Comparing the Diagnostic Accuracy of RTE and SWE in Differentiating Malignant Thyroid Nodules from Benign Ones: a Meta-Analysis

Abstract

Background: Approximately 10-20 million Americans have been clinically diagnosed with thyroid nodules. Shear wave elastography (SWE) and real-time elastography (RTE) are two primary forms of elastography for identifying the status of thyroid nodules. The aim of this study is to assess the performance of RTE and SWE in identifying malignant thyroid nodules. Methods: Relevant articles were systematically retrieved from PubMed, Embase and Cochrane Library. In order to evaluate the overall diagnostic accuracy, we have considered pooled sensitivity (SEN), specificity (SPE), area under the curve (AUC) and partial AUC with corresponding 95% confidence intervals (95%CIs). Stratified analyses by ethnicity (Caucasian, Asian), the number of malignant nodules (> 50, < 50), score system (elasticity scores: ES and strain ration: SR) and ES (> 4, < 4) were performed to explore potential sources of heterogeneity. All statistical tests were performed using the R 3.2.1 software package. Results: We analyzed 80 trials from 71 studies with 16,624 subjects (12,348 for SWE, 4,276 for RTE). The pooled results suggested that RTE is more accurate than SWE in diagnosing malignant cases (RTE: SEN= 0.829, 95%CI = 0.799-0.855, SPE = 0.828, 95%CI = 0.789-0.862, AUC = 0.889; SWE: SEN = 0.784, 95%CI = 0.732-0.828, SPE = 0.824, 95%CI = 0.766-0.871, AUC = 0.859). No significant difference was found in the subgroup analyses. Conclusion: Our findings revealed that RTE is superior to SWE in differentiating malignant and benign thyroid nodules. Nevertheless, more studies focusing on the diagnostic accuracy of RTE and SWE during different stages of thyroid nodules development should be carried out in the future.

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

“…Studies included nodules from 2 -71 mm and most were papillary carcinomas. Therefore, cut-off values have a wide range and a single threshold cannot be established [82,83,85]. The sensitivity for SWE has been reported as 63.8 -93.8 %, and the specificity as 50 -88.2 % [96, 97, 100, 102, 104 -106].…”

Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

“…A big meta-analysis on 71 studies with a total of 16,624 patients showed that RTE is slightly better in differentiating benignancy from malignancy in thyroid lesions, with pooled Se = 82.9% for RTE; Se = 78.4% for SWE and Sp = 82.8% for RTE; and Sp = 82.4% for SWE [66].…”

TI-RADS Diagnostic Performance: Which Algorithm Is Superior and How Elastography and 4D Vascularity Improve the Malignancy Risk Assessment

“…It is nowadays more and more widely used to better thyroid nodule discrimination. Both real-time elastography (RTE) and shear wave elastography (SWE) proved to have good results in indicating the malignancy risk using increased stiffness as a criterion of suspicion, with superior outcomes for RTE [8][9][10].…”