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European Radiology

, Volume 24, Issue 11, pp 2729–2738 | Cite as

Diagnostic performance of shear wave elastography in the identification of malignant thyroid nodules: a meta-analysis

  • Peiliang Lin
  • Minqi Chen
  • Baoxian Liu
  • Siwen Wang
  • Xiaoxi LiEmail author
Ultrasound

Abstract

Objective

This meta-analysis aimed to assess the performance of shear wave elastography (SWE) in the identification of malignant thyroid nodules.

Methods

Web of Science, Scopus, PubMed, and the references of narrative reviews were searched for relevant studies with a publication date through October 2013. The methodological quality was assessed using QUADAS tools. Data synthesis was calculated using the bivariate mixed-effects regression model.

Results

Of the 131 studies identified, 15 (11.5 %) were included, in which SWE, point-SWE or 2D SWE, was used to evaluate 1,867 thyroid nodules in 1,525 patients. Methodological assessment revealed study quality was moderate to high. The pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve of SWE for detecting malignant thyroid nodules were 84.3 % (95 % confidence interval [CI], 76.9–89.7 %), 88.4 % (95 % CI, 84.0–91.7 %), and 93 % (95 % CI, 90–95 %), respectively. As a screening tool, positive and negative predictive values were 27.7–44.7 % and 98.1–99.1 %, respectively, calculated with a malignance prevalence of 5–10 % in thyroid nodules. A publication bias regression test revealed no significant small-study bias.

Conclusions

SWE is a highly accurate diagnostic modality for the identification of malignant thyroid nodules, with promise for integration into routine imaging protocols for thyroid nodules.

Key Points

Shear wave elastography (SWE) is a group of novel ultrasound-based technologies.

Meta-analysis was employed to assess relevant studies of SWE of thyroid nodules.

SWE had high sensitivity and specificity in identifying malignant thyroid nodules.

The high negative predictive value of SWE can reduce unnecessary biopsies.

Keywords

Ult rasound Elasticity imaging techniques Thyroid neoplasms Thyroid nodule Meta-analysis 

Abbreviations

2D SWE

2-dimensional shear wave elastography

ARFI

acoustic radiation force impulse

AUC

area under the summary receiver operating characteristic curve

CI

confidence interval

Df

degrees of freedom

DOR

diagnostic odds ratio

EFSUMB

European Federation of Societies for Ultrasound in Medicine and Biology

ES

elasticity score

ESS

effective sample size

FN

false negative

FNAB

fine-needle aspirate biopsy

FP

false positive

NPV

negative predictive value

PPV

positive predictive value

pSWE

point shear wave elastography

QUADAS

quality assessment of diagnostic accuracy studies

ROC

receiver operating characteristic curve

SE

strain elastography

SR

strain ratio

SWE

shear wave elastography

SWR

shear wave velocity ratio

SWV

shear wave velocity

TN

true negative

TP

true positive

Notes

Acknowledgments

The scientific guarantor of this publication is Xiaoxi Li. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval and written informed consent were not required because our study was a meta-analysis based on published data.. Some study subjects or cohorts have been previously reported in the studies included in our meta-analysis. However, the results of our research based on these studies are original and have not been published or presented previously at meetings. Methodology: diagnostic or prognostic study, performed at one institution.

