Vascular flow a predictor of malignant thyroid nodules: a meta-analysis

Khadra, Helmi; Bakeer, Mohamed; Hu, Tian; Kandil, Emad

doi:10.1016/j.jamcollsurg.2014.07.618

Cited by 7 publications

(9 citation statements)

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“…For example, an increased risk of malignancy has been associated with the presence of microcalcifications, irregular or spiculated margins with no halo, marked hypoechogenicity, mostly solid composition, and taller than wider shape. Although increased intranodular vascularity itself is not useful for differentiation of malignant from benign nodules (3–5), however, disordered central hypervascularity is more specific to US features of malignancy (6–8). On the other hand, presence of peripheral vascularity, round shape, isoechogenicity, spongiform appearance, smooth margins, and cystic composition are associated with benignancy (9–11).…”

Section: Introductionmentioning

confidence: 99%

Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography

et al. 2018

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Rationale and Objectives Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (i.e. benign) fine needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. Materials and Methods A total number of 155 patients (106 female and 49 male) (average age 57.48±14.44 years) with 173 thyroid nodules (average size 24.89±15.41mm, range 5–68mm) scheduled for fine needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomical planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. Results Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. 95.45% sensitivity, 86.61% specificity, 0.58 PPV, and 0.99 NPV were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. Conclusions The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (p<0.0001). However, probe orientation and internal features such as calcifications, vascular component and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.

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Section: Introductionmentioning

confidence: 99%

Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography

et al. 2018

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“…The examination of vascular ow of thyroid nodules is an age-old issue and has played a role in the evaluation of nodules. However, in the latest edition of the American Thyroid Association guideline(6), vascular ow was removed, indicating that this feature is not su ciently speci c to predict a nodule as malignant, and sensitivity is also lower than other features (14)(15)(16). We have reviewed previous studies and found that they may have emphasized the abundance and distribution of vascular ow on CDFI over the details of vascular architecture.…”

Section: Discussionmentioning

confidence: 99%

“…Color Doppler ow imaging (CDFI), as the most well-established technology with the capability of visualizing ow patterns, is theoretical to classify malignancy on the basis of the vascular information. Although CDFI has been used to predict suspicious malignancy of thyroid nodules (5,(10)(11)(12)(13), existing studies have not reached an agreement regarding its assessment (14,15). One of the reasons is that the previous studies simply took the abundance and distribution of vascular ow into consideration, regardless of vascular architecture.…”

Section: Introductionmentioning

confidence: 99%

“…Sonographers have rarely observed the vascular architecture using CDFI because nodular hypervascularity could potentially be confused for benignity. On the other hand, although recent studies demonstrated that central vascularization was a characteristic of malignancy in consideration of the distribution of vascular ow (12,13), the conclusions of different researchers have been controversial (14)(15)(16). Therefore, a reliable assessment to identify which nodules warrant FNA on the basis of vascular architecture would be highly desirable.…”

Section: Introductionmentioning

confidence: 99%

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Coexisting sonographic features of “tumor neovascularization-like pattern” and “echogenic areas” in thyroid nodules: Diagnostic performance in prediction of papillary carcinoma

Tong

Qiu

et al. 2019

Preprint

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Purpose To determine the diagnostic performance of the sonographic finding of tumor neovascularization-like patterns and echogenic areas in differentiating papillary carcinomas from benign nodules.Materials and methods We prospectively analyzed ultrasound-guided fine-needle aspiration (FNA) of thyroid nodules for the two features. In total, 299 nodules (evenly distributed benign vs papillary carcinoma) were evaluated by two blinded readers for intense small penetrating vessels and homogenous mild hyper-echoic areas within the nodules and correlated with FNA-confirmed pathologic diagnosis. A set of nodules with and without the features was selected for further pathologic review and comparison to establish a pathologic basis for the finding.Results The specificity of the “tumor neovascularization-like pattern” and “echogenic areas” in papillary thyroid cancers (PTCs) was 90.6% and 91.3%, respectively. There was a significant correlation, with P < 0.0001, between the “tumor neovascularization-like pattern” and “echogenic areas” in PTCs on both sonographic and pathologic levels. Additionally, the newly identified features as a single variable were more predictive of malignancy than the well-studied features. Inclusion of these new features markedly improved the predictive ability of PTC (AUROC = 0.873 versus 0.801, P < 0.0001).Conclusion Despite their relatively low sensitivity, the “tumor neovascularization-like pattern” and “echogenic areas” are highly specific for PTC and can be a useful sonographic finding in decisions regarding FNA.

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“…It is generally believed that hypervascularity is a feature of thyroid malignancy [17,18]. Some other studies suggested that vascular pattern of thyroid nodules can be useful to predict the thyroid malignancy e.g., thyroid nodules with dominant central vascularity are frequently associated with malignant thyroid nodules, whereas benign thyroid nodules tend to have peripheral vascularity or appear avascular [19,20]. Ultrasound elastography is a non-invasive imaging technique that measures tissue stiffness and provides color-coded elasticity map.…”

Section: Introductionmentioning

confidence: 99%

Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules

et al. 2017

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Shear wave elastography provides information about the stiffness of thyroid nodules that could be a new indicator of malignancy. The current study aimed to investigate the feasibility of using shear wave elastography (SWE) alone and in conjunction with grey scale ultrasound (GSU) to predict malignancy in 111 solitary thyroid nodules. Malignant thyroid nodules tended to have microcalcification, hypoechogenicity, tall to width ratio >1, and irregular borders (p < 0.05). SWE indices (E maximum and E mean ) of malignant nodules (median ± standard error: 85.2 ± 8.1 kPa and 26.6 ± 2.5 kPa) were significantly higher than those of benign nodules (median ± standard error: 50.3 ± 3.1 kPa and 20.2 ± 1 kPa) (p < 0.05). The optimal cut-off of E maximum and E mean for distinguishing benign and malignant nodules was 67.3 kPa and 23.1 kPa, respectively. Diagnostic performances for GSU + E maximum , GSU + E mean , GSU, E maximum and E mean were: 70. 4%, 74.1%, 96.3%, 70.4% and 74.1% for sensitivity, 83.3%, 79.8%, 46.4%, 70.2%, and 66.7% for specificity, and 80.2%, 78.4%, 58.5%, 70.3%, and 68.5% for accuracy, respectively. Our results suggested that combining GSU with SWE (using E maximum or E mean ) increased the overall diagnostic accuracy in distinguishing benign and malignant thyroid nodules.

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Vascular flow a predictor of malignant thyroid nodules: a meta-analysis

Cited by 7 publications

References 0 publications

Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography

Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography

Coexisting sonographic features of “tumor neovascularization-like pattern” and “echogenic areas” in thyroid nodules: Diagnostic performance in prediction of papillary carcinoma

Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules

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