Abstract
In shear wave elastography (SWE) studies, the optimal cutoff value of Young’s modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method. The objective of this study was to evaluate the influence of thyroid nodule size on the clinical diagnostic efficacy of SWE. A total of 356 thyroid nodules of 280 patients were divided into three groups according to size (Group A: ≤ 1 cm; Group B: 1–2 cm; Group C: ≥ 2 cm). SWE was used to measure the maximum Young's modulus (Emax) values of all thyroid nodules. Receiver operating characteristic (ROC) curves were drawn with pathological results as the gold standard. For all nodules, the optimal cutoff value of Emax in SWE for diagnosing malignant thyroid nodules was 36.2 kPa. The sensitivity and specificity were 76.5% and 78.4%, respectively. Groups A, B, and C had different optimal Emax cutoff values of 33.7 kPa, 37.7 kPa, and 55.1 kPa, respectively. The area under the ROC curve (AUC) values of Groups A, B, and C (0.844, 0.886, and 0.935, respectively) were all greater than the values for all lesions (0.830). The specificity values of Groups A, B, and C (86.4%, 82.6%, and 88.2%, respectively) were all increased, and the sensitivity values of Groups B and C (89.7% and 96.4%, respectively) were also increased compared with the values for all lesions. Thyroid nodule size affects the optimal Emax cutoff value of SWE. We suggest that different cutoff values be used to diagnose benign and malignant thyroid nodules according to lesion size.
Highlights
In shear wave elastography (SWE) studies, the optimal cutoff value of Young’s modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method
The inclusion criteria were as follows: (1) the patients underwent thyroid surgery and had pathological results; (2) the patients had not been previously treated for thyroid nodules; and (3) the patients had no history of radiotherapy of the head and neck regions
The exclusion criteria were as follows: (1) more than 25% of the nodule consisted of the cystic component; (2) the nodule contained coarse or rim calcifications, which cause information loss in SWE images; (3) the nodule was located in the isthmus or adjacent to the cartilage of the trachea and common carotid artery; and (4) benign and malignant nodules appeared in the same thyroid lobe
Summary
In shear wave elastography (SWE) studies, the optimal cutoff value of Young’s modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method. The maximum value measured by SWE (Emax) is the most commonly used parameter, and the sensitivity and specificity of SWE for differentiating benign from malignant thyroid nodules are 0.79–0.86 and 0.84–0.90, r espectively[3]. There is no consensus regarding the diagnostic threshold of Emax, and various cutoff values have been proposed (36.5–94.0 kPa)[4,5,6,7,8,9,10,11,12,13] This situation may be related to the various sizes of thyroid nodules: lesion size has been reported to affect the Emax value[2,7,14,15].
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