Differentiation of Thyroid Nodules Difficult to Diagnose With Contrast-Enhanced Ultrasonography and Real-Time Elastography.

Xuehua Xi,Ruyu Liu,Xiao Yang,Luying Gao,Xiaoyan Zhang,Bo Zhang,Ruina Zhao,Shibao Fang,Xingjian Lai,Yuxin Jiang,Qiong Wu,Shenling Zhu,Jingzhu Xu

doi:10.3389/fonc.2020.00112

Abstract

According to the 2015 American Thyroid Association (ATA), referred risk stratification and thyroid nodules with intermediate- and low-suspicion patterns are difficult to diagnose. The objective of this study is to evaluate the diagnostic performance of contrast-enhanced ultrasonography (CEUS) and elastosonography (ES) for the differentiation of these thyroid nodules. From November 2011 to June 2016, a total of 163 thyroid nodules with intermediate- and low-suspicion patterns in 150 consecutive patients at our hospital were studied before surgery. With surgical pathology as the standard, the diagnostic value of CEUS and ES was analyzed. There were 29 (17.8%) malignant lesions and 134 (82.2%) benign lesions. The enhancement patterns of CEUS, the echogenicity, and the elastography were significantly different between malignant and benign lesions (P < 0.05). Heterogenous enhancement was more common in malignant nodules, and the sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio were 51.7, 88.1, 48.4, 89.4, and 10.1%, respectively. The diagnostic accuracy of CEUS was better than the conventional ultrasound [area under the curve (AUC), 0.729 vs. 0.616, P = 0.021]. The enhancement patterns of CEUS were helpful in the differential diagnosis of thyroid nodules with intermediate and low suspicion.

Highlights

The 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer [1] (2015 ATA guidelines) proposed a risk stratification of thyroid nodules based on a series of studies on the ultrasonographic features of thyroid nodules
A total of 604 patients with thyroid nodules admitted to Peking Union Medical College Hospital (PUMCH) from November 2011 to June 2016 who met the following criteria were included in this study: (a) conventional ultrasonography (CUS) indicated that the thyroid nodule was of intermediate or low suspicion according to the 2015 ATA guidelines for referred risk stratification, and (b) the largest diameter of the nodule was larger than 5 mm in size
The remainder of the benign lesions consisted of six follicular adenomas (FAs, 25.4%) and nine Hashimoto thyroiditis (HT) (6.7%)

Summary

Introduction

The 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer [1] (2015 ATA guidelines) proposed a risk stratification of thyroid nodules based on a series of studies on the ultrasonographic features of thyroid nodules. The guide classifies the sonographic appearance of the vast majority of thyroid nodules into the following categories of ultrasound patterns: high suspicion, intermediate suspicion, low suspicion, very low suspicion, and benign. Low-suspicion (malignancy risk, 5–10%) nodules are isoechoic or hyperechoic solid nodules or partially cystic nodules with eccentric uniformly solid areas without malignant features. These nodules have similar ultrasound features as nodules suspicious of follicular lesions in the “British Thyroid Association Guidelines for the Management of Thyroid Cancer” [2] (BTA guidelines). Despite the fact that the malignancy risk is not relatively high, differentiating malignant from benign lesions by conventional ultrasonography (CUS) is challenging

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