy 3 nodules with US, USE and CEUS, considering the experimental cut-off points obtained from the ROC curves was: sensitivity 64%, specificity 92%, PPV 75% and accuracy 84%. Conclusion The ELX 2/1 index in conjunction with the US score can be useful in orienting surgical strategies in Thy 3 nodules. The information added by CEUS is less sensitive than that provided by US and USE. The use of a cut-off based on histology can reduce thyroidectomy. Observation should be the first choice when not all instrumental results are suspect.
Collapse
Affiliation(s)
- Massimo Giusti
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy ; UO Clinica Endocrinologica, Viale Benedetto XV, 6, I-16100 Genoa, Italy
| | - Claudia Campomenosi
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Stefano Gay
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Barbara Massa
- Cytopathology and Pathology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | - Eleonora Monti
- Endocrine Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | |
Collapse
|
31
|
Yu D, Han Y, Chen T. Contrast-Enhanced Ultrasound for Differentiation of Benign and Malignant Thyroid Lesions. Otolaryngol Head Neck Surg 2014; 151:909-15. [PMID: 25344590 DOI: 10.1177/0194599814555838] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Contrast-enhanced ultrasound (CEUS) is a new noninvasive modality for the diagnosis of thyroid nodules. However, the performance of CEUS in differentiating malignant and benign thyroid nodules has not been systematically evaluated. This meta-analysis was performed to assess the accuracy of CEUS in diagnosing thyroid nodules. Data Sources PubMed, Embase, and the references of included studies were examined. Review Methods We recorded the characteristics of the included studies and assessed the quality of each study using the Quality Assessment of Diagnostic Accuracy Studies tool. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated. We also evaluated the publication bias. Results This meta-analysis included 7 studies with a total of 597 thyroid nodules. The pooled the sensitivity, specificity, and positive and negative LR were 0.853, 0.876, 5.822, and 0.195, respectively. The DOR and AUC were 34.730 and 0.9162, respectively. Heterogeneity existed between the included studies. The results of subgroup analyses indicated that the evaluation processes are likely the predominant source of heterogeneity. No significant publication bias was observed. Conclusion Contrast-enhanced ultrasound is a promising noninvasive technique for the differential diagnosis of benign and malignant thyroid nodules and could be a valuable supplemental method to fine-needle aspiration.
Collapse
Affiliation(s)
- Dongmei Yu
- Department of Special Examinations, Qingdao Women and Children Hospital, Qingdao, China
| | - Yuna Han
- Department of Special Examinations, Qingdao Women and Children Hospital, Qingdao, China
| | - Taotao Chen
- Department of Special Examinations, Qingdao Women and Children Hospital, Qingdao, China
| |
Collapse
|
32
|
The use of sonoelastographic elasticity index to differentiate benign and malignant thyroid nodules. Jpn J Radiol 2013; 31:750-4. [DOI: 10.1007/s11604-013-0248-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/09/2013] [Indexed: 12/21/2022]
|
33
|
Abstract
Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders. Advanced ultrasound techniques in thyroid imaging have not only fascinated the radiologists but also attracted the surgeons and endocrinologists who are using these techniques in their daily clinical and operative practice. This review provides an overview of indications for ultrasound in various thyroid diseases, describes characteristic ultrasound findings in these diseases, and illustrates major diagnostic pitfalls of thyroid ultrasound.
Collapse
Affiliation(s)
- Vikas Chaudhary
- Department of Radiodiagnosis, Employees’ State Insurance Corporation Model Hospital, Gurgaon, Haryana, India
| | - Shahina Bano
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi, India
| |
Collapse
|