scholarly journals Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma

2019 ◽  
Vol 8 (8) ◽  
pp. 1195-1205 ◽  
Author(s):  
Kristine Zøylner Swan ◽  
Steen Joop Bonnema ◽  
Marie Louise Jespersen ◽  
Viveque Egsgaard Nielsen
Keyword(s):  
Diagnostic Accuracy ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Thyroid Malignancy ◽  
Operating Characteristics ◽  
Factors Affecting ◽  
Benign Nodules

Thyroid nodular disease is common, but predicting the risk of malignancy can be difficult. In this prospective study, we aimed to assess the diagnostic accuracy of shear wave elastography (SWE) in predicting thyroid malignancy. Patients with thyroid nodules were enrolled from a surgical tertiary unit. Elasticity index (EI) measured by SWE was registered for seven EI outcomes assessing nodular stiffness and heterogeneity. The diagnosis was determined histologically. In total, 329 patients (mean age: 55 ± 13 years) with 413 thyroid nodules (mean size: 32 ± 13 mm, 88 malignant) were enrolled. Values of SWE region of interest (ROI) for malignant and benign nodules were highly overlapping (ranges for SWE-ROImean: malignant 3–100 kPa; benign 4–182 kPa), and no difference between malignant and benign nodules was found for any other EI outcome investigated (P = 0.13–0.96). There was no association between EI and the histological diagnosis by receiver operating characteristics analysis (area under the curve: 0.51–0.56). Consequently, defining a cut-off point of EI for the prediction of malignancy was not clinically meaningful. Testing our data on previously proposed cut-off points revealed a low accuracy of SWE (56–80%). By regression analysis, factors affecting EI included nodule size >30 mm, heterogeneous echogenicity, micro- or macrocalcifications and solitary nodule. In conclusion, EI, measured by SWE, showed huge overlap between malignant and benign nodules, and low diagnostic accuracy in the prediction of thyroid malignancy. Our study supports that firmness of thyroid nodules, as assessed by SWE, should not be a key feature in the evaluation of such lesions.

Diagnostic Value of Real-Time Shear Wave Elastography in Diagnosing Thyroid Cancer

2018 ◽  
Vol 68 (12) ◽  
pp. 2818-2822
Author(s):  
Maria Cristina Oprea ◽  
Mihaela Vlad ◽  
Ioana Golu ◽  
Ioan Sporea ◽  
Lazar Fulger
Keyword(s):  
Shear Wave ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Imaging Techniques ◽  
Area Under The Curve ◽  
Thyroid Volume ◽  
Shear Wave Elastography ◽  
Maximum Diameter ◽  
Diagnostic Tools ◽  
Tissue Elasticity

Thyroid nodules are a common pathology found in 50 to 60% of otherwise healthy people. Diagnostic imaging techniques are help discriminating between benign and malignant nodules, while fine needle aspiration is still a gold standard. Shear wave elastography, a recent imaging technique, holds the promise to become reliable diagnostic tools and is currently used in combination with ultrasound. We here report data obtained in a series of 52 thyroid nodules analysed by means of elastography, as well as conventional and Doppler ultrasound. We found no differences in age, nodule and thyroid volume, length, width, thickness and maximum diameter between benign and malignant lesions. Several sonographic patterns are considered to be predictive of malignancy, out of which we only found the intranodular blood flow to be statistically significant. By the means of shear wave elastography we have first assessed tissue elasticities, which are shown in a range of colours, depending on tissue elasticity/stiffness. Then, we have measured and recorded four parameters automatically displayed by the system, namely SWE-mean, SWE-max, SWE-SD and SWE-ratio. Data analysis showed all these quantitative parameters had good sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, as calculated by the ROC curve. As with these parameters, the cut-off points were lower than in literature, still able to indicate reliable diagnoses, which were confirmed by histopathological exam. Our conclusion is that shear wave elastography has great potential for reliably and accurately diagnosing thyroid malignancies.

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo(New Corresponding Author) ◽  
Hye Jeong Kim(Former Corresponding Author) ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it shows a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy remains unclear. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (E Mean , p<0.001; E Max , p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a valuable and standardized method in clinical practice. Moreover, our results showed that fibrosis in the histopathology increased EI on SWE and might lead to the discrepancy of the cut-off values in detecting thyroid cancer.

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis Leading to Discrepant Cut-off Values in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo ◽  
Hye Jeong Kim ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it showed a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy has not been clarified yet. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (EMean, p<0.001; EMax, p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a new, valuable, and standardized method in clinical practice. Moreover, our results showed that causes the elevation of EI leading to wide discrepant cut-off values of thyroid cancer was the formation of fibrosis.

scholarly journals Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules

2017 ◽  
Vol 7 (11) ◽  
pp. 1103 ◽  
Author(s):  
Faisal Baig ◽  
Shirley Liu ◽  
Hoi-Chun Lam ◽  
Shea-Ping Yip ◽  
Helen Law ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Shear Wave Elastography ◽  
Grey Scale

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo ◽  
Hye Jeong Kim ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it showed a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy has not been clarified yet. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (EMean, p<0.001; EMax, p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a valuable and standardized method in clinical practice. Moreover, our results showed that fibrosis in the histopathology increased EI on SWE and might lead to the discrepancy of the cut-off values in detecting thyroid cancer.

Shear Wave Elastography Combined with Thyroid Imaging Report and Data System for Risk Stratification of Thyroid Nodule Malignant Tumor

2021 ◽  
Vol 11 (3) ◽  
pp. 863-868
Author(s):  
Xiaoyun Wang ◽  
Suhong, Zhao ◽  
Weihua Zhao ◽  
Xianhua Zhao
Keyword(s):  
Shear Wave ◽  
Thyroid Nodules ◽  
Shear Wave Elastography ◽  
Fine Needle Biopsy ◽  
Data System ◽  
Thyroid Imaging ◽  
Similarity Ratio ◽  
Elastic Ratio ◽  
Benign Nodules

Benign and malignant thyroid cancer diagnosis is crucial. Our study intends to evaluate the role of shear wave elastography (SWE) and thyroid imaging report and data system (TI-RADS) in diagnosing the benign and malignant thyroid nodules. 100 thyroid nodules patients were recruited and evaluated by SWE and TI-RADS before fine needle biopsy and/or surgery. The maximum elastic index (Emax), mean elasticity index of thyroid nodules (Emean), minimum elastic index (Emin) and elastic ratio (ER) was measured and compared between different imaging. Ultrasound diagnosis showed solid nodules with significant hypoechoic, unclear boundary, and microcalcification. TI-RADS value was measured based on suspected ultrasound features. Combination of SWE and TI-RADS was performed. Among the 100 nodules, 38 were benign (38.0%), 62 were malignant (62.0%), and malignant nodules had significantly elevated SWE and TI-RADS compared with benign nodules (P < 0.001). The optimal SWE threshold for Emax was 51.95 kPa, with a sensitivity of 81.44% and specificity of 83.19%. There were two methods for combining SWE and TI-RADS. One was sequential detection, with a specificity of 95.80%, positive similarity ratio of 18.16 and PPV of 96.73%; the other was parallel detection method with a sensitivity of 94.85%, negative similarity ratio of 0.07 and PPV of 90.00%. Our results suggest that combination of SWE and TI-RADS might be applied to identify benign and malignant thyroid cancers.

Sign in / Sign up

Export Citation Format

Share Document