Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

Schiaffino, Simone; Santamorena, Graziana; Massa, Barbara; Ansaldo, Gianluca; Turtulici, Giovanni; Giusti, Massimo

doi:10.12659/msm.909870

Cited by 15 publications

(14 citation statements)

References 43 publications

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“…RTE and SWE do not seem interchangeable but may be used complementary. Interestingly, when strain index, SWV, and BRAF mutation were considered together, Sp was enhanced, but Se was lower compared to US findings alone [68].…”

Section: Elastography: Place In Indeterminate Cytology Resultsmentioning

confidence: 88%

“…Nondiagnostic and indeterminate cytology represent the great limitations of FNAC and gray-scale US can sometimes be poorly predictive. About half of these nodules can avoid surgery by performing a second biopsy [68]. There was one study that reported higher prevalence of cancer on repeat FNAB, maybe as a consequence of the class of high-risk nodules that underwent second FNAB [69].…”

Section: Elastography: Place In Indeterminate Cytology Resultsmentioning

confidence: 99%

“…This cytological category still remains uncertain in diagnosis, and in some cases, a strategy that combines advanced ultrasound methods was documented to provide higher accuracy in diagnosis than use of a single technique [68]. More studies are required concerning this approach.…”

Section: Elastography: Place In Indeterminate Cytology Resultsmentioning

confidence: 99%

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Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

Borlea¹,

Cotoi²,

Mozoş³

et al. 2019

Knowledges on Thyroid Cancer

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The most precise evaluation of thyroid masses is by high-sensitive ultrasound. Complementary to B-mode ultrasound, elastography can add valuable information by determining tissue stiffness-an important predictor for malignancy. All major guidelines recommend nodules with high suspicious ultrasound characteristics larger than 1 cm to be addressed to ultrasound-guided fine needle aspiration biopsy (FNAB) to rule out malignancy. The main limitation of this procedure is represented by indeterminate cytology, which accounts for up to 20-25% of biopsy results. Molecular markers imply elevated costs and their performance needs further study. Elastography may be helpful in establishing the optimal therapeutic attitude for this cytological category. Currently, there are two ultrasound elastography methods available for assessing tissue stiffness using the parallel deformation to the applied force direction (strain) or the perpendicular deformation to the force direction (shear wave). These methods will be presented and compared in this chapter, with their indications and limitations for a better understanding of their application in nodular thyroid pathology.

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Section: Elastography: Place In Indeterminate Cytology Resultsmentioning

confidence: 88%

Section: Elastography: Place In Indeterminate Cytology Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

Borlea¹,

Cotoi²,

Mozoş³

et al. 2019

Knowledges on Thyroid Cancer

View full text Add to dashboard Cite

show abstract

“…Rather than its individual value, it is more important to know the frequency at which elastography reveals a level of suspicion for malignancy that differs from that estimated by US (B-mode) and to what extent this level is modified by elastography. Regarding this additional value of elastography specifically in nodules with indeterminate cytology, the results are not uniform (Trimboli et al 2015, Cantisani et al 2016, Bardet et al 2017, Azizi et al 2018, Gay et al 2018, Liu et al 2018, Ríos et al 2018. If obtained, elevated stiffness on elastography is considered a suspicious finding for malignancy but it must be remembered that readings may be low in non-papillary thyroid carcinomas.…”

Section: Endocrine-related Cancermentioning

confidence: 99%

Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

Rosário

Rocha

Mourão

2021

Endocrine-Related Cancer

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In thyroid nodules (TN) submitted to fine-needle aspiration (FNA), Bethesda categories III and IV are considered “indeterminate” cytology. This result corresponds to 10-25% of all FNAs and the risk of malignancy (RoM) ranges from 10% to 30% for category III and from 15% to 40% for category IV. This review analyzed the practical applicability of accessible imaging method in the management of patients with cytologically indeterminate TN > 1 cm (ITN). When ITN are highly suspicious on ultrasonography (US), the RoM supports surgical indication even in the absence of additional tests. The same can be applied to ITN of intermediate suspicion but with elevated stiffness on elastography. Follow-up without additional tests is acceptable in the case of ITN with low-risk cytology and low-suspicion appearance on US and elastography (if obtained). In the case of ITN without highly suspicious US appearance, 123I scintigraphy may be obtained in patients with TSH < 1-1.5 mIU/L to rule out hyperfunctioning nodules before requesting diagnostic methods that are more expensive and less accessible. In addition, in ITN with not very suspicious US appearance, 18FDG-PET may be obtained. If this method does not reveal nodular uptake, the risk of the nodule corresponding to a macrocarcinoma is sufficiently low in order to allow follow-up. The positive predictive value of focal nodular uptake on 18FDG-PET depends on the pre-test RoM, cytological findings, and maximum SUV. There is currently no evidence for the use of computed tomography, magnetic resonance imaging or imaging using 99mTc-MIBI to define the nature of ITN.

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“…Currently, there are many elastographic techniques used in clinical practice: shear wave elastography biplane method, point share wave elastography, strain/real-time elastography, respectively fibroscan. [12]. The method is non-invasive, completely painless for the patient and can be easily performed even during routine ultrasound examinations.…”

Section: Introductionmentioning

confidence: 99%

Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules

et al. 2019

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Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6–13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases.

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Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

Cited by 15 publications

References 43 publications

Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules

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