Calcification of thyroid nodules increases shear-wave speed (SWS) measurement: using multiple calcification-specific SWS cutoff values outperforms a single uniform cutoff value in diagnosing malignant thyroid nodules

Abstract

Conventional ultrasound cannot satisfactorily distinguish malignant and benign thyroid nodules. Shear-wave elastography (SWE) can evaluate tissue stiffness and complement conventional ultrasound in diagnosing malignant nodules. However, calcification of nodules may affect the results of SWE. The purposes of this study are to compare the differences of shear-wave speed (SWS) measurement among different calcification groups and compare the diagnostic performance between using a single uniform SWS cutoff value and multiple individual calcification-specific cutoff values using technique of point SWS measurement. We retrospectively identified 517 thyroid nodules (346 benign and 171 malignant nodules) examined by conventional ultrasound and point SWS measurement. There were 177 non-calcified, 159 micro-calcified and 181 macro-calcified nodules. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) was computed. The mean SWS in malignant nodules more than doubled that of benign nodules (4.81±2.03 m/s vs. 2.29±0.99 m/s, p<0.001). The mean SWS of nodules progressively increased from the non-calcification (2.60±1.49 m/s), to micro-calcification (3.27±1.85 m/s) and to macro-calcification (3.68±2.26 m/s) groups (p<0.001), which was true in both the benign and malignant nodules. If we used individual SWS cutoff values for non- (SWS >2.42 m/s), micro- (SWS >2.88 m/s) and macro-calcification (SWS >3.59 m/s) nodules in the whole group, the AUC was 0.859 (95% confidence interval [CI], 0.826-0.888), which was significantly better than the AUC of 0.816 (95% CI, 0.780-0.848) if a single uniform cutoff value (SWS >2.72 m/s) was applied to all the nodules regardless of calcification status (p=0.011). The cutoff values of SWS for different calcified nodules warrant future prospective validation.

Added value of mass characteristic frequency to 2-D shear wave elastography for differentiation of benign and malignant thyroid nodules

“…We found that the presence of macrocalcifications on B-mode ultrasound imaging increased SWS in malignant thyroid nodules. This was an expected finding and consistent with prior studies, as intra-nodular calcifications are known to affect lesion stiffness (Gregory et al, 2015;Chen et al, 2016;Sun et al, 2017). Interestingly, we found that peripheral rim calcifications did not significantly affect SWS in either benign or malignant thyroid nodules.…”

Computed Tomography Imaging Features of Lung Cancer under Artificial Intelligence Algorithm and Its Correlation with Pathology

“…CT has high-density resolution in the diagnosis of lung cancer and can avoid overlapping of chest wall, heart, and mediastinum. Many small lesions in hidden parts of the lung can be found, which is of great help in judging the scope of lesions and disease staging [21,22].…”

Influence of lesion size on shear wave elastography in the diagnosis of benign and malignant thyroid nodules

“…However, the Emax values in Groups B and C had high diagnostic sensitivity, consistent with the pathological development process of thyroid cancer, and these values were slightly higher than the results of previous research 18 , which may be related to the inclusion and exclusion criteria. This study excluded internal or peripheral nodules with coarse calcification, a decision that was based on previous studies 23 showing that calcification can increase Emax. This is one of the main reasons for the high false-positive rate of SWE-based diagnosis of malignant nodules.…”