Value of the Ultrasound Elastography in the Diagnosis of Thyroid Nodules

Abstract Background Thyroid disease is of common occurrence, especially in iodine deficient areas. Thyroid nodules have been reported in as many as 50% of the population, at autopsy. They may be discovered in up to 41% of the patients at ultrasonography (US). Aim of the Work The aim of this study is to evaluate the value of Ultrasound- Elastography in the Diagnosis of thyroid nodules for reducing the number of unnecessary Thyroidectomises which add burden to the patient and community, consequently the complications of this surgery will be reduced. Patients and Methods This prospective cohort study was conducted at El Demerdash, Ain Shams University Hospital on Fifty (50) patients with the diagnosis of multi-nodular goiter, who were treated by total thyroidectomy between November 2016 and November 2018 with minimum follow up of one month postoperatively. An informed consent was taken from all patients who accepted to participate in our study after ethical committee approval. Results Elastography has 100% sensitivity and 95.5% specificity as it suspected malignancy (positive suspecting findings) in 8 patients; six of them were proved to be malignant and two of them were benign by histopathology accounting for high positive predictive value (75%) and it suspected benignity (negative suspecting findings) in 42 patients; all of them were perfectly correlated with the histopathology accounting for high negative predictive value (100%). These results showed nearly the same values of the Elastography in the previous studies had been done regarding this concern. Conclusion Conclusively, In the future, FNAC perhaps will not be used for the diagnosis of malignancy in patients presented with multi-nodular goitres who were diagnosed as suspicious of malignancy by Sono-elastography.

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Could Negative Tc-99m-Methoxyisobutylisonitrile (MIBI) Scintigraphy Obviate the Need for Surgery for Bethesda III and IV Thyroid Nodules?

Surgeries ◽

10.3390/surgeries2030026 ◽

2021 ◽

Vol 2 (3) ◽

pp. 260-267

Author(s):

Stella Armefti ◽

Jasmin Mettler ◽

Matthias Schmidt ◽

Michael Faust ◽

Marianne Engels ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Thyroid Nodules ◽

Needle Aspiration ◽

University Hospital ◽

Molecular Testing ◽

High Negative Predictive Value ◽

Indeterminate Cytology ◽

Sensitivity Specificity ◽

Mibi Scintigraphy

In about 20% of all cases, the fine needle aspiration cytology (FNAC) results are equivocal, delivering the two common categories of indeterminate cytology, Bethesda III and IV. The observed rates of malignancy vary widely among institutions, with the urgent need for a more precise risk stratification. 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) is less expensive than molecular testing and has been shown to have a high negative predictive value. For this reason, the results of MIBI scintigraphy in adult patients with indeterminate FNAC were collected, and correlated with the final pathology reports of surgical specimens. Patients receiving FNAC, MIBI scintigraphy and surgery for sonographic suspicious hypofunctional thyroid nodules between 2015 and 2019 at the University Hospital of Cologne, Germany were identified. Sensitivity, specificity, positive predictive and negative predictive value of MIBI scintigraphy were calculated. Seventy-eight patients with sonographic suspicious hypofunctional thyroid nodules underwent surgery after interdisciplinary case discussion of both FNAC and MIBI results. In 49 (62.5%) cases, FNAC consisted of Bethesda III and IV results. In 39 (79.6%) of these cases, MIBI scintigraphy resulted in mismatch and intermediary results, but in only 4 (10.2%) of these cases was a carcinoma diagnosed. The negative predictive value of MIBI scintigraphy was 90–100%, respectively. Relying on the negative predictive value of MIBI match results might have obviated the need for surgery in 20.4% cases; one papillary microcarcinoma, however, would have been missed. MIBI scintigraphy has an underused potential for improving the diagnostic precision of hypofunctional thyroid nodules.

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Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients

European Journal of Preventive Cardiology ◽

10.1177/2047487318817662 ◽

2018 ◽

Vol 27 (6) ◽

pp. 633-644 ◽

Cited By ~ 3

Author(s):

Marco Proietti ◽

Alessio Farcomeni ◽

Giulio Francesco Romiti ◽

Arianna Di Rocco ◽

Filippo Placentino ◽

...

