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

The Great Synergistic Performance for Adjunction of ACR TI-RADS and Color Flow Imaging Vascularity Scoring in Predicting Malignant Thyroid Nodules

“…Combining ACR TI-RADS and CFI vascularity score effectively improved the ability to differentiate malignant from benign TNs. This result is consistent with a previous study introduced by Baz et al [15]. It is also compatible with a similar study introduced by Appetecchia et al who reported that the combination of ultrasound imaging criteria and CFI vascularity increased the screening sensitivity and accuracy in distinguishing malignant TNs [19].…”

“…The ROC curve found that, the sensitivity of CFI vascularity score alone is higher than the sensitivity of TI-RADS alone (85.19% vs 57.41%). A previous study introduced by Baz et al reported that CFI vascularity score alone has a 54.5% sensitivity and 100% speci city, 100% PPV, and 81.4% NPV for malignancy in TNs [15], which revealed less sensitivity but higher speci city for CFI vascularity score than those in our study.…”

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

“…Aside from vascularity, and size, shear wave elastography (SWE) has been introduced into the evaluation of thyroid nodules in recent years [ 25 ]. Although these techniques are still not integrated into the present guidelines, their supplementation to various guidelines seems to improve the diagnosis of malignant nodules both in our study and in the available literature [ 26 ]. Further research is thus recommended on the supplementation of these techniques in nodules with nearly normal US characteristics.…”

Inter‐Rater Reliability of Thyroid Ultrasound Risk Criteria: A Systematic Review and Meta‐Analysis

“…In addition to training and standardization, continuous monitoring of reliability statistics and formal feedback mechanisms have improved inter‐rater reliability estimates in observational studies 65 . Additionally, revision of modern risk criteria via the proposed inclusion of strain elastography or color doppler may improve objectivity and reduce variability between radiologists 66,67 . Up to 46% of thyroid ultrasounds are ordered unnecessarily and not in agreement with Choosing Wisely recommendations 68 .…”

“…65 Additionally, revision of modern risk criteria via the proposed inclusion of strain elastography or color doppler may improve objectivity and reduce variability between radiologists. 66,67 Up to 46% of thyroid ultrasounds are ordered unnecessarily and not in agreement with Choosing Wisely recommendations. 68 Hence, an improvement in inter-rater reliability is imperative in facilitating clinical uptake of thyroid ultrasound criteria since a lack of trust in reporting will lead to needlessly repeated ultrasounds, increased hospital expenditures, and unnecessary thyroid investigations.…”