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

Nell, Sjoerd; Kist, Jakob W.; Debray, Thomas P A; Keizer, Bart de; Oostenbrugge, Tim J. van; Rinkes, Inne H.M. Borel; Valk, Gerlof D.; Vriens, Menno R.

doi:10.1016/j.ejrad.2015.01.003

Cited by 57 publications

(48 citation statements)

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“…To date, in both strain and SWE techniques, physicians always compared the stiffness values of the nodule and parenchyma to differentiate malignant lesions from benign lesions [15][16][17]. In these studies, by US elastography combined with gray scale ultrasonography, the researchers have tried to differentiate benign and malignant thyroid nodules with a relatively significant degree of sensitivity ranging from 75% to 96%.…”

Section: Discussionmentioning

confidence: 99%

A dilemma at gray scale thyroid ultrasound: microcalcification or not? Differentiation with Acoustic Radiation Force Impulse Imaging–Virtual Touch Imaging.

et al. 2016

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Aims: To evaluate the capacity of virtual touch imaging (VTI) of the acoustic radiation force impulse (ARFI) techniquein the differential diagnosis of micro-echogenicities in thyroid nodules. Material and methods: The study comprised 28patients. Gray scale and ARFI displacement maps were used during ultrasound examination.In the same session, fine needleaspiration biopsy (FNAB) samples were obtained from the dominant nodule hav-ing micro-echogenicities. Two radiologists blinded to the FNAB results and clinical data of the patients evaluated these images and rated ARFI echogenicities according to the degree of shining points on the displacement maps and classified them as isohypoechogenic, isohyperechogenic, and obvious hyperechogenic. To differentiate between benignancy and malignancy, “a new sign” was defined as follows: in the ARFI maps obtained by VTI, iso-echogenic or hyper-echogenic appearance of micro-echogenic foci was evaluated as benignancy and hypo-echogenic appearance of micro-echogenic foci was evaluated as malignancy. Results: The FNAB results indicated 14 cases and benign nodules in the other 14 cases. Interobserver agreement between the two radiologists was highly significant for the classification of the micro-echogenic foci (Kappa=0.659, p<0.001). When we reclassified the hyperechoic and isohyperechoic foci as “benign” and isohypoechoic foci as “malignant”, the interobserver agreement between the two radiologists increased (Kappa=0.772, p<0.001). The evaluation of the first and second radiologists were highly concordant with the gold standard pathology results (Kappa=0.786, p<0.001 and Kappa=0.714, p<0.001, respectively). Conclusions: ARFI method with specific VTI features could be a very useful tool in the differentiation of malignant microcalcifications in thyroid nodules.

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Section: Discussionmentioning

confidence: 99%

A dilemma at gray scale thyroid ultrasound: microcalcification or not? Differentiation with Acoustic Radiation Force Impulse Imaging–Virtual Touch Imaging.

et al. 2016

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“…Modern imaging technology such as real-time elastography is used to evaluate malignant and benign tumors in these days. Some researchers have reported the effectiveness of technology to make a malignant from benign tumors differential diagnosis [16,17]. We are now using realtime elastography and shear wave elasticity imaging as well as conventional ultrasonography to distinguish between follicular carcinoma and follicular adenoma, but excellent data are not obtained in our hospital at the present moment.…”

Section: Us Findings Lci(+) Lci(-) Totalmentioning

confidence: 99%

Tumor protrusion with intensive blood signals on ultrasonography is a strongly suggestive finding of follicular thyroid carcinoma.

et al. 2016

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Aim: It is difficult to differentiate follicular carcinomas (FC) from follicular adenomas (FA) because ultrasonography and cytology provide very similar findings. FC is histopathologically diagnosed to have capsular and/or vascular invasion. In a few patients, tumor protrusions are observed by preoperative ultrasonography as large forms of capsular invasion of follicular carcinomas. The aim of the study was to clarify the predictive value of tumor protrusions on preoperative ultrasonography for follicular carcinomas. Material and methods: A total of 531 patients (FC: 184 patients, FA: 347 patients) undergoing thyroid surgery were included in this study. A tumor protrusion on ultrasonography was defined as follows: 1) a solid tumor extending beyond a marginal line of capsular zone of the main tumor on B-mode ultrasonography; 2) intensive blood signals observed within the protrusion area on Doppler ultrasonography. The large form of capsular invasion was defined if the protrusion lesion was histopathologically diagnosed to be a capsular invasion of follicular carcinoma. Results: The sensitivity of tumor protrusion was 0.071, specificity 0.994, positive predictive value 0.867, and negative predictive value 0.669 for FC diagnosis. For the large form of capsular invasion in FC the sensitivity of tumor protrusion was 0.813, specificity 0.982, positive predictive value 0.684, and negative predictive value 0.982. Conclusions: A tumor protrusion with intensive blood signals extending from the main tumor on ultrasonography strongly suggests a large form of capsular invasion of follicular carcinoma.

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“…However, several studies demonstrated the usefulness of SE in avoiding unnecessary FNA and discriminating malignant from benign nodules. The sensitivity and specificity vary from 43.2-100% up to 70-92%, respectively, along with wide alterations of the positive predictive value (40-60%); however, the most common point is the high NPV results (90-99%) in almost all studies (20)(21)(22)(23). Despite all its limitations, we consider SE to be a reliable method in the diagnosis of benign nodules, taking into consideration the high NPV ratios in the majority of the studies.…”

Section: Discussionmentioning

confidence: 99%

Avoidance of unnecessary fine-needle aspiration with the use of the Thyroid Imaging Reporting Data System classification and strain elastography based on The Bethesda System for Reporting Thyroid Cytopathology

Erkan

Canberk

Kilicoglu

et al. 2016

Molecular and Clinical Oncology

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Abstract. Thyroid fine-needle aspiration (FNA) biopsy has been widely accepted as an accurate and cost-effective tool in the management of thyroid nodules. To avoid unnecessary FNAs and provide appropriate management, patient evaluation should be based on a multidisciplinary approach. For this purpose, the Thyroid Imaging Reporting and Data System (TI-RADS) and strain elastography (SE) were proposed as tools for the risk assessment of malignancy in thyroid nodules. The aim of the present study was to analyze the utility of TI-RADS system and SE, along with FNA, and prospectively evaluate 369 consecutive patients referred for FNA of a thyroid nodule. TI-RADS was tested against The Bethesda System for Reporting Thyroid Cytopathology to determine whether there was an agreement between the two classification systems; statistically, some agreement was observed. Medians of the maximum SE values (E-max) were obtained for benign and malignant FNA results and found to be 1.97 [interquartile range (IQR): 1.87] and 2.8 (IQR: 3.42), respectively (P=0.004). The number of studies investigating the utility of TI-RADS and SE along with TBSRCT is currently limited. Our study demonstrated that a multidisciplinary approach with the use of TI-RADS and SE may mildly improve the management of thyroid nodules.

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

Cited by 57 publications

References 56 publications

A dilemma at gray scale thyroid ultrasound: microcalcification or not? Differentiation with Acoustic Radiation Force Impulse Imaging–Virtual Touch Imaging.

A dilemma at gray scale thyroid ultrasound: microcalcification or not? Differentiation with Acoustic Radiation Force Impulse Imaging–Virtual Touch Imaging.

Tumor protrusion with intensive blood signals on ultrasonography is a strongly suggestive finding of follicular thyroid carcinoma.

Avoidance of unnecessary fine-needle aspiration with the use of the Thyroid Imaging Reporting Data System classification and strain elastography based on The Bethesda System for Reporting Thyroid Cytopathology

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