Ultrasound Sensitivity for Thyroid Malignancy Is Increased by Real-Time Elastography: A Prospective Multicenter Study

Trimboli, Pierpaolo; Guglielmi, Rinaldo; Monti, Salvatore; Misischi, Irene; Graziano, Filomena; Nasrollah, Naim; Amendola, Stefano; Morgante, S.; Deiana, Maria Grazia; Valabrega, Stefano; Toscano, Vincenzo; Papini, Enrico

doi:10.1210/jc.2012-2951

Cited by 175 publications

(148 citation statements)

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“…Depending on the combination of US criteria, 12 -51 ma- Original Article 267 lignant nodules misclassified by B-mode/Doppler ultrasound could be correctly diagnosed by elastography. This additive value has also been reported in previously published studies [43]. Therefore, SE should be used in addition to conventional US in the diagnostic work-up of thyroid nodules.…”

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confidence: 83%

Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study

et al. 2016

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▼Purpose: Many patients with thyroid nodules are presently referred to surgery for not only therapeutic but also diagnostic purposes. The aim of noninvasive diagnostic methods is to optimize the selection of patients for surgery. Strain elastography (SE) enables the ultrasound-based determination of tissue elasticity. The aim of the present study was to evaluate the value of SE for the differentiation of thyroid nodules in a prospective multicenter study. Materials and Methods: The study was registered at clinicaltrials.gov and was approved by the local ethics committees of all participating centers. All patients received an ultrasound (US) of the thyroid gland including color Doppler US. In addition, all nodules were evaluated by SE (Hitachi Medical Systems) using qualitative image interpretation of color distribution (SE-ES), strain value and strain ratio. Results: Overall, 602 patients with 657 thyroid nodules (567 benign, 90 malignant) from 7 centers were included in the final analysis. The sensitivity, specificity, NPV, PPV, +LR were 21 %, 73 %, 86 %, 11 %, 0.8, respectively, for color Doppler US; 69 %, 75 %, 94 %, 30 %, 2.9, respectively, for SE-ES; 56 %, 81 %, 92 %, 32 %, 2.9, respectively, for SEstrain value; and 58 %, 78 %, 92 %, 30 %, 2.6, respectively, for SE-strain ratio. The diagnostic accuracy was 71 % for both strain value and strain ratio of nodules. Conclusion: SE as an additional ultrasound tool improves the value of ultrasound for the workup of thyroid nodules. It might reduce diagnostic surgery of thyroid nodules in the future. Zusammenfassung ▼Ziel: Viele Patienten mit Schilddrüsenknoten werden nicht nur therapeutisch, sondern auch zu diagnostischem Zweck operiert. Ziel von nicht-invasiven diagnostischen Verfahren ist es daher die Selektion von Patienten zur Operation zu optimieren. Strain Elastografie (SE) ermöglicht die Ultraschall-basierte Messung der Gewebeelastizität. Das Ziel der vorliegenden Studie war es den Stellenwert der SE in einer prospektiven Multizenter-Studie für die Differenzierung von Schilddrüsenknoten zu evaluieren. Material und Methoden: Die Studie wurde bei clinicaltrials.gov registriert und von den lokalen Ethikkommissionen der teilnehmenden Zentren genehmigt. Alle Patienten erhielten einen Ultraschall (US) der Schilddrüse inklusive Farbduplex-US. Zusätzlich wurden alle Knoten mittels SE (Hitachi Medical System) untersucht und eine Beurteilung der qualitativen Farbverteilung (SE-ES) und eine semiquantitative Messung der Elastizität mittels strain value und strain ratio durchgeführt. Ergebnisse: Insgesamt wurden 602 Patienten mit 657 Schilddrüsenknoten (567 benigne, 90 maligne) an 7 deutschen Zentren ausgewertet. Sensitivität, Spezifität, NPV, PPV, und +LR betrugen entsprechend 21 %, 73 %, 86 %, 11 %, 0,8 für den Duplex-US; 69 %, 75 %, 94 %, 30 %, 2,9 für SE-ES; 56 %, 81 %, 92 %, 32 %, 2,9 für SE-strain value; 58 %, 78 %, 92 %, 30 %, 2,6 für SE-strain ratio. Die diagnostische Genauigkeit betrug 71 % sowohl für SEstrain value, als auch SE-strain ratio. Schlussfo...

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Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study

et al. 2016

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“…patients who had undergone FNA cytology before surgery and patients with no preoperative FNA cytology) was analyzed by chi squared or Fisher lar margin and microcalcifications), and scintigraphy (i.e. cold nodule) are traditionally considered as risk factors for thyroid malignancy [9][10][11][12][13][14]. As such, those lesions carrying these characteristics need to be carefully examined [5][6][7][8].…”

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Early diagnosis by FNA cytology should not influence the outcome of differentiated thyroid cancer

et al. 2016

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“…Improvements of thyroid cytopathology by the introduction of thin core needle biopsy, with the assessment of the nodule capsule and the perinodular tissue, have appeared to ameliorate recognition of malignancy in cytologically indeterminate nodules [9]. Similarly, combination of nodule ultrasound features with measures of nodule stiffness, obtained by real-time elastography, has appeared to increase sensitivity for malignancy and to strengthen the selection of patients who do not need further diagnostic testing [10]. However, the analysis of diagnostic molecular markers on indeterminate FNAC specimens has caught the greatest interest.…”

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BRAF mutation assessment in papillary thyroid cancer: are we ready to use it in clinical practice?

Puxeddu

2013

Endocrine

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Ultrasound Sensitivity for Thyroid Malignancy Is Increased by Real-Time Elastography: A Prospective Multicenter Study

Cited by 175 publications

References 27 publications

Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study

Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study

Early diagnosis by FNA cytology should not influence the outcome of differentiated thyroid cancer

BRAF mutation assessment in papillary thyroid cancer: are we ready to use it in clinical practice?

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