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Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience

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Abstract

Objectives

To evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) in distinguishing malignant from benign thyroid nodules.

Methods

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.

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.

Conclusion

2D-SWE is a promising diagnostic tool for discriminating malignant thyroid nodules, although the performance for nodules ≤10 mm is not satisfactory.

Key Points

• 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.

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Abbreviations

2D-SWE:

Two-dimensional shear wave elastography

AUC:

Areas under the ROC curve

FNA:

Fine-needle aspiration

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

ROI:

Region of interest

SWE_max:

Maximum SWE value in the 2-mm ROI

SWE_mean:

Mean SWE value in the 2-mm ROI

SWE_min:

Minimum SWE value in the 2-mm ROI

SWE_whole_mean:

Mean SWE value in the largest ROI

SWE_whole_min:

Minimum SWE value in the largest ROI

SWE_ratio:

Ratio between SWE_mean and the elastic value of the surrounding thyroid tissue

US:

Ultrasound

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China

    Baoxian Liu, Jinyu Liang, Yanling Zheng, Xiaoyan Xie, Guangliang Huang, Luyao Zhou & Wei Wang

  2. Department of Hepatobiliary Surgery, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China

    Mingde Lu

  3. Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China

    Baoxian Liu, Jinyu Liang, Yanling Zheng, Xiaoyan Xie, Guangliang Huang, Luyao Zhou, Wei Wang & Mingde Lu

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  1. Baoxian Liu
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  2. Jinyu Liang
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  3. Yanling Zheng
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  4. Xiaoyan Xie
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  7. Wei Wang
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  8. Mingde Lu
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Correspondence to Xiaoyan Xie.

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Liu, B., Liang, J., Zheng, Y. et al. Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience. Eur Radiol 25, 624–634 (2015). https://doi.org/10.1007/s00330-014-3455-8

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  • DOI: https://doi.org/10.1007/s00330-014-3455-8

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