Q-Elastography in the Presurgical Diagnosis of Thyroid Nodules with Indeterminate Cytology

Abstract

Quantitative ultrasound (US) elastography (Q-USE), able to evaluate tissue stiffness has been indicated as a new diagnostic tool to differentiate benign from malignant thyroid lesions. Aim of this prospective study, conducted at the Department of Surgical Sciences, of the “Sapienza” University of Rome, was to evaluate the diagnostic accuracy of Q-USE, compared with US parameters, in thyroid nodules with indeterminate cytology (Thy3).The case study included 140 nodules from 140 consecutive patients. Patient’s thyroid nodules were evaluated by Q-USE, measuring the strain ratio (SR) of stiffness between nodular and surrounding normal thyroid tissue, and conventional US parameters prior fine-needle aspiration cytology. Those with Thy3 diagnosis were included in the study. Forty of the nodules analyzed harbored a malignant lesion. Q-USE demonstrated that malignant nodules have a significant higher stiffness with respect to benign one and an optimun SR cut-off value of 2.05 was individuated following ROC analysis. Univariate analysis showed that hypoechogenicity, irregular margins and SR >2.05 associated with malignancy, with an accuracy of 67.2%, 81,0% and 89.8%, respectively. Data were unaffected by nodule size or thyroiditis. These findings were confirmed in multivariate analysis demonstrating a significant association of the SR and the irregular margins with thyroid nodule’s malignancy. In conclusion, we demonstrated the diagnostic utility of Q-USE in the differential diagnosis of thyroid nodules with indeterminate cytology that, if confirmed, could be of major clinical utility in patients’ presurgical selection.

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

“…Realtime elastography (RTE) a qualitative method has been evaluated in a number of studies [8][9][10][11][12][13][18][19][20]. A recent meta-analysis performed by Bojunga et al [13] summarizes the results of several studies reporting a global sensitivity and specificity of 92 and 90 %, respectively, for RTE in the diagnosis of malignant thyroid nodules.…”

“…Qualitative and semi-quantitative elastosonography methods have been evaluated in a variety of studies on the thyroid with promising results [8][9][10][11][12]. A meta-analysis of eight studies, yielded a mean sensitivity of 92 % and mean specificity of 90 % [13].…”

Thyroid Ultrasound: State of the Art. Part 2 – Focal Thyroid Lesions

“…Follicular carcinomas can be soft and difficult to be differentiated from benign nodules, although some good results have also been reported both with SR SE [61] and with SWE [22]. In the latter paper a cut-off value of 22.30 kPa can help differentiate malignant from benign follicular thyroid lesions with sensitivity of 82%, specificity of 88%, and positive and negative predictive values of 75% and 91%, respectively.…”

Elastographic and contrast-enhanced ultrasound features of a benign schwannoma of the common fibular nerve

“…More recently, US contrast agents and US-elastography have been proposed as additional diagnostic tools for the evaluation of various organs [5,6,8]. However, only one rare case of schwannoma of the liver studied with CEUS is reported in the literature, and there is no report describing schwannoma studied with elastography.…”

“…In recent years, contrast-enhanced ultrasonography (CEUS) and US-elastography have been successfully used in different fields [5,6]. However, only one study describes a rare case of hepatic schwannoma studied with CEUS [7] and only one case of leydigioma studied with both CEUS and US-elastography has been reported [8].…”