The learning curve of real time elastosonography: a preliminary study conducted for the assessment of malignancy risk in thyroid nodules

Abstract

Background: Malignancy is correlated with stiffness which is assessed by real time elastosonography (RTE). RTE is not used in routine practice. We aimed to establish the learning curve of RTE on radiology residents. Methods: Forty ≥1 cm solitary thyroid nodules referred to fine needle aspiration cytology were examined with RTE by a radiology specialist and two radiology residents separately. Patients with malignant and undetermined FNAC findings underwent surgery. Strain ratio and elasticity score results of the radiology residents were compared to the results of the radiology specialist taking the histopathology results as the reference. To establish the learning curve and compare the diagnostic accuracy of residents, Receiver Operating Characteric curves were generated and Area Under the Curve were calculated. Results: Thirty-four nodules were benign and the others were malignant. The radiology specialist had a very high correct class prediction for the differentiation of benign versus malignant thyroid nodules. Statistical analysis of the strain ratio measurements showed that one of the residents had similar results with the radiology specialist after the seventh patient and the other one after the fourth patient. On the other hand the elasticity score measurements of all examiners had low correct class prediction. Conclusions: Strain ratio measurement by RTE is an easily learned sonographic method that can assist in the evaluation of benign versus malignant nature of the lesions. However, interpretation of the elasticity scores requires more expertise. The results of this preliminary study need to be verified with a larger sample population.

Ultrasound elastography in thyroid disease

“…Among the cited causes for false negative results are: follicular carcinoma, very well differentiated carcinoma, carcinoma with central necrosis and degeneration, small papillary carcinoma in lymphoma and microcarcinoma [13,70]. One study showed a very steep learning curve, with constant and reproducible results after only seven patients [62]. However, more studies on the intra-and interobserver variability of SR are needed.…”

“…The influence of a learning curve has been proven by the existence of inconsistent results over time [62].…”

Shear Wave Sonoelastography Findings of Testicles in Chronic Kidney Disease Patients Who Undergo Hemodialysis

“…It has been shown to be efficient in the evaluation of nodules in the breast, prostate, thyroid, and lymph nodes [8][9][10][11][12][13]. The use of SE has also started for the discrimination of malignancy in testis lesions [11,12,14]. Preliminary research has revealed that the values of elasticity of the testicles are related to their volume and functional capacity [15].…”

“…Sonoelastography (SE) is a new noninvasive diagnostic method that is used to measure the elasticity of biological tissues [7]. It has been shown to be efficient in the evaluation of nodules in the breast, prostate, thyroid, and lymph nodes [8][9][10][11][12][13]. The use of SE has also started for the discrimination of malignancy in testis lesions [11,12,14].…”

Carpal tunnel syndrome: elastosonographic strain ratio andcross-sectional area evaluation for the diagnosis and disease severity.

“…Real time elastosonography (RTE) has recently emerged as a sonographic method which measures the stiffness of the lesions and various tissues [15][16][17][18][19][20]. The utility of RTE in the CTS patients needs to be researched due to the limited number of studies in this field.…”