Keyword(s):

Atrial Fibrillation ◽

Negative Predictive Value ◽

Predictive Value ◽

Predictive Ability ◽

Risk Scores ◽

Clinical Risk ◽

Increased Risk ◽

High Negative Predictive Value ◽

Meta Regression

Aims Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. Methods We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2DS2-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Results Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2DS2-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS2: 0.64 (0.63–0.65), CHA2DS2-VASc: 0.62 (0.61–0.64), HAS-BLED: 0.62 (0.58–0.66)). Network meta-regression found no significant differences in predictive ability. CHA2DS2-VASc score had consistently high negative predictive value (≥94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years). Conclusion In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA2DS2-VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.

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Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0853-1821 ◽

2019 ◽

Vol 40 (04) ◽

pp. 495-503 ◽

Cited By ~ 13

Author(s):

Vito Cantisani ◽

Emanuele David ◽

Hektor Grazhdani ◽

Antonello Rubini ◽

Maija Radzina ◽

...

Keyword(s):

Thyroid Nodule ◽

Shear Wave ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Shear Wave Elastography ◽

Strain Ratio ◽

Ultrasound Elastography ◽

Prospective Evaluation ◽

2D Ultrasound

Abstract Purpose To evaluate the diagnostic performance of strain ratio elastography (SRE) and shear wave elastography (SWE) alone and in combination with Thyroid Imaging Reporting and Data System (TIRADS) classification parameters to improve differentiation between benign and malignant thyroid nodules. Materials and Methods In this prospective study benign (n = 191) and malignant (n = 52) thyroid nodules were examined with high-resolution ultrasound (US) features using the TIRADS lexicon and SRE semiquantitative and SWE quantitative findings using histology or cytology as the gold standard with a 12-month follow-up. Sensitivity (Se), specificity (Sp) and the area under the ROC curve (AUROC) were used to evaluate the diagnostic performance of each feature and combinations of the methods. Results TIRADS score showed a sensitivity of 59.6 %, a specificity of 83.8 % with an AUROC of 0.717, a PPV of 50.0 % and an NPV of 88.4 %. SRE yielded the highest performance with a sensitivity of 82.7 %, a specificity of 92.7 % with AUROC of 0.877, a PPV 75.4 % and an NPV of 95.2 %. SWE (kPa) had a sensitivity and specificity of 67.3 % and 82.7 %, respectively, with an AUROC of 0.750, a PPV of 51.5 % and an NPV of 90.3 %. Differences were significant for SRE only but not for SWE. Conclusion Ultrasound elastography may improve thyroid nodule discrimination. In particular, SRE has a better performance than TIRADS classification, while their combination improves sensitivity.

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Afirma Testing in Thyroid Nodules with Indeterminate Cytology: A single Medical Institute Experience

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.207 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S94-S95

Author(s):

Z Yang ◽

T Zhang ◽

L Layfield ◽

M Esebua

Keyword(s):

Predictive Value ◽

Thyroid Nodules ◽

False Negative ◽

Follicular Adenoma ◽

Follicular Carcinoma ◽

Medical Institute ◽

Cell Adenoma ◽

Indeterminate Cytology ◽

Thyroid Fna

Abstract Introduction/Objective About 10 to 30% of thyroid fine needle aspiration (FNA) nodules have indeterminate cytology, including Bethesda III, IV, and V. Afirma Gene Expression Classifier (GEC) measuring the expression of 167 mRNA was designed to classify the indeterminate thyroid nodules into benign and suspicious categories. This study aimed to evaluate the clinical performance of the Afirma GEC testing in these indeterminate thyroid lesions. Methods Medical records of patients with indeterminate thyroid FNA results and corresponding Afirma GEC results from November 2012 to December 2019 were retrieved. Subsequent surgical follow-up results were obtained. GEC results were compared to the histologic diagnoses. Results 1. There were 77 cases with indeterminate thyroid FNA results. Cytology diagnosis included 67 Bethesda III and 10 Bethesda IV. Afirma GEC results were benign for 41 cases (53%), suspicious for 32 cases (42%), and non- diagnostic for 4 cases (5%). Twenty seven of 32 cases (84%) with suspicious GEC results had surgical follow-up which revealed 12 malignant and 15 benign histologic diagnoses. Only 11 of 41 cases (27%) with benign GEC results had surgery which showed 8 benign and 3 malignant diagnoses. Based on the data, the sensitivity of this test is 80% and specificity is 65%. Positive predictive value (PPV) is 44% and negative predictive value (NPV) is 73%. The false positive cases include 5 Hurthle cell adenoma, 4 nodular hyperplasia, 3 follicular adenoma, 2 Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFPT), and 1 lymphocytic thyroiditis. The false negative cases include 2 minimally invasive follicular carcinoma (from same patient) and 1 papillary thyroid carcinoma. Conclusion 1. We demonstrated in this study that a little more than half of the cases with indeterminate thyroid cytology had negative Afirma GEC results. 2.Afirma test has relatively low specificity (65%) and PPV (44%). The sensitivity (80%) and NPV (73%) is relatively higher but is lower than the values in most literature. This could be due to the fact that majority of the Afirma GEC negative cases in this study did not have surgical follow-up and the sample size is small. 3.Afirma GEC test is a relatively good “rule-out” molecular test for indeterminate thyroid nodules but is not a reliable “rule-in” test due to the low specificity and PPV.

