Association between diagnostic efficacy of acoustic radiation force impulse for benign and malignant thyroid nodules and the presence or absence of non-papillary thyroid cancer: A meta-analysis

Abstract

PurposeThe aim of this study was to investigate the diagnostic efficacy of Acoustic Radiation Force Impulse (ARFI) for benign and malignant thyroid nodules in the presence and absence of non-papillary thyroid cancer (NPTC) and to determine the cut-off values of Shear Wave Velocity (SWV) for the highest diagnostic efficacy of Virtual Touch Quantification (VTQ) and Virtual Touch Tissue Imaging and Quantification (VTIQ).MethodsThe diagnostic accuracy of ARFI for benign and malignant thyroid nodules was assessed by pooling sensitivity, specificity and area under the curve (AUC) in each group in the presence and absence of both non-papillary thyroid glands, using histology and cytology as the gold standard. All included studies were divided into two groups according to VTQ and VTIQ, and each group was ranked according to the magnitude of the SWV cutoff value to determine the SWV cutoff interval with the highest diagnostic efficacy for VTQ and VTIQ.ResultsA total of 57 studies were collected on the evaluation of ARFI for the diagnosis of benign and malignant thyroid nodules. The results showed that the presence of non-papillary thyroid carcinoma led to differences in the specificity of VTIQ for the identification of benign and malignant thyroid nodules, and the differences were statistically significant. In addition, the diagnostic efficacy of VTQ was best when the cutoff value of SWV was in the interval of 2.48-2.55 m/s, and the diagnostic efficacy of VTIQ was best when the cutoff value of SWV was in the interval of 3.01-3.15 m/s.ConclusionVTQ and VTIQ have a high diagnostic value for benign and malignant thyroid nodules; however, when the malignant nodules in the study contain non-papillary thyroid carcinoma occupying the thyroid gland, the findings should be viewed in a comprehensive manner.

Ultrasound Imaging of Thyroid Pathologies: A Pictorial Review

“…37 The cut-off between benign and malignant nodules with the best diagnostic efficacy ranges between 2.48 and 2.55 m/s. 38 Diffuse thyroid diseases like Hashimoto or Grave's disease may also show high shear wave values of 2.68 AE 0.5 m/s. 8 However, the range of elasticity values that can be depicted is narrow in m/s (usually 0.5-8.4 m/s or 0-10 m/s, depending on the manufacturer) and hence, very hard or very soft tissues are expressed as nonmeasurable ("X.XX m/s").…”

“…37 The values are higher in papillary carcinomas due to their calcifications and fibrous component compared with follicular carcinoma which has more cellular components. 38 A few pitfalls of elastography include lower stiffness in malignancies with necrosis, cystic areas, and smaller sizes, higher stiffness in benign nodules with calcifications or thyroiditis with more fibrous components, dependence on the application of adequate probe compression, need for including adjacent normal thyroid parenchyma in the field for strain or elasticity ratios which may not be possible in large nodules and varying cut-off values of elastography parameters by different studies to distinguish benign and malignant nodules.…”