Abstract
To retrospectively evaluate the diagnostic performance of shear wave elastography (SWE) and thyroid imaging reporting and data system (TI-RADS) in differentiating malignant and benign thyroid nodules. A total of 313 thyroid nodules in 227 patients were included. All thyroid nodules were underwent SWE and TI-RADS before fine needle aspiration biopsy and/or surgery. SWE elasticity indices of the maximum (Emax), mean (Emean), minimum (Emin) and elastic ratio (ER) in thyroid nodules were measured. Nodules with solid component, marked hypoechogenicity, poorly defined margins, micro-calcifications, and a taller-than-wide shape were classified as suspicious at gray-scale ultrasonography. The level of TI-RADS was determined according to the number of suspicious ultrasonography features. The combined methods of SWE and TI-RADS in thyroid nodules were calculated. In the 313 nodules, 194 were malignant, and 119 were benign. SWE and TI-RADS were significantly higher in malignant nodules than benign nodules (P < 0.001). The most accurate SWE cut-off value, 51.95 kPa for Emax, achieved a sensitivity of 81.44% and a specificity of 83.19% for discriminating malignant nodules from benign nodules. There are two methods in combination with SWE and TI-RADS. The one is “tandem” method, which has a higher specificity (95.80%), positive likelihood ratio (18.16) and positive predictive value (96.73%). The other one is “parallel” method, which shows sensitivity (94.85%), negative likelihood ratio (0.07) and negative predictive value (90.00%).We believe that the methods could be used as a simple tool to stratify the risk of thyroid nodules accurately.
Highlights
Thyroid nodular disease (TND) is one of the most widespread endocrine disorders
One hundred ninety-one malignant lesions were confirmed as papillary thyroid carcinomas, and 3 cases were medullary thyroid carcinomas based on surgical specimens
Emean, Emin and elastic ratio (ER) of shear wave elastography (SWE) were significantly higher in malignant nodules than in benign nodules (P < 0.001) (Table 2)
Summary
Thyroid nodular disease (TND) is one of the most widespread endocrine disorders. The incidence of TND has gradually increased, and approximately 5% to 15% of them are malignant nodules [1]. Conventional ultrasonography (US) has become the preferred imaging method for diagnosing thyroid diseases, its key limitation includes poor differentiation of benign from malignant nodules. Fewer than 5.0-6.5% of incidentally discovered TND are malignant [3]. Thyroid nodule ultrasound characterization performed by experienced clinicians allows the selection of tumors to be punctured and guides fine needle aspiration (FNA) biopsy. FNA plays an important role in differentiating TND because of its high sensitivity and specificity [4, 5]. FNA biopsy shows numerous weaknesses, FNA is an invasive method and may have a false-negative rate or a false-positive rate [6, 7] and reveals high nondiagnostic (10-15%) or indeterminate (1020%) possibility [8]
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