Comparison of the diagnostic accuracy of combined elastosonography and <scp>BRAF</scp> analysis <i>vs</i> cytology and ultrasonography for thyroid nodule suspected of malignancy

Nacamulli, Davide; Nico, Lorena; Barollo, Susi; Zambonin, Laura; Pennelli, Gianmaria; Girelli, Maria Elisa; Ide, Eric Casal; Pelizzo, Maria Rosa; Vianello, Federica; Negro, Isabella; Watutantrige-Fernando, Sara; Mantero, Franco; Mian, Caterina

doi:10.1111/j.1365-2265.2012.04427.x

Cited by 10 publications

(14 citation statements)

References 31 publications

(49 reference statements)

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“…Qualitative elastography has been described as a promising new technique in differentiating benign from malignant thyroid nodules [30][31][32][33][34][35][36][37][38][39][40][41][42]. The aim of this systematic review and metaanalysis was to investigate the diagnostic value of qualitative elastography in distinguishing benign from malignant thyroid nodules in patients referred for FNA and, thereby, potentially prevent unnecessary invasive diagnostic procedures.…”

Section: Discussionmentioning

confidence: 99%

Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules. A systematic review and meta-analysis

Nell

Kist

Debray³

et al. 2015

European Journal of Radiology

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Section: Discussionmentioning

confidence: 99%

Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules. A systematic review and meta-analysis

Nell

Kist

Debray³

et al. 2015

European Journal of Radiology

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“…Quantitative ultrasound elastography is more accurate than conventional ultrasound in the diagnosis of thyroid nodules and it is useful for the pre-surgical selection of patients [5,8,11,24]. Malignant nodules have been consistently reported to exhibit significantly greater stiffness compared to benign lesions [5,11,24].…”

Section: Discussionmentioning

confidence: 99%

“…Malignant nodules have been consistently reported to exhibit significantly greater stiffness compared to benign lesions [5,11,24]. …”

Section: Discussionmentioning

confidence: 99%

“…Nodule aspirates positive for: galectin-3, BRAF point mutations, the formation of PAX8-PPARγ1 chimeric oncogene, and the RET/PTC mutation have all been associated (even if to different extents) with thyroid cancer risk [8,12,17,25-27]; thus, the combined analysis of multiple markers is likely to be of the greatest clinical use in reducing the rate of unnecessary surgical procedures and associated complications [8]. Nacamulli [24] combined elastosonography with molecular testing for BRAF mutations and found that it improved the preoperative identification of thyroid malignancies; the author concluded that this strategy holds great potential for reducing the number of unnecessary surgical procedures. Alexander et al [1] reported the results of a large, prospective, multicenter study validating a gene-expression classifier in patients with indeterminate thyroid nodules: 78 of the 85 nodules were identified as suspicious with a sensitivity of 92% and a specificity of 52%; the authors suggest that a more conservative approach should be considered for most patients with benign results from gene-expression classifier testing [1].…”

Section: Discussionmentioning

confidence: 99%

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Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

et al. 2014

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BackgroundIdentification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients.MethodsThe study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy.ResultsMalignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy.ConclusionsThe rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.

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“…[1011121314151617181920212223] The primary goal of these studies is to demonstrate availability, benefits, and predictive values of noninvasive methods such as elastography to reduce the number of patients, for whom invasive diagnostic methods would be referred to or who would undergo surgery.…”

Section: Discussionmentioning

confidence: 99%

Elastography in Distinguishing Benign from Malignant Thyroid Nodules

Çolakoğlu

Yıldırım²,

Aliş

et al. 2016

Journal of Clinical Imaging Science

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Aim:The aim of this study is to test the diagnostic success of strain elastography in distinguishing benign from malignant thyroid nodules.Materials and Methods:The size, echogenicity, and halo integrity of 293 thyroid nodules and the presence of microcalcification in these nodules were evaluated on gray-scale examination. Doppler characteristics and elastography patterns were also evaluated and recorded. Nodules were classified in four categories (patterns 1–4) based on elastographic examination.Results:According to the cytopathological findings, 222 nodules were benign, and 71 nodules were malignant. The risk of a nodule to be malignant was 3.8 times increased by hypoechogenicity, 7.7 times increased by the presence of microcalcification, and 11.5 times increased by the absence of halo. On Doppler patterns, the presence of central vascularity increased the malignancy risk of a nodule by 5.8 times. According to the receiver operating characteristic analysis, patterns 3 and 4 were malignant, and patterns 1 and 2 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of elastography were 100%, 80.2%, 61.7%, 100%, and 85%, respectively.Conclusion:Strain elastography can be used as a noninvasive method in distinguishing benign from malignant thyroid nodules and in identifying the patients who would undergo surgery.

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Comparison of the diagnostic accuracy of combined elastosonography and BRAF analysis vs cytology and ultrasonography for thyroid nodule suspected of malignancy

Cited by 10 publications

References 31 publications

Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules. A systematic review and meta-analysis

Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules. A systematic review and meta-analysis

Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

Elastography in Distinguishing Benign from Malignant Thyroid Nodules

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