Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience
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To evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) in distinguishing malignant from benign thyroid nodules.
A total of 331 focal thyroid nodules from 271 patients scheduled for fine-needle aspiration or thyroid surgery were included. After a routine conventional ultrasound evaluation, 2D-SWE examinations were performed to obtain 2D-SWE measurements on a colour-coded mapping, which were then correlated with pathology results.
A total of 230 nodules were benign and 101 were malignant on pathology. The areas under the receiver operating characteristic curve (AUC) of mean and minimum values in the largest region of interest (ROI) over the whole nodule, and mean, maximum and minimum values in 2-mm ROI over the stiffest area of the nodule were 0.794, 0.673, 0.808, 0.805 and 0.799, respectively. The most accurate cut-off value, 39.3 kPa, for mean value in a 2-mm ROI achieved 66.3 % sensitivity and 84.4 % specificity to discriminate malignancy. Nodule size correlated with 2D-SWE value for malignant nodules (P < 0.01). In the group of nodules ≤10 mm, the AUC was 0.730, while it was 0.883 in nodules sized 11–30 mm and 0.821 in nodules >30 mm.
2D-SWE is a promising diagnostic tool for discriminating malignant thyroid nodules, although the performance for nodules ≤10 mm is not satisfactory.
• 2D-shear wave elastography (2D-SWE) helps differentiate benign nodules from malignancy.
• Calcification will increase the 2D-SWE value.
• 2D-SWE appears limited in terms of identifying papillary thyroid microcarcinomas accurately.
• Combination of 2D-SWE and conventional ultrasound is highly sensitivity for thyroid malignancy.
Keywords2D-shear wave elastography Thyroid nodules Malignancy Ultrasound Fine-needle aspiration
Two-dimensional shear wave elastography
Areas under the ROC curve
Negative predictive value
Positive predictive value
Receiver operating characteristic
Region of interest
Maximum SWE value in the 2-mm ROI
Mean SWE value in the 2-mm ROI
Minimum SWE value in the 2-mm ROI
Mean SWE value in the largest ROI
Minimum SWE value in the largest ROI
Ratio between SWE_mean and the elastic value of the surrounding thyroid tissue
The scientific guarantor of this publication is Xiaoyan Xie. 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 was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.