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Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MR imaging criteria to predict conversion to CDMS

Multiple Sclerosis Journal ◽

10.1177/135245850100700603 ◽

2001 ◽

Vol 7 (6) ◽

pp. 359-363 ◽

Cited By ~ 62

Author(s):

M Tintoré ◽

A Rovira ◽

L Brieva ◽

E Grivé ◽

R Jardí ◽

...

Keyword(s):

Mr Imaging ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

High Sensitivity ◽

Oligoclonal Bands ◽

High Negative Predictive Value ◽

Csf Oligoclonal Bands ◽

Sensitivity Specificity

Aim of the study: To evaluate and compare the capacity of oligoclonal bands (OB) and three sets of MR imaging criteria to predict the conversion of clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS). Patients and methods: One hundred and twelve patients with CIS were prospectively studied with MR imaging and determination of OB. Based on the clinical follow-up (conversion or not conversion to CDMS), we calculated the sensitivity, specificity accuracy, positive and negative predictive value of the OB, and MR imaging criteria proposed by Paty et al, Fazekas et al and Barkhof et al. Results: CDMS developed in 26 (23.2%) patients after a mean follow-up of 31 months (range 12-62). OB were positive in 70 (62.5%) patients and were associated with a higher risk of developing CDMS. OB showed a sensitivity of 81%, specificity of 43%, accuracy of 52%, positive predictive value (PPV) of 30% and negative predictive value (NPV) of 88%. Paty and Fazekas criteria showed the same results with a sensitivity of 77%, specificity of 51%, accuracy of 57%, positive predictive value of 32% and negative predictive value of 88%. Barkhof criteria showed a sensitivity of 65%, specificity of 70%, accuracy of 69%, PPV of 40% and NPV of 87%. The greatest accuracy was achieved when patients with positive OB and three or four Barkhof's criteria were selected. Conclusions: We observed a high prevalence of OB in CIS. OB and MR imaging (Paty's and Fazekas' criteria) have high sensitivity. Barkhof's criteria have a higher specificity. Both OB and MR imaging criteria have a high negative predictive value.

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Radio Pathological Correlation of Thyroid Nodules Using Tirads Based Ultrasound Classification and Bethesda Classification for FNAC: a Prospective Study

Medicina Moderna - Modern Medicine ◽

10.31689/rmm.2020.27.3.209 ◽

2020 ◽

Vol 27 (3) ◽

pp. 209-213

Author(s):

