Advertisement

European Radiology

, Volume 24, Issue 1, pp 143–150 | Cite as

Q-Elastosonography of Solid Thyroid Nodules: Assessment of Diagnostic Efficacy and Interobserver Variability in a Large Patient Cohort

  • Vito CantisaniEmail author
  • Hektor Grazhdani
  • Paolo Ricci
  • Koenraad Mortele
  • Mattia Di Segni
  • Vito D’Andrea
  • Adriano Redler
  • Giorgio Di Rocco
  • Laura Giacomelli
  • Elena Maggini
  • Carlo Chiesa
  • Sukru Mehmet Erturk
  • Salvatore Sorrenti
  • Carlo Catalano
  • Ferdinando D’Ambrosio
Ultrasound

Abstract

Objective

Evaluation of the diagnostic efficacy and interobserver agreement of Q-elastography in the differentiation of benign from malignant thyroid nodules.

Methods

A total of 344 thyroid nodules in 288 patients were examined with grey-scale and colour Doppler ultrasound (CDUS) and Q-elastography by two independent operators. Nodules with hypoechogenicity, poorly defined margins, microcalcifications, and intralesional vascularity were classified as suspicious. Diagnostic performances of CDUS features and Q-elastography for predicting thyroid malignancy were estimated using ROC analysis. Cytology or histopathology was the reference standard. Interobserver agreement in the evaluation of CDUS and Q-elastography was assessed using Cohen's k-statistic.

Results

Q-elastography showed excellent diagnostic performance for the prediction of thyroid malignancy, with sensitivity of 93 % and specificity of 92 % for operator 1 (best cutoff at 2.02), and sensitivity of 84 % and specificity of 79 % for operator 2 (best cutoff at 1.86). Performance of Q-elastography was superior to that of CDUS. Reproducibility of the findings was excellent for both Q-elastography and CDUS features as assessed with Cohen's k, which was highest for strain ratio measurements (0.95) and lowest for the echogenicity score (0.83).

Conclusions

Q-elastography showed excellent performance. It is a valid and reproducible diagnostic method as well as a promising tool for identifying suspicious solid thyroid nodules needing cytological assessment and surgery.

Key Points

• Elastography is an additional tool for optimal characterisation of malignant thyroid nodules.

• The use of semiquantitative elastographic evaluation increases the diagnostic performance,

• The interobserver agreement of quantitative elastography can be considered to be good.

Keywords

Thyroid nodules Ultrasound Elastography Interobserver variability 

Notes

Acknowledgements

The authors would like to thank Dr. Corrado De Vito for his evaluable contribution to the statistical elaboration of our results.

