Diagnosis of Thyroid Nodule with New Ultrasound Imaging Modalities

Abstract

Introduction: B-mode ultrasound (US) technology is an integral part of diagnosing and assessing risk stratification of thyroid nodules (TNs). The addition of shear wave elastography and three-dimensional (3D) US imaging may improve risk stratification for thyroid cancer (TC). Materials and Methods: The patient was evaluated in our clinic with US imaging including B-mode, shear wave elastography, 3D-US, and fine needle aspiration biopsy (FNAB). Laboratory measurements were performed at LabCorp. The patient gave informed consent. Case: A 20-year-old female referred for hypothyroidism who was on levothyroxine 25mg daily. Her thyroid-stimulating hormone (TSH) was 3.870 (0.45-4.5 mIU/mL). Thyroid peroxidase antibody and thyroglobulin antibody were elevated, suggestive of Hashimoto's thyroiditis. Her thyroid ultrasongraph showed a heterogeneous thyroid gland with a hypoechoic TN in the right lobe measuring 9.2 • 8.9 • 9 mm. Shear wave elastography examination was suggestive of a hard TN. The shear wave velocity (SWV) measurements for the target TN was 3.9 m/s. 3D-US examination demonstrated a hypoechoic TN with irregular margins and a volume of 0.322 cm 3. FNAB of right TN was performed. The cytopathology was read as malignant (Bethesa Category VI), diagnostic for papillary thyroid cancer (PTC). She underwent total thyroidectomy. Surgical pathology report showed an 8 mm PTC in the right lobe and 2 mm PTC in the left lobe with a background of Hashimoto's thyroiditis. There were 3/10 positive lymph nodes (LNs) for metastases. The largest metastatic LN measured 5 mm at level 6. Discussion: This case illustrates recent advances in US technology. For decades, clinicians relied on B-mode US to assess the risk for TC. This case illustrates important challenges and advances in US technology. Current ACR-TIRADS guideline for TN management is based on B-mode US features and TN size. 1 In our experience, including additional factors such as elastography, 3D-US, and laboratory evaluation helps to improve our diagnostic accuracy. In this case, her laboratory was suggestive of autoimmune thyroid disease. This information was helpful to put this patient in a higher risk category. Recent large studies reported an association between differentiated TC and autoimmune thyroid disease and/or TSH when all Bethesda classifications were included. 2-4 Shear wave elastography examination showed that this TN had a high SWV, suggestive of a hard TN, which is suspicious for malignancy. Several recent publications have reported that elastography can assess the malignant potential of TN. 5-10 In our prospective study, we reported that in a single cutoff analysis for predicting malignancy in TNs, a maximum SWV of 3.54 m/s had the best sensitivity. With greater SWV values, specificity increased but sensitivity decreased. 6 3D-US technology enhances our ability to visualize the target lesion because of adding a new dimension, coronal view, to the existing B-mode that consists of transverse and longitudinal views. In this case, irregular margins of the...

Imaging Algorithm-Based Real-Time Shear Wave Elastography Combined with Thyroglobulin Antibodies in Diagnosis of Thyroid Cancer

“…It can display the diseased tissue in time and does not require artificial pressure on the patient's tissue, which can reduce the impact on the patient. erefore, it has become an important auxiliary diagnosis for the differential diagnosis of benign and malignant thyroid nodules [6].…”

Precision Medicine with 3D Ultrasound

“…The shear wave velocity (SWV) measurement for the TN was 3.1 m/s. 3D-US examination demonstrated an isoechoic TN with irregular margins, and the volume was 0.119 cm 3 . FNAB of the TN was performed.…”

“…3D-US technology improves view of the target lesion by adding a third dimension, coronal view, to the transverse and longitudinal views of B-mode US. 2,3 B-mode imaging provides excellent view of TNs. However, it has a low sensitivity for predicting TC.…”

Elastography and Morphology Changes of Testicles in Postoperative Hypothyroidism Patients

“…Послеоперационный гипотиреоз -главная клиническая проблема в клинической практике врачей [2]. Естественно, гипотиреоз приводит к изменению функции яичек, особенно при гипогонадотропном гипогонадизме; однако были обнаружены и другие причины функциональных изменений яичек [3]. Современные данные о тестикулярной сонографической эластографии касаются, например, опухолевых масс или болезненных воспалительных и ишемических состояний, но не вторичных свойств тканей, возникающих в результате метаболических заболеваний, таких как гипотиреоз.…”

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