Richa TIWARI ◽

Ruchi GUPTA ◽

Amit Kumar VERMA ◽

Sanjeev KUMAR ◽

Yogita KATIYAR

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Thyroid Nodules ◽

Screening Tool ◽

Observer Variability ◽

Inter Observer Variability ◽

High Negative Predictive Value ◽

Cation System ◽

A Prospective Study ◽

Ultrasound Classification

Background: Thyroid gland is afflicted by various pathologies amongst which nodules are the cause of maximum concern because of their malignant potential. With the introduction of high resolution ultrasound and use of Thyroid imaging reporting and data system (TIRADS) classifi cation as a widely used universal grading system, there has been reduced inter-observer variability and increased inter-departmental communication. In this study, we studied the TIRADS ultrasound grading as a screening tool and compared it with the BETHESDA grading on FNAC. Material and methods: 200 patients with thyroid nodules were subjected to ultrasound and USG guided FNAC. Each was assigned a TIRADS and Bethesda grade. Findings were compared to assess the sensitivity, specifi city, PPV (positive predictive value) and NPV (negative predictive value) of ultrasound in differentiating benign from malignant nodules. RESULT: Out of 200 nodules examined, 116 nodules belonged to TIRADS 2 while 44, 13 and 27 belonged to TIRADS 3, 4 and 5 respectively. On FNAC, 162 patients belonged Bethesda 2 & 12, 7, 15 and 4 to Bethesda 3, 4, 5 and 6 respectively. The sensitivity, specifi city, PPV and NPV of ultrasound were found to be 92.3, 90.8, 60 and 98.75 % respectively. Conclusion: TIRADS is an effective risk stratifi cation system which should be routinely used in our clinical practice as it can predict the possibility of a particular nodule for being malignant to a great extent. Especially keeping in mind its high negative predictive value, FNAC can be deferred in TIRADS 2 patients which form a majority of cases reporting to pathology department for thyroid FNAC.

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Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound

Hormone Research in Paediatrics ◽

10.1159/000509118 ◽

2020 ◽

Vol 93 (4) ◽

pp. 239-244

Author(s):

Shruthi Arora ◽

Jane Khoury ◽

Andrew T. Trout ◽

Janet Chuang

Keyword(s):

Predictive Value ◽

Lower Risk ◽

Thyroid Nodules ◽

Pediatric Population ◽

Retrospective Chart Review ◽

Needle Aspiration ◽

Risk Category ◽

American Thyroid Association ◽

Risk Of Malignancy

Introduction: The standard workup of thyroid nodules concerning for malignancy includes fine-needle aspiration (FNA). In 2015, the American Thyroid Association (ATA) guidelines for the management of pediatric thyroid nodules recommended that all nodules with a Bethesda III cytology undergo surgical resection. Objectives: To correlate a Bethesda III cytology with histologic and clinical outcomes to determine the relevance of the ATA recommendations, and to evaluate whether Thyroid Imaging Reporting and Data System (TI-RADS) scoring could identify Bethesda III nodules at a lower risk of malignancy. Methods: A retrospective chart review of patients who had undergone thyroid nodule FNA from 2008 to 2018 was performed. Malignancy rates were determined for each Bethesda category. The reference standard was histopathology or 2-year follow-up of imaging outcomes for nonoperative cases. Ultrasound exams of Bethesda III nodules were reviewed and TI-RADS scores assigned. Results: A total of 143 FNA samples from 128 patients were identified. The mean age was 14.9 years (range 7–22). Twenty-two (15%) of the FNA samples were Bethesda III; the malignancy rate was 38%. A TI-RADS score was assigned in 20 of the 22 Bethesda III nodules. ROC analysis found an optimal cut-off for malignancy prediction of ≥7 points (risk category TR5). The negative predictive value was 85.7% (95% CI 35.9–99.6) and the positive predictive value was 83.3% (95% CI 57.2–98.2). Conclusion: Although, at baseline, thyroid nodules with a Bethesda III classification carry a moderate risk of malignancy in the pediatric population, TI-RADS scoring can identify nodules with a lower risk within this group. If validated by larger studies, this can inform decision making and reduce unneeded surgery.

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SONOGRAPHIC FOLLOW-UP OF PATIENTS WITH DIFFERENTIATED THYROID CARCINOMA: A COMPARISON OF THE ULTRASOUND ELASTOGRAPHY, POWER DOPPLER ULTRASOUND, AND B-MODE ULTRASOUND FEATURES IN DETECTING MALIGNANT LYMPH NODES

Endocrine Practice ◽

10.4158/ep-2018-0567 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1049-1055

Author(s):

