Abstract
To investigate confounding factors of real-time ultrasound elastography (RTE) and to evaluate the diagnostic performance of ultrasound (US)-guided FNA for thyroid nodules with indeterminate elastography compared with conventional US. This study included 244 nodules with indeterminate elastography caused by several confounding factors (large or small size, deep location, isthmic or paratracheal location, calcification, thyroiditis, conflicting results between conventional US and RTE), and corresponding prevalences of malignancy were calculated. Additionally, conventional US and US-FNA data were collected and compared. The prevalences of malignancy of confounding factors were 74.1%, 75.0%, 73.3%, 46.2%, 27.3%, and 53.2%, respectively. Sonographic features (border, margin, echogenicity, echohomogeneity, and microcalcification) were significantly different between benign and malignant thyroid nodules (p < 0.05), and most of them exhibited good sensitivity but unsatisfactory specificity and accuracy. While US-FNA exhibited better performance with a sensitivity of 96.9%, a specificity of 99.1% and an accuracy of 98.0% in the diagnosis of malignancy. Given that indeterminate RTE is inevitable with a rather high malignant risk due to several confounding factors, our study revealed that US-FNA was a valuable tool in nodules with indeterminate elastography by increasing the detection rate of thyroid malignancy.
Highlights
Thyroid nodules are increasingly common and can be found in approximately 67% of the general population given the widespread application of ultrasonography (US) imaging techniques[1], while the incidence of thyroid cancer is up to 5–15%2,3
Several studies have evaluated the utility of Real-time ultrasound elastography (RTE) in refining the diagnosis of thyroid nodules with indeterminate or non-diagnostic cytology, and the application of the combination of US and RTE was helpful in relevant managements[7,8,9,10]
The purpose of our study was to investigate the common confounding factors of RTE and evaluate the diagnostic performance of further ultrasound (US)-guided fine-needle aspiration (FNA) for thyroid nodules with indeterminate elastography compared with conventional US
Summary
Thyroid nodules are increasingly common and can be found in approximately 67% of the general population given the widespread application of ultrasonography (US) imaging techniques[1], while the incidence of thyroid cancer is up to 5–15%2,3. It seems almost impossible to perform FNA for each thyroid nodule with appropriate indications in China, which is a typical country with a large population. Real-time ultrasound elastography (RTE) is emerging as another effective but non-invasive tool to differentiate malignant from benign thyroid nodules by evaluating tissue stiffness with high sensitivity and specificity[6]. Some uncertainties regarding indeterminate diagnosis are associated with RTE and caused by several factors, including rather large or small size, deep location, isthmic or paratracheal position, calcification, and background of thyroiditis[13]. The purpose of our study was to investigate the common confounding factors of RTE and evaluate the diagnostic performance of further ultrasound (US)-guided FNA for thyroid nodules with indeterminate elastography compared with conventional US
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