Predicting malignancy in thyroid nodules with benign cytology results: The role of Conventional Ultrasound, Shear Wave Elastography and BRAF V600E

BACKGROUND: Ultrasound-guided fine-needle aspiration (US-FNA) is the most accurate method for preoperative diagnosis of thyroid nodules, but how to deal with false negative results. OBJECTIVE: This study aimed to find preoperative diagnosis methods including Conventional Ultrasound (CUS), Shear Wave Elastography (SWE) and BRAF V600E testing to differentiate false negative nodules. METHODS: Forty-nine nodules in 49 patients with benign FNA results and pathological diagnoses were included. CUS and SWE features were evaluated. BRAF V600E analysis was performed after FNA. Diagnostic performances of three methods were analyzed in predicting malignancy in benign FNA results. RESULTS: Twenty-seven of 49 nodules were malignant, and 22 nodules were benign. Hypoechogenicity, taller-than-wider, irregular boundary, microcalcification, SWE max, SWE mean and BRAF V600E mutation were risk factors for malignancy. All 7 malignant nodules with BRAF V600E mutations and 18 of 20 malignant nodules without BRAF V600E mutations have two or more suspicious CUS features. Six of 7 malignant nodules with BRAF V600E mutations and 16 of 20 malignant nodules without BRAF V600E mutations had SWE mean value greater than the cut-off value. CONCLUSIONS: CUS, SWE and BRAF V600E were diagnostic tools for malignancy in FNA benign nodules. Further clinical decisions should be considered for nodules with 2 or more suspicious CUS features and SWE parameters greater than cut-off values whether BRAF V600E is mutational or not.

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Thyroid Nodules with Preoperative Benign Cytology and BRAF V600E Mutations: the Role of Conventional Ultrasound and Shear Wave Elastography

10.21203/rs.3.rs-96936/v1 ◽

2020 ◽

Author(s):

Ying Zhang ◽

Feng Lu ◽

Yi-Feng Zhang ◽

Han-Xiang Wang ◽

Shi Hui ◽

...

Keyword(s):

Risk Factors ◽

Predictive Value ◽

Thyroid Nodules ◽

False Negative ◽

Shear Wave Elastography ◽

Braf V600e ◽

Negative Results ◽

False Negative Results ◽

Conventional Ultrasound ◽

Missed Diagnosis

Abstract Objectives: Ultrasound-guided fine-needle aspiration (FNA) is the most accurate and economical means for the differential diagnosis of thyroid nodules, but false negative results also existed. This study aimed to predict the false negative results of FNA, reduce the missed diagnosis and improve the current management strategy of thyroid nodules. Methods: A total of 1232 consecutive patients with thyroid nodules who received FNA and BRAF V600E detection were adopted. All patients received both CUS (conventional ultrasound) and SWE (shear wave elastography) examinations and characteristics of these thyroid nodules were analyzed to evaluated the diagnostic performances of risk factors for malignancy.Results: Finally, 26 nodules with benign cytology and BRAF V600E mutations were enrolled. Undefined boundary, microcalcification and E max ratio > 1.49 were risk factors for malignancy (P<0.05), and the area under the receiver operating curve (ROC) of above CUS features and elastic value were 0.817 (95% CI: 0.617, 0.940), 0.792 (95% CI: 0.588, 0.925) and 0.792 (95% CI: 0.617, 0.940) respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 80.0%, 83.3%, 94.1%, 55.6% and 80.7% for undefined boundary, 75.0%, 83.3%, 93.8%, 50.0% and 76.9% for microcalcification and 75.0%, 83.3%, 93.8%, 50.0% and 76.9% for E max ratio > 1.49 respectively. There was no difference between benign and malignant nodules in the patient age, sex and nodule sizes (P>0.05).Conclusions: Undefined boundary, microcalcification and E max ratio > 1.49 were risk factors for malignancy in benign cytology nodules. When FNA results were benign but above characteristics could be found in the thyroid nodules with BRAF V600E mutation, further clinical decisions should be carried out to reduce the missed diagnosis.

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

Revista de Chimie ◽

10.37358/rc.17.12.5985 ◽

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.

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Comparison of strain elastography, shear wave elastography, and conventional ultrasound in diagnosing thyroid nodules

Journal of Medical Ultrasound ◽

10.4103/jmu.jmu_46_18 ◽

2019 ◽

Vol 27 (1) ◽

pp. 26 ◽

Cited By ~ 5

Author(s):

Yung-Sheng Chen ◽

Li-Jen Liao ◽

Huan-Wen Chen ◽

Wan-Lun Hsu

Keyword(s):

Shear Wave ◽

Thyroid Nodules ◽

Shear Wave Elastography ◽

Strain Elastography ◽

Conventional Ultrasound

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Shear Wave Elastography May Add a New Dimension to Ultrasound Evaluation of Thyroid Nodules: Case Series with Comparative Evaluation

Journal of Thyroid Research ◽

10.1155/2012/657147 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 25

Author(s):

Rafal Z. Slapa ◽

Antoni Piwowonski ◽

Wieslaw S. Jakubowski ◽

Jacek Bierca ◽

Kazimierz T. Szopinski ◽

...