Berna İmge Aydoğan ◽

Ugur Ünlütürk ◽

Funda Seher Özalp Ateş ◽

Murat Faik Erdoğan

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Positive Predictive Value ◽

Lymph Nodes ◽

Predictive Value ◽

Differentiated Thyroid Cancer ◽

Power Doppler ◽

Ultrasound Elastography ◽

Malignant Lymph Nodes

Objective: The aim of this study was to assess and compare the diagnostic power of B-mode ultrasonography (US), power Doppler US (PD), and ultrasound elastography (USE) in detecting malignant lymph nodes (LNs) during follow-up of patients who were operated on for differentiated thyroid cancer (DTC). Methods: In this prospective study, a total of 103 cervical LNs having suspicious malignant features from 72 patients with DTC were examined using US, PD, and USE. USE scores were classified from 1 to 3 according to the presence of elasticity (1, soft; 2, intermediate; 3, hard). The strain ratios (SRs) of all LNs were calculated according to adjacent muscle tissue. Results: The most-sensitive ultrasonographic features were hilum loss and hypoechogenicity, with 94.4% and 80.6% sensitivity and 93.5% and 84.4% negative predictive value, respectively. The most-specific feature was the presence of cystic component, with 98.5% specificity and 85.7% positive predictive value. Presence of diffuse/chaotic or irregular vascularity in PD had 47.2% sensitivity and 83.6% specificity in predicting metastasis. In USE, the sensitivity and specificity of score 3 were 56.7% and 74.2%, respectively. The median SR of metastatic LNs was higher than that of benign LNs (median SR [min–max], 3.0 [0.16 and 29] vs. 1.89 [0.26 and 37.9]), but the difference was not significant ( P = .07). Multivariate logistic regression analyses revealed 4.9-, 6.6-, and 10-fold increases in metastasis risk for short/long axis ratio ≥0.5, nodal vascularity, and score 3 USE, respectively ( P<.05). Conclusion: While USE had higher sensitivity, PD had higher specificity in detecting malignant LNs, but none of these techniques was as sensitive and specific as gray-scale US features. Abbreviations: CI = confidence interval; DTC = differentiated thyroid cancer; LN = lymph node; LN-Tg = lymph node–thyroglobulin; NPV = negative predictive value; PD = power Doppler; PPV = positive predictive value; ROI = region of interest; SR = strain ratio; US = ultrasonography; USE = ultrasound elastography

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Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience

Otolaryngology ◽

10.1177/0194599820911718 ◽

2020 ◽

Vol 162 (5) ◽

pp. 634-640 ◽

Cited By ~ 3

Author(s):

Amy Vora ◽

Shelby Holt ◽

Wasim Haque ◽

Ildiko Lingvay

Keyword(s):

Literature Review ◽

Negative Predictive Value ◽

Predictive Value ◽

Thyroid Nodules ◽

Tertiary Care ◽

Resection Rate ◽

Comprehensive Literature Review ◽

Indeterminate Cytology

Objective To assess outcomes of thyroid nodules analyzed with the AFIRMA gene expression classifier (GEC) and to perform a comprehensive literature review. Study Design Retrospective analysis of patients with thyroid nodules who underwent AFIRMA GEC testing at our institution. Settings A tertiary care academic institution. Subjects and Methods We collected clinical outcomes for 416 thyroid nodules that were analyzed with AFIRMA GEC between 2011 and 2015, including long-term follow-up through 2019. We performed a comprehensive literature review. Results The resection rate for nodules with “suspicious” GEC results was 85% with a positive predictive value of 37%. The resection rate for nodules with “benign” GEC results was 24% with a negative predictive value of 90%. The prevalence of thyroid malignancy in patients with thyroid nodules with indeterminate cytology at our institution during this timeframe was 41%, thus lowering our negative predictive value. Mean follow-up duration for unresected nodules was 27.8 months. Our resection rates for nodules with “benign” GEC were among the highest reported in the literature. Conclusions Molecular marker testing of thyroid nodules with indeterminate cytology can aid in the surgical decision making by obviating the need for diagnostic surgery and/or guiding extent of resection. Patients with other indications for surgery may not benefit from such costly testing.

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MULTINODULAR GOITER;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.06.1784 ◽

2013 ◽

Vol 20 (06) ◽

pp. 1035-1041

Author(s):

ZULFIQAR ALI BHATTI, ◽

JAVED AHMED PHULPOTO, ◽

NOOR AHMED SHAIKH,

Keyword(s):

Multinodular Goiter ◽

Prospective Observational Study ◽

Thyroid Nodules ◽

Significant Risk ◽

Nodular Goiter ◽

University Hospital ◽

Risk Of Malignancy ◽

The Common ◽

Thyroid Profile ◽

Surgical Unit

Objective: The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter(MNG) after surgical resection on histopathological basis. Introduction: Multi nodular goiter (MNG) is one of the common presentationsof various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although incomparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. Material andmethods: This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical collegehospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients wereadmitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC ofdominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathologyof operated specimen was the main criteria for malignancy. Results: Among the 94 cases which were included in this study, 9 (9.5%)cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonestentity. Conclusions: The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated andencouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy.

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