Abstract
PurposeTo assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules.Materials and methods128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05.ResultsSensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%).ConclusionStrain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.
Highlights
IntroductionIn 2018 the "International Agency of Research on Cancer (IARC)” recorded 567,233 new cases of thyroid cancer worldwide with an incidence rate of 3.4/100,000 in men and 11.5/100,000 in women [1].The growing incidence of thyroid neoplasms is primarily related to the "overdiagnosis" due to the increasingly widespread use of neck imaging techniques such as ultrasound; more than half of the newly diagnosed thyroid cancers in Italy have a low-risk of persistence or recurrence [2].1 3 Vol.:(0123456789)La radiologia medica (2021) 126:1189–1200Recent papers [3] have documented the increase in incidentally thyroid lesions diagnosis that is related to neck ultrasound examinations in 67% [4], to neck CT [5], to MRI in 15% [6] and PET examinations in the remaining 1- 2% of cases [7].ultrasound, being a non-invasive, repeatable over time, widely diffused, and low-cost exam, allows an initial stratification of the risk of malignancy of the thyroid nodule, trying to reduce the number of unnecessary fineneedle aspiration cytology (FNAC)
The present study aimed to evaluate the different diagnostic performance of the two main elastosonography techniques, semi-quantitative (SRE) and quantitative (SWE), in the risk stratification of thyroid nodules with indeterminate cytology in comparison and in addition to the B-mode ultrasound evaluation according to K-TIRADS classification (Table 1) [32]
96 out of 128 indeterminate cytology nodules were included in the analysis (79 TIR3B and 17 TIR3A)
Summary
In 2018 the "International Agency of Research on Cancer (IARC)” recorded 567,233 new cases of thyroid cancer worldwide with an incidence rate of 3.4/100,000 in men and 11.5/100,000 in women [1].The growing incidence of thyroid neoplasms is primarily related to the "overdiagnosis" due to the increasingly widespread use of neck imaging techniques such as ultrasound; more than half of the newly diagnosed thyroid cancers in Italy have a low-risk of persistence or recurrence [2].1 3 Vol.:(0123456789)La radiologia medica (2021) 126:1189–1200Recent papers [3] have documented the increase in incidentally thyroid lesions diagnosis that is related to neck ultrasound examinations in 67% [4], to neck CT [5], to MRI in 15% [6] and PET examinations in the remaining 1- 2% of cases [7].ultrasound, being a non-invasive, repeatable over time, widely diffused, and low-cost exam, allows an initial stratification of the risk of malignancy of the thyroid nodule, trying to reduce the number of unnecessary fineneedle aspiration cytology (FNAC). The growing incidence of thyroid neoplasms is primarily related to the "overdiagnosis" due to the increasingly widespread use of neck imaging techniques such as ultrasound; more than half of the newly diagnosed thyroid cancers in Italy have a low-risk of persistence or recurrence [2]. Recent papers [3] have documented the increase in incidentally thyroid lesions diagnosis that is related to neck ultrasound examinations in 67% [4], to neck CT [5], to MRI in 15% [6] and PET examinations in the remaining 1- 2% of cases [7]. Ultrasound, being a non-invasive, repeatable over time, widely diffused, and low-cost exam, allows an initial stratification of the risk of malignancy of the thyroid nodule, trying to reduce the number of unnecessary fineneedle aspiration cytology (FNAC). According to the estimated malignancy risk, the clinician may decide to perform or not FNAC
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