References

  1. 1.
    Wiest PW, Hartshorne MF, Inskip PD et al (1998) Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. J Ultrasound Med 17:487–496PubMedGoogle Scholar
  2. 2.
    Tomimori E, Pedrinola F, Cavaliere H, Knobel M, Medeiros-Neto G (1995) Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid 5:273–276PubMedCrossRefGoogle Scholar
  3. 3.
    Brander A, Viikinkoski P, Nickels J, Kivisaari L (1991) Thyroid gland: US screening in a random adult population. Radiology 181:683–687PubMedGoogle Scholar
  4. 4.
    Tumbridge WM, Evered DC, Hall R et al (1997) The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf) 7:481–93CrossRefGoogle Scholar
  5. 5.
    Fish SA, Langer JE, Mandel SJ (2008) Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin N Am 37:401–17CrossRefGoogle Scholar
  6. 6.
    Cappelli C, Castellano M, Pirola I et al (2007) The predictive value of ultrasound findings in the management of thyroid nodules. QJM 100:29–35PubMedCrossRefGoogle Scholar
  7. 7.
    Hoang JK, Lee WK, Lee M, Johnson D, Farrell S (2007) US features of thyroid malignancy: pearls and pitfalls. Radiographics 27:847–860PubMedCrossRefGoogle Scholar
  8. 8.
    Kim MJ, Kim EK, Park SI et al (2008) US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics 28:1869–86PubMedCrossRefGoogle Scholar
  9. 9.
    Gharib H, Papini E, Valcavi R, AACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi et al (2006) Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102PubMedGoogle Scholar
  10. 10.
    Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T (2006) Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology 17:251–256PubMedCrossRefGoogle Scholar
  11. 11.
    Garra BS (2011) Elastography: current status, future prospects, and making it work for you. Ultrasound Q 27:177–86PubMedCrossRefGoogle Scholar
  12. 12.
    Lyshchik A, Higashi T, Asato R et al (2005) Thyroid gland tumor diagnosis at US elastography. Radiology 237:202–211PubMedCrossRefGoogle Scholar
  13. 13.
    Lyshchik A, Higashi T, Asato R et al (2007) Cervical lymph node metastases: diagnosis at sonoelastography – initial experience. Radiology 243:258–67PubMedCrossRefGoogle Scholar
  14. 14.
    Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–50PubMedCrossRefGoogle Scholar
  15. 15.
    Dighe M, Unmin B, Richardson ML et al (2008) Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology 248:662–669PubMedCrossRefGoogle Scholar
  16. 16.
    Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z (2009) Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med 28:861–867PubMedGoogle Scholar
  17. 17.
    Luo S, Kim EH, Dighe M, Kim Y (2011) Thyroid nodule classification using ultrasound elastography via linear discriminant analysis. Ultrasonics 51:425–431PubMedCrossRefGoogle Scholar
  18. 18.
    Rago T, Santini F, Scutari M, Pinchera A, Vitti P (2007) Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 92:2917–2922PubMedCrossRefGoogle Scholar
  19. 19.
    Friedrich-Rust M, Sperber A, Holzer L et al (2010) Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes 118:602–9PubMedCrossRefGoogle Scholar
  20. 20.
    Asteria C, Giovanardi A, Pizzocaro A et al (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18:523–531PubMedCrossRefGoogle Scholar
  21. 21.
    Rubaltelli L, Corradin S, Dorigo A et al (2008) Differential diagnosis of benign and malignant thyroid nodules at elastography. Ultraschall Med 30:175–179PubMedCrossRefGoogle Scholar
  22. 22.
    Tranquart F, Bleuzen A, Pierre-Renoult P, Chabrolle C, Sam GM, Lecomte P (2008) Elastography of thyroid lesions. J Radiol 89:35–39PubMedCrossRefGoogle Scholar
  23. 23.
    Dighe M, Bae U, Richardson ML, Dubinsky TJ, Minoshima S, Kim Y (2008) Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology 248:662–669PubMedCrossRefGoogle Scholar
  24. 24.
    Cantisani V, D'Andrea V, Biancari F et al (2012) Prospective evaluation of multiparametric ultrasound and quantitative elastography in the differential diagnosis of benign and malignant thyroid nodules: Preliminary experience. Eur J Radiol 81:2678–83PubMedCrossRefGoogle Scholar
  25. 25.
    Cantisani V, Ulisse S, Guaitoli E, De Vito C, Caruso R et al (2012) Q-Elastography in the presurgical diagnosis of thyroid nodules with indeterminate cytology. PLoS ONE 7:e50725PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Park SH, Kim SJ, Kim EK, Kim MJ, Son EJ, Kwak JY (2009) Interobserver agreement in assessing the sonographic and elastographic features of malignant thyroid nodules. AJR Am J Roentgenol 193:W416–23PubMedCrossRefGoogle Scholar
  27. 27.
    Cooper D, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 1911:1167–214CrossRefGoogle Scholar
  28. 28.
    Landis J, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  29. 29.
    Fleiss JL (1986) The design and analysis of clinical experiments. Wiley, New York, pp 1–32Google Scholar
  30. 30.
    Bojunga J, Herrmann E, Meyer G et al (2010) Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 20:1145–1150PubMedCrossRefGoogle Scholar
  31. 31.
    Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY (2012) Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 262:1002–13PubMedCrossRefGoogle Scholar
  32. 32.
    Merino S, Arrazola J, Càrdenas A et al (2011) Utility and interobserver agreement of ultrasound elastography in the detection of malignant thyroid nodules in clinical care. Am J of Neuroradiol 32:2142–2148CrossRefGoogle Scholar
  33. 33.
    Ragazzoni F, Deandrea M, Mormile A et al (2012) High diagnostic accuracy and interobserver reliability of real-time elastography in the evaluation of thyroid nodules. Ultrasound Med Biol 38:1154–1162PubMedCrossRefGoogle Scholar
  34. 34.
    Lim DJ, Luo S, Kim MH, Ko SH, Kim Y (2012) Interobserver agreement and intraobserver reproducibility in thyroid ultrasound elastography. Am J Roentgenol 198:896–901CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Vito Cantisani
    • 1
    Email author
  • Hektor Grazhdani
    • 1
  • Paolo Ricci
    • 1
  • Koenraad Mortele
    • 1
  • Mattia Di Segni
    • 1
  • Vito D’Andrea
    • 1
  • Adriano Redler
    • 1
  • Giorgio Di Rocco
    • 1
  • Laura Giacomelli
    • 1
  • Elena Maggini
    • 1
  • Carlo Chiesa
    • 1
  • Sukru Mehmet Erturk
    • 1
  • Salvatore Sorrenti
    • 1
  • Carlo Catalano
    • 1
  • Ferdinando D’Ambrosio
    • 1
  1. 1.Department of Radiology, Oncology, and Anatomy PathologyUniversity “La Sapienza”RomeItaly

Personalised recommendations