Multimodal ultrasonography evaluation in thyroid nodule characterization: what is the ideal algorithm?

Abstract

The aim of this study is to investigate the diagnostic performances of Ultrasonography (US), Shear-wave Elastography(SWE), and Superb Microvascular Imaging (SMI) findings in the diagnosis of malignant thyroid nodules (MTNs) and todetermine the US algorithm with the best diagnostic performance. Eighty-one nodules in 77 patientswho had underwent multimodal US with biopsy results, were evaluated. Echogenicity, nodule components, contours, presenceand type of calcification, and size were analyzed with US. Nodule stiffness and vascular index (VI) measurements wereperformed via SWE and SMI. The power of the US algorithm in predicting malignancy was evaluated. Hypoechogenicity,irregular contour, aspect ratio (anteroposterior (AP)/transvers diameter) >1, and >43.9 kPa were the characteristicshad significant efficacy in the diagnosis of MTNs. Sensitivity, specificity, and AUC values were respectively 100%, 48.5%,and 0.742 for hypoechogenicity; 80%, 90.1%, and 0.855 for irregular contour; 60%, 71.2%, and 0.656 for aspect ratio >1;60%, 72.7%, and 0.671 for >43.9 kPa; and 93.3%, 90.9%, and 0.921 for the US algorithm. VI did not show significant efficacyin diagnosis. Some B-mode and SWE findings showed sufficient efficacy in differentiating benign and malignnodules on their own. However, diagnostic accuracy increased significantly when the US algorithm was applied.