Elastography for the Diagnosis of High-Suspicion Thyroid Nodules Based on the 2015 American Thyroid Association Guidelines: A Multicenter Study
Abstract Background: Accurate diagnosis of high-risk nodules of 2015 American thyroid association(ATA) would reduce invasive testing. Elastography is useful for identifying benign and malignant thyroid nodules. Aims: To investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 guidelines in the Chinese population. Materials and Methods: A total of 1445 thyroid nodules were subjected to conventional ultrasound and strain elastography examinations. Receiver operating characteristic(ROC) curves were plotted to evaluate the diagnostic performance of elasticity score(ES) and strain ratio(SR). Logistic regression analysis was used to determine the predictors of malignancy. Results: The areas under the curve of ES and SR were 0.828 and 0.732. The sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of ES were 92.4%, 60.7%, 79.0%, 76.3% and 85.5% , and those of the SR were 81.1%, 50.1%, 68.9%, 65.9% and 67.9%. Logistic regression analysis showed that microcalcification (OR=5.290), taller than wide (OR=12.710), irregular margin (OR=10.117), extrathyroidal extension (OR=6.412), ES (OR=3.741) and SR (OR=1.083) were independent predictors of malignant thyroid nodules. Sensitivity, specificity, accuracy, PPV and NPV of ES were all superior in nodules ≥1 cm than in those <1 cm (95.0% vs 90.4%, 68.8% vs 56.8%, 85.9% vs 74.4%, 85.2% vs 69.9%, 87.8% vs 84.2%, respectively). Conclusions: Elastography with ES is valuable for assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.