References

  1. 1.
    Tunbridge WMG, Evered DC, Hall R et al (1977) The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol 7:481–493CrossRefGoogle Scholar
  2. 2.
    Knudsen N, Laurberg P, Perrild H, Bülow I, Ovesen L, Jørgensen T (2002) Risk factors for goiter and thyroid nodules. Thyroid 12:879–888PubMedCrossRefGoogle Scholar
  3. 3.
    Reiners C, Wegscheider K, Schicha H et al (2004) Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14:926–932PubMedCrossRefGoogle Scholar
  4. 4.
    Singer PA, Cooper DS, Daniels GH et al (1996) Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med 156:2165–2172PubMedCrossRefGoogle Scholar
  5. 5.
    Alexander EK (2008) Approach to the patient with a cytologically indeterminate thyroid nodule. J Clin Endocrinol Metab 93:4175–4182PubMedCrossRefGoogle Scholar
  6. 6.
    Wojcinski S, Farrokh A, Weber S et al (2010) Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS(R)-US classification system with sonoelastography. Ultraschall Med 31:484–491PubMedCrossRefGoogle Scholar
  7. 7.
    Aigner F, Mitterberger M, Rehder P et al (2010) Status of transrectal ultrasound imaging of the prostate. J Endourol 24:685–691PubMedCrossRefGoogle Scholar
  8. 8.
    Ying L, Lin X, Xie ZL, Tang FY, Hu YP, Shi KQ (2012) Clinical utility of acoustic radiation force impulse imaging for identification of malignant liver lesions: a meta-analysis. Eur Radiol 22:2798–2805PubMedCrossRefGoogle Scholar
  9. 9.
    Bojunga J, Herrmann E, Meyer G, Weber S, Zeuzem S, Friedrich-Rust M Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 20:1145–1150Google Scholar
  10. 10.
    Razavi SA, Hadduck TA, Sadigh G, Dwamena BA (2013) Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis. AJR Am J Roentgenol 200:1317PubMedCrossRefGoogle Scholar
  11. 11.
    Bamber J, Cosgrove D, Dietrich CF et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 34:169–184PubMedCrossRefGoogle Scholar
  12. 12.
    Friedrich-Rust M, Romenski O, Meyer G et al (2012) Acoustic Radiation Force Impulse-Imaging for the evaluation of the thyroid gland: A limited patient feasibility study. Ultrasonics 52:69–74PubMedCrossRefGoogle Scholar
  13. 13.
    Gu J, Du L, Bai M et al (2012) Preliminary Study on the Diagnostic Value of Acoustic Radiation Force Impulse Technology for Differentiating Between Benign and Malignant Thyroid Nodules. J Ultrasound Med 31:763–771PubMedGoogle Scholar
  14. 14.
    Sebag F, Vaillant-Lombard J, Berbis J et al (2010) Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab 95:5281–5288PubMedCrossRefGoogle Scholar
  15. 15.
    Yu L, Wu J, Li J (2012) Application Value of Virtual Touch Tissue Quantification in the Diagnosis of Papillary Thyroid Microcarcinoma. Chinese General Practice 15:3206–3208Google Scholar
  16. 16.
    Zhang FJ, Han RL (2013) The value of acoustic radiation force impulse (ARFI) in the differential diagnosis of thyroid nodules. Eur J Radiol 82:e686–e690PubMedCrossRefGoogle Scholar
  17. 17.
    Bhatia KS, Tong CS, Cho CC, Yuen EH, Lee YY, Ahuja AT (2012) Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. Eur Radiol 22:2397–2406PubMedCrossRefGoogle Scholar
  18. 18.
    Xiao L, Zhao Y, Gao L et al (2012) Value of virtual touch tissue quantification technique in the diagnosis of small solid thyroid nodules. Chinese Journal of Ultrasonography 21:771–774Google Scholar
  19. 19.
    Zhang F, Han R, Liu M (2012) Ultrasonic Elastography and Virtual Touch Tissue Quantification in Benign and Malignant Thyroid Nodules. Chinese Journal of Ultrasonic in Medicine 28:120–123Google Scholar
  20. 20.
    Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ (2009) Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA 301:415–424PubMedCrossRefGoogle Scholar
  22. 22.
    van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624PubMedCrossRefGoogle Scholar
  23. 23.
    van Houwelingen HC, Zwinderman KH, Stijnen T (1993) A bivariate approach to meta-analysis. Stat Med 12:2273–2284PubMedCrossRefGoogle Scholar
  24. 24.
    Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142PubMedCrossRefGoogle Scholar
  25. 25.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893PubMedCrossRefGoogle Scholar
  27. 27.
    Bojunga J, Dauth N, Berner C et al (2012) Acoustic Radiation Force Impulse Imaging for Differentiation of Thyroid Nodules. PLoS One 7:e42735PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Chen S, Zhu L, Chen X et al (2011) Virtual touch tissue quantification in diagnosis of thyroid papillary carcinoma. Chin J Med Imaging Technol 27:2451–2455Google Scholar
  29. 29.
    Hou XJ, Sun AX, Zhou XL et al (2013) The application of Virtual Touch tissue quantification (VTQ) in diagnosis of thyroid lesions: A preliminary study. Eur J Radiol 82:797–801PubMedCrossRefGoogle Scholar
  30. 30.
    Ni J, Huang P, Zhang H et al (2013) Diagnostic value of virtual touch tissue quantification in discriminating thyroid benign and malignant nodule. Chin J Ultrasonogr 22:137–140Google Scholar
  31. 31.
    Veyrieres JB, Albarel F, Lombard JV et al (2012) A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: a reality? Eur J Radiol 81:3965–3972PubMedCrossRefGoogle Scholar
  32. 32.
    Zhan J, Zhu L, Zhu J, Chai Q, Chen L, Chen Y (2012) Ultrasound elastography compared with acoustic radiation force impulse imagine in differential diagnosis of benign and malignant thyroid nodules. Chin J Med Imaging Technol 28:1815–1818Google Scholar
  33. 33.
    Zhang YF, Xu HX, He Y et al (2012) Virtual Touch Tissue Quantification of Acoustic Radiation Force Impulse: A New Ultrasound Elastic Imaging in the Diagnosis of Thyroid Nodules. PLoS One 7:e49094PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Kim JK, Baek JH, Lee JH et al (2009) Ultrasound elastography for thyroid nodules: a reliable study? Ultrasound Med Biol 38:1508–1513CrossRefGoogle Scholar
  35. 35.
    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
  36. 36.
    Melodelima D, Bamber JC, Duck FA, Shipley JA (2007) Transient elastography using impulsive ultrasound radiation force: a preliminary comparison with surface palpation elastography. Ultrasound Med Biol 33:959–969PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Peiliang Lin
    • 1
  • Minqi Chen
    • 2
  • Baoxian Liu
    • 2
  • Siwen Wang
    • 1
  • Xiaoxi Li
    • 1
    Email author
  1. 1.Department of Vascular and Thyroid SurgeryFirst Affiliated Hospital, Sun Yat-Sen UniversityGuangzhouChina
  2. 2.Department of UltrasoundFirst Affiliated Hospital, Sun Yat-Sen UniversityGuangzhouChina

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