Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules

Abstract

Shear wave elastography provides information about the stiffness of thyroid nodules that could be a new indicator of malignancy. The current study aimed to investigate the feasibility of using shear wave elastography (SWE) alone and in conjunction with grey scale ultrasound (GSU) to predict malignancy in 111 solitary thyroid nodules. Malignant thyroid nodules tended to have microcalcification, hypoechogenicity, tall to width ratio >1, and irregular borders (p < 0.05). SWE indices (E maximum and E mean ) of malignant nodules (median ± standard error: 85.2 ± 8.1 kPa and 26.6 ± 2.5 kPa) were significantly higher than those of benign nodules (median ± standard error: 50.3 ± 3.1 kPa and 20.2 ± 1 kPa) (p < 0.05). The optimal cut-off of E maximum and E mean for distinguishing benign and malignant nodules was 67.3 kPa and 23.1 kPa, respectively. Diagnostic performances for GSU + E maximum , GSU + E mean , GSU, E maximum and E mean were: 70. 4%, 74.1%, 96.3%, 70.4% and 74.1% for sensitivity, 83.3%, 79.8%, 46.4%, 70.2%, and 66.7% for specificity, and 80.2%, 78.4%, 58.5%, 70.3%, and 68.5% for accuracy, respectively. Our results suggested that combining GSU with SWE (using E maximum or E mean ) increased the overall diagnostic accuracy in distinguishing benign and malignant thyroid nodules.

Combined Shear Wave Elastography and EU TIRADS in Differentiating Malignant and Benign Thyroid Nodules

“…This concurred with findings of Swan et al [ 27 ] for which no SWE index outperformed the French TIRADS (an earlier version of the EU TIRADS) [ 19 ]. Some previous studies found the addition of SWE to grey scale ultrasound assessment with or without TIRADS to have no diagnostic value, while others found an improved diagnostic performance as evidenced by an increase in sensitivity and/or specificity [ 16 , 17 , 28 , 29 , 30 , 31 , 32 ]. The differences can be attributed to diverse study designs and SWE measurement methods.…”

The Role of Shear Wave Elastography in the Discrimination Between Malignant and Benign Thyroid Nodules

“…The optimal cut-off SWE value of 65 kPa achieved an AUROC of 0.94, with the Se of 85.2% and the Sp of 93.9% ( 3 ). According to Baig et al ( 14 ), the SWE indices (including E max and E mean) of malignant nodules (85.2 ± 8.1 kPa and 26.6 ± 2.5 kPa, respectively) were significantly higher than those of benign nodules (50.3 ± 3.1 kPa and 20.2 ± 1 kPa, respectively). The optimal cut-off values identified the distinction between benign and malignant nodules for EI max and EI mean were 67.3 kPa and 23.1 kPa, respectively.…”

“…The results reported by Baig et al, who examined 111 thyroid nodules (including 27 malignant and 84 benign nodules), showed that grayscale US alone had a high Se (96.3%), a low Sp (46.4%), and an overall Acc of 58.5% for the discrimination between benign and malignant nodules. When grayscale US was combined with SWE parameters (cut-off EI max value of 67.3 kPa and a cut-off EI mean value of 23.1 kPa), the overall Acc increased to 80.2% and 78.4%, with Se values of 70.4% and 74.1%, and Sp values of 83.3% and 79.8%, respectively ( 14 ). Veyrieres et al performed SWE analysis in 297 thyroid nodules (including 35 malignant nodules) and found that the optimal cut-off value was 66 kPa.…”

Analysis of influencing factors of shear wave elastography of the superficial tissue: A phantom study

“…However, we found that many studies have shown great differences in the cut-off value. In thyroid lesions, some studies ( 12 ) concluded that the cut-off value for thyroid nodules was 27.49 kpa which was lower than the optimal cut-off value of 67.3 kpa obtained by Baig et al ( 13 ) and 85.2 kpa by Park et al ( 14 ). Some scholars believe that this is due to a certain difference in the thyroid tissue structure between Chinese and Western populations ( 15 ).…”