Comparison of diagnostic value of SWE, FNA and BRAF gene detection in ACR TI-RADS 4 and 5 thyroid nodules

Abstract

OBJECTIVES: To compare the diagnostic value of shear wave elastography (SWE), fine needle aspiration (FNA) and BRAF gene detection (BRAFV600E gene mutation detection) in ACR TI-RADS 4 and 5 thyroid nodules. METHODS: SWE images, FNA cytological results and BRAF detection results of ACR TI-RADS 4 and 5 thyroid nodules confirmed by pathology were analyzed retrospectively. The receiver operating characteristic (ROC) curve was drawn to determine the best cutoff value of SWE Emax. In the combined diagnosis of SWE, FNA and BRAF, firstly, the nodules with BRAF gene mutation were included in the positive ones, secondly, the nodules with benign and malignant FNA were included in the FNA + SWE or FNA + SWE + BRAF negative and positive ones respectively, finally, for FNA uncertain nodules: those whose SWE Emax were less than or equal to the cutoff value were included in FNA + SWE or FNA + SWE + BRAF negative ones, and those whose SWE Emax were greater than the cutoff value were included in positive ones. The diagnostic efficacy of SWE, FNA, SWE + FNA, FNA + BRAF and their combination in ACR TI-RADS 4 and 5 thyroid nodules were compared. RESULTS: The ROC curve showed that the best cutoff value of SWE Emax was 40.9 kpa, and the area under ROC curve (AUC) was 0.842 (0.800∼0.885). The sensitivity, specificity and accuracy of SWE were 76.3% (270/354), 75.5% (80/106) and 76.1% (350/460), respectively. The sensitivity, specificity and accuracy of FNA were 58.2% (206/354), 88.7% (94/106) and 65.2(300/460), respectively. The sensitivity, specificity and accuracy of FNA + BRAF were 95.5% (338/354), 88.7% (94/106) and 93.9% (432/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA were 85.9% (304/354), 98.1% (104/106) and 88.7% (408/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA + BRAF were 98.3% (348/354), 98.1% (104/106) and 98.3% (452/460), respectively. For the diagnostic accuracy, SWE + FNA + BRAF > FNA + BRAF > FNA + SWE > SWE > FNA, the difference was statistically significant (all P > 0.05). CONCLUSIONS: For ACR TI-RADS 4 and 5 thyroid nodules, SWE and FNA have high diagnostic efficiency. For the diagnostic accuracy, FNA + BRAF is better than FNA + SWE. FNA combination with BRAF gene detection further improves the diagnostic sensitivity and accuracy of FNA. The combined application of the three is the best.

Contrast-enhanced ultrasound and shear wave elastography in the diagnosis of ACR TI-RADS 4 and 5 category thyroid nodules coexisting with Hashimoto’s thyroiditis

“…Liao et al ( 37 ) found that SWE could be an independent predictor for malignant thyroid nodules; the sensitivity and specificity were 81% and 65%, respectively, with the best cutoff of Emean being 32 kPa. In this study, we found that SWE was useful in the differentiation of benign and malignant ACR TI-RADS 4 and 5 category thyroid nodules, which was consistent with a previous study ( 35 – 37 ), and HT did not seem to affect the stiffness of thyroid nodules. Compared with Emin, Emean, and Eratio, Emax >46.8 kPa had the best diagnostic performance for ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT in this study.…”

“…Compared with SE, SWE is less influenced by the experience and operation of the operator. Zhang et al ( 35 ) found that SWE had high diagnostic efficiency for ACR TI-RADS 4 and 5 category thyroid nodules; the accuracy was 76.1%, with the best cutoff of Emax being 40.9 kPa. Chen et al ( 36 ) conducted a meta-analysis with 4,296 thyroid nodules and found that Supersonic shear imaging showed high accuracy in the differentiation between benign and malignant thyroid nodules, which could serve as a noninvasive and important tool for thyroid nodule evaluation.…”

Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

“…The reasons for this may be ethnic differences mentioned above and other non-classical PTC subtypes which seldom carry BRAF mutation. The specificity of BRAF mutation detection is reported ranging from 88.7% to 100%, 27,28 and some studies have found that few cases with BRAF mutation were not PTC in postoperative histology. 29 The specificity in this study is slightly lower, which may be correlated with not enrolling follow-up benign patients.…”

Diagnostic value of ACR TI-RADS combined with three-dimensional shear wave elastography in ACR TI-RADS 4 and 5 thyroid nodules

“…[9][10][11][12] Some studies suggested that TI-RADS combined with SWE was an effective diagnostic method. [3,[13][14][15][16] However, due to the influence of the acoustic shadow of the trachea, the elasticity value for thyroid nodules adjacent to the trachea or blood vessels could not be accurately measured in the 2D plane. Yang et al [17] believed that the elasticity score obtained by 2D-SWE elastography and the elasticity ratio obtained by pressure elastography were limited in the differential diagnosis of thyroid nodules.…”