Assessment of perinodular stiffness in differentiating malignant from benign thyroid nodules

Abstract

Objective: We evaluated the diagnostic accuracy of perinodular stiffness, four risk stratification systems (RSSs) (KWAK-TIRADS, ACR-TIRADS, EU-TIRADS, and C-TIRADS), and the combination of perinodular stiffness and these four RSSs in differentiating malignant from benign thyroid nodules (TNs). Methods: A total of 788 TNs in 726 patients were examined with conventional ultrasound (US) examination and sound touch elastography (STE). All TNs were classified by each of the four RSSs. The stiffness inside (E) the TNs was measured by STE. The stiffness of the 2.0mm perinodular region (Eshell) was measured with the Shell measurement function of STE. The diagnostic performances of four RSSs, the E values, and the Eshell values were evaluated. All TNs were further divided into subgroups based on size (≤ 10 mm group and > 10 mm group). Results: Ninety-six TNs were classified as benign and 692 as malignant. Among the single-method approaches, ACR-TIRADS showed the highest AUC (0.77) for differentiating malignant from benign TNs for all TNs included. Eshell showed the highest AUC (0.75) in differentiating malignant from benign TNs for TNs with sizes ≤ 10 mm, and there were no significant differences in AUC among all single methods for diagnosis of TNs with sizes > 10 mm (P > 0.05). The combination of C-TIRADS and Eshell/E yielded the highest AUC for all TNs (0.83) and for TNs with size ≤ 10 mm (0.85) compared with other combinations. Conclusions: Eshell/E combined with conventional US improves the diagnostic accuracy in TNs, and may reduce unnecessary fine needle aspiration.

Explore the Diagnostic Efficiency of Chinese Thyroid Imaging Reporting and Data Systems by Comparing With the Other Four Systems (ACR TI-RADS, Kwak-TIRADS, KSThR-TIRADS, and EU-TIRADS): A Single-Center Study

“…This study shows that Kwak-TIRADS had the highest sensitivity. Hu et al ( 25 ) was similar to this study. C-TIRADS had the highest specificity(82.3%),PPV(69.2%) and accuracy (76.0%).…”

Evaluation of Ultrasound Elastography Combined With Chi-Square Automatic Interactive Detector in Reducing Unnecessary Fine-Needle Aspiration on TIRADS 4 Thyroid Nodules

“…In actual measurements, the internal stiffness of TNs can be quantitatively assessed by sound touch elastography (STE) and peripheral stiffness using the Shell measurement function. Our previous study confirmed that measuring a tissue stiffness of 2 mm around TNs using the Shell measurement function could improve the accuracy of differentiating between malignant and benign TNs ( 15 , 16 ).…”

“…At present, several versions of RSSs exist worldwide. Some studies confirmed that ACR-TIRADS had high diagnostic efficiency in differentiating between benign and malignant TNs and a better performance in avoiding unnecessary FNA, but did not have the highest sensitivity among RSSs (16,(24)(25)(26). For TIRADS 4 TNs, many FNA results were benign, which increased the unnecessary puncture risk and economic burden for patients (6,26).…”

Diagnostic performance of C-TIRADS in malignancy risk stratification of thyroid nodules: A systematic review and meta-analysis

“…C-TIRADS takes into account both the international standards for the US evaluation and the local conditions of the national health organization in China. Presently, C-TIRADS have been used in some studies to classify thyroid nodules (12)(13)(14), but the systematic performance of C-TIRADS has been so far marginally explored.…”