Keyword(s):

Shear Wave ◽

Large Scale ◽

Thyroid Nodules ◽

False Negative ◽

Case Series ◽

Shear Wave Elastography ◽

True Negative ◽

Strain Elastography ◽

Negative Results ◽

Ultrasound Evaluation

Although elastography can enhance the differential diagnosis of thyroid nodules, its diagnostic performance is not ideal at present. Further improvements in the technique and creation of robust diagnostic criteria are necessary. The purpose of this study was to compare the usefulness of strain elastography and a new generation of elasticity imaging called supersonic shear wave elastography (SSWE) in differential evaluation of thyroid nodules. Six thyroid nodules in 4 patients were studied. SSWE yielded 1 true-positive and 5 true-negative results. Strain elastography yielded 5 false-positive results and 1 false-negative result. A novel finding appreciated with SSWE, were punctate foci of increased stiffness corresponding to microcalcifications in 4 nodules, some not visible on B-mode ultrasound, as opposed to soft, colloid-inspissated areas visible on B-mode ultrasound in 2 nodules. This preliminary paper indicates that SSWE may outperform strain elastography in differentiation of thyroid nodules with regard to their stiffness. SSWE showed the possibility of differentiation of high echogenic foci into microcalcifications and inspissated colloid, adding a new dimension to thyroid elastography. Further multicenter large-scale studies of thyroid nodules evaluating different elastographic methods are warranted.

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Suggested amendment of TI-RADS classification of thyroid nodules by shear wave elastography

Acta Radiologica ◽

10.1177/0284185119889567 ◽

2019 ◽

Vol 61 (8) ◽

pp. 1026-1033

Author(s):

Jin-Ru Yang ◽

Yan Song ◽

Shan-Shan Xue ◽

Li-Tao Ruan

Keyword(s):

Shear Wave ◽

Operating Characteristic ◽

Thyroid Nodules ◽

Characteristic Curve ◽

Shear Wave Elastography ◽

Needle Aspiration ◽

Ultrasound Elastography ◽

Conventional Ultrasound ◽

Ultrasonic Shear

Background The application of the ultrasound elastography and Thyroid Imaging Reporting and Data System (TI-RADS) classification further expands the scope of ultrasound differential diagnosis between benign and malignant thyroid nodules. Purpose To investigate the value of the quantitative parameter of ultrasonic shear waves in optimizing the TI-RADS classification of thyroid nodules. Material and Methods A total of 168 thyroid nodules, initially classified using TI-RADS and scanned by shear wave elastography (SWE), were retrospectively analyzed. All cases were diagnosed by fine needle aspiration and histology following surgery. Results The benign rate of TI-RADS 3 nodules was 76.5%, while the benign rate of TI-RADS 4a nodules was 71.7%. Furthermore, the malignant rate of TI-RADS 4b nodules was 69.7%, while the malignant rate of TI-RADS 4c nodules was 85.7%. In differentiating benign from malignant nodules, the combination of TI-RADS classification and Emean had the largest area under the receiver operating characteristic curve (AUC). Using an Emean value of 42.25 kpa as the cut-off point, the malignant rate of TI-RADS 4a nodules decreased from 28.3% to 23.5%, while the malignant rate of TI-RADS 4b nodules increased from 69.7% to 79.4%. Compared to conventional ultrasound alone, the sensitivity, negative predictive value, and AUC of conventional ultrasound combined with SWE in the diagnosis of benign and malignant thyroid nodules significantly improved ( P=0.012, 0.029, 0.001). Conclusion The SWE technique can be used to further determine the benign and malignant nature of TI-RADS 4 lesions, providing further reference for the choice of clinical treatment. The TI-RADS classification system corrected by SWE is more significant in the diagnosis of benign and malignant thyroid nodules.

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Conventional ultrasound, color Doppler, TI-RADS, and shear wave elastography for thyroid nodule differentiation: a study of efficacy compared with the histopathology results

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00474-5 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ahmed Abd Alrahman Baz ◽

Afaf Hamdy Ibrahim Mohamed ◽

Yasmine Fathy Ghazi El-Esawy ◽

Khaled Helmy El-kaffas

Keyword(s):

Shear Wave ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Color Doppler ◽

Shear Wave Elastography ◽

Color Doppler Imaging ◽

Diagnostic Procedures ◽

Doppler Imaging ◽

Conventional Ultrasound ◽

Histopathological Results

Abstract Background Although a minority of the thyroid nodules is malignant, usually the invasive diagnostic procedures are warranted. This prospective study aims to assess the diagnostic performance of the US criteria in addition to the TI-RADS score and the SWE for the differentiation between the benign and malignant thyroid nodules as a potential surrogate for the invasive procedures. Results Ninety-nine patients with thyroid nodules (79 females and 20 males, with a mean age of 45.9 ± 7.7 years; 30–69 years) were enrolled in this study and underwent conventional ultrasound, color Doppler, TI-RADS scoring, and shear wave elastography (SWE); the findings were correlated to the histopathological results. Our results revealed a significant increase in SWE elasticity indices (EIs) and presence of color Doppler signals in malignant nodules as compared with the benign ones (ρ < 0.05). Combined TI-RADS and SWE as well as TI-RADS and color Doppler imaging had given a better sensitivity for detection of malignancy. Conclusion Elasticity indices had shown a significantly high diagnostic performance that is almost approaching the histopathological results. Combined SWE, color Doppler and TI-RADS, as a sum of findings, could effectively differentiate between benign and malignant thyroid nodules. Furthermore, it had offered a non-invasive tool for accurate risk stratification of malignant nodules.

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