Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?

Nattabi, Haliimah Abubakar; Sharif, Norhafidzah Mohamed; Yahya, Noorazrul; Ahmad, Rozilawati; Mohamad, Mazlyfarina; Zaki, Faizah Mohd; Yusoff, Ahmad Nazlim

doi:10.1016/j.acra.2017.09.002

Cited by 22 publications

(29 citation statements)

References 37 publications

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“…S-Emean (≥ 23.75 kPa) was chosen as the diagnostic value of 2D SWE. AUC, sensitivity, specificity and accuracy were 0.752, 0.695, 0.763 and 0.722, similar to the results of past researches 14. 3D-T-mean (≥ 20.75 kPa) was the diagnostic value of 3D SWE.…”

Section: Discussionsupporting

confidence: 88%

“…In conclusion, the combination of B-mode ultrasound with 2D/3D SWE improved diagnostic value significantly, and B-mode + 2D SWE could be the optimal combination method in differential diagnosis. Some earlier reports had the similar conclusion 14-15, but Wang F et al found that adding SWE to conventional US did not improve diagnostic performance 12.…”

Section: Discussionmentioning

confidence: 84%

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Comparisons and Combined Application of Two-Dimensional and Three-Dimensional Real-time Shear Wave Elastography in Diagnosis of Thyroid Nodules

Han¹,

Du²,

Li³

et al. 2019

J. Cancer

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Purpose Two-dimensional and three-dimensional real-time shear wave elastography (2D+3D SWE) represents a new technology for the quantification of tissue elasticity. This study investigated whether they could be performed to differentiate between benign and malignant thyroid nodules. Methods Conventional B-mode ultrasound, 2D and 3D SWE were performed in 96 patients with 97 thyroid nodules with pathology results. Results All the elastography values of 2D&3D SWE in malignant thyroid nodules were higher than those in benign nodules. These two elastography methods alone could not improve diagnostic value comparing to B-mode ultrasound significantly. However, B-mode US + 2D SWE (TI-RADS ≥ 4c or S-Emean ≥ 23.75 kPa, suspicious), B-mode US + 3D SWE (TI-RADS ≥ 4c or 3D-T-Emean ≥ 20.75 kPa, suspicious), B-mode US + 2D + 3D SWE (TI-RADS ≥ 4c or S-Emean ≥ 23.75 kPa or 3D-T-Emean ≥ 20.75 kPa, suspicious) had higher sensitivity and accuracy values than those of 3 methods alone but lower specificity values. Among them, B-mode ultrasound + 2D SWE had the highest sensitivity, NPV, accuracy and Youden's index (0.881, 0.788, 0.804 and 0.57). Conclusions 2D SWE or 3D SWE alone could not improve the diagnostic value of differentiating malignant from benign thyroid nodules comparing to conventional B-mode ultrasound. But combination methods could improve the diagnostic value, especially B-mode US + 2D SWE.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 84%

Comparisons and Combined Application of Two-Dimensional and Three-Dimensional Real-time Shear Wave Elastography in Diagnosis of Thyroid Nodules

Han¹,

Du²,

Li³

et al. 2019

J. Cancer

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“…(32) found no difference in EI between 110 benign and 21 malignant nodules with indeterminate cytology. Moreover, a recent meta-analysis – including 2851 nodules from 14 studies – found suboptimal diagnostic accuracy of thyroid SWE, with a significant heterogeneity between studies and a pooled sensitivity and specificity of 0.66 and 0.78, respectively (33). These results contrast those from previous meta-analyses (34, 35, 36) which, however, included a smaller number of nodules and used sensitivity and specificity estimates applying to different cut-off points (33, 34, 35, 36).…”

Section: Discussionmentioning

confidence: 99%

Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma

Swan

Bonnema

Jespersen

et al. 2019

Endocrine Connections

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Thyroid nodular disease is common, but predicting the risk of malignancy can be difficult. In this prospective study, we aimed to assess the diagnostic accuracy of shear wave elastography (SWE) in predicting thyroid malignancy. Patients with thyroid nodules were enrolled from a surgical tertiary unit. Elasticity index (EI) measured by SWE was registered for seven EI outcomes assessing nodular stiffness and heterogeneity. The diagnosis was determined histologically. In total, 329 patients (mean age: 55 ± 13 years) with 413 thyroid nodules (mean size: 32 ± 13 mm, 88 malignant) were enrolled. Values of SWE region of interest (ROI) for malignant and benign nodules were highly overlapping (ranges for SWE-ROImean: malignant 3–100 kPa; benign 4–182 kPa), and no difference between malignant and benign nodules was found for any other EI outcome investigated (P = 0.13–0.96). There was no association between EI and the histological diagnosis by receiver operating characteristics analysis (area under the curve: 0.51–0.56). Consequently, defining a cut-off point of EI for the prediction of malignancy was not clinically meaningful. Testing our data on previously proposed cut-off points revealed a low accuracy of SWE (56–80%). By regression analysis, factors affecting EI included nodule size >30 mm, heterogeneous echogenicity, micro- or macrocalcifications and solitary nodule. In conclusion, EI, measured by SWE, showed huge overlap between malignant and benign nodules, and low diagnostic accuracy in the prediction of thyroid malignancy. Our study supports that firmness of thyroid nodules, as assessed by SWE, should not be a key feature in the evaluation of such lesions.

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“…Studies included nodules from 2 -71 mm and most were papillary carcinomas. Therefore, cut-off values have a wide range and a single threshold cannot be established [82,83,85]. The sensitivity for SWE has been reported as 63.8 -93.8 %, and the specificity as 50 -88.2 % [96, 97, 100, 102, 104 -106].…”

Section: Swementioning

confidence: 99%

“…The sensitivity for SWE has been reported as 63.8 -93.8 %, and the specificity as 50 -88.2 % [96, 97, 100, 102, 104 -106]. The most recent meta-analysis [82] included 14 studies and 2851 thyroid nodules with cut-off values ranging from 26.6 to 85.2 kPa. It concluded that 2D-SWE has a fairly good diagnostic accuracy although the sensitivity and specificity are average.…”

Section: Swementioning

confidence: 99%

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

et al. 2019

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Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?

Cited by 22 publications

References 37 publications

Comparisons and Combined Application of Two-Dimensional and Three-Dimensional Real-time Shear Wave Elastography in Diagnosis of Thyroid Nodules

Comparisons and Combined Application of Two-Dimensional and Three-Dimensional Real-time Shear Wave Elastography in Diagnosis of Thyroid Nodules

Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

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