Clinical value of elasticity imaging and contrast-enhanced ultrasound in the diagnosis of papillary thyroid microcarcinoma

Abstract

Abstract. The present study aimed to evaluate the value of elasticity imaging and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of papillary thyroid microcarcinoma (TMC). In total, 73 patients exhibiting a total of 80 small thyroid nodules, which were difficult to diagnose using conventional ultrasonography, underwent elasticity imaging and CEUS. The diagnostic findings were subsequently clarified by intraoperative and pathological examination, and the accuracy of the 2 diagnostic methods was compared. The correct diagnostic rate of CEUS was 85% (68/80 nodules), of which 6 cases of TMC were misdiagnosed as benign lesions and 6 benign nodules were misdiagnosed as TMC. By contrast, the accuracy rate of the elasticity imaging, based on the 5-point diagnostic method, was 92.5% (74/80 nodules), of which 3 cases of TMC were misdiagnosed as benign nodules and 3 benign nodules were misdiagnosed as TMC. Furthermore, elasticity imaging in the diagnosis of TMC was determined to have sensitivity, specificity and accuracy rates of 94.0, 90.0 and 92.5%, respectively, whereas the corresponding rates for CEUS were 88.0, 80.0 and 85.0%, respectively. Thus, ultrasonographic elasticity imaging exhibited significant advantages in the diagnosis of TMC compared with CEUS (P<0.05). The use of CEUS demonstrates no evident advantage in the diagnosis of TMC; however, an elasticity score of ≥3 is of high clinical value as a diagnostic criterion for TMC. IntroductionAt present, there are >300 million individuals with thyroid disease worldwide (1). In particular, thyroid nodules, which are the second most common endocrine system disease, have received increasing attention (2,3). Conventional ultrasonography was previously considered to be the preferred diagnostic tool for patients with thyroid disease, and has been reported as the most effective method for the clinical assessment and treatment of this disorder (4). However, with the development of high-frequency ultrasonography, the early detection of thyroid lesions has improved (5). Thus, high-frequency ultrasonography has become the preferred method for the clinical evaluation and treatment of thyroid disease (6). Accordingly, thyroid nodules identified on cervical ultrasonographic examination account for 50% of all reported thyroid nodules (7). Papillary thyroid microcarcinoma (TMC) is an early-stage subtype of thyroid carcinoma with a maximum tumor diameter of ≤10 mm and a frequency of 65-99% among all thyroid carcinomas (8). However, nodular thyroid lesions measuring ≤1 cm in diameter may possess features that are characteristic of different types of lesions, commonly resulting in an uncertain diagnosis during pre-operative conventional ultrasonography (8). Therefore, the development of novel pre-operative diagnostic methods is required.In previous years, contrast-enhanced ultrasound (CEUS) and ultrasonic elastography (UE) have become popular research topics, and these modalities have been proposed for the diagnosis and differential diagnosis of thyroid lesion...

Advantages of the Korean Thyroid Imaging Reporting and Data System Combined with Contrast-Enhanced Ultrasound in Diagnosing Papillary Thyroid Microcarcinoma

“…Jebreel et al (27) reported that Vascular endothelial growth factor (VEGF) immunostaining was stronger in thyroid cancer, thyroiditis and Graves' disease than in adjacent normal thyroid tissues. Therefore, the differences in the microvessel density of benign and malignant nodules may not be evident when lesions < 1 cm in diameter (23). In the present study, 13 PTMC (8.7%) exhibited iso-or hyper-enhancement in the lesions and surrounding tissues.…”

“…In previous studies, researchers have demonstrated that, under CEUS, ring enhancement showed an accuracy of 88.5% for benign lesions, and heterogeneous enhancement showed an accuracy of 90.4% for malignant lesions (22). Li et al (23) concluded that low, weak, or uneven enhancements are valuable perfusion features for evaluating papillary thyroid carcinoma but that a uniform, high-enhanced perfusion mode was typical of benign nodules. In the present study, we confirmed that the following features such as enhancement intensity and rim-like en-6 Iran J Radiol.…”

Differential diagnosis of thyroid nodules through a combination of multiple ultrasonography techniques: A decision‑tree model

“…Additional parameters will need to be considered for the development of a thorough predictive model. Previously developed algorithms for diagnosing thyroid nodules have integrated ES analysis (26,27). In a study of 141 nodules, most of the benign nodules scored in the range 2-3, while malignant nodules scored ~5 (26).…”

Contrast-enhanced ultrasound for the differential diagnosis of thyroid nodules: An updated meta-analysis with comprehensive heterogeneity analysis

“…meta-regression analysis did not show that nodular size was a source of heterogeneity. Several studies reported that CEUS features were closely related to nodule size [31,39]. Yuan et al [39] implied in thyroid cancers less than 1 cm in diameter, the hypoenhancement was more common than thyroid cancers with diameters greater than 2 cm.…”

“…Several studies reported that CEUS features were closely related to nodule size [31,39]. Yuan et al [39] implied in thyroid cancers less than 1 cm in diameter, the hypoenhancement was more common than thyroid cancers with diameters greater than 2 cm. Ma's [31] research showed that heterogeneous enhancement was an independent predictor for predicting papillary thyroid microcarcinoma (PTMC).…”