Ultraschall Med 2019; 40(04): 495-503
DOI: 10.1055/a-0853-1821
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization

Prospektive Evaluierung der semiquantitativen Kompressionselastografie und der quantitativen 2D-Scherwellenultraschallelastografie (SWE) in Verbindung mit der TIRADS-Klassifikation zur Charakterisierung von Schilddrüsenknoten
Vito Cantisani
1   Department of Radiology, Sapienza-University of Rome, Rome, Italy
,
Emanuele David
2   Radiology Unit, Papardo-Hospital, Messina, Italy
,
Hektor Grazhdani
3   Poliambulatorio Roma Eur, Associazione dei Cavalieri Italiani Sovrano Militare Ordine di Malta, Rome, Italy
,
Antonello Rubini
1   Department of Radiology, Sapienza-University of Rome, Rome, Italy
,
Maija Radzina
4   Diagnostic Radiology Institute, P. Stradina Clinical University-Hospital, Riga, Latvia
,
Christoph F. Dietrich
5   Innere Medizin 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
,
Cosimo Durante
6   Department of Internal Medicine and Medical Specialities, Sapienza-University of Rome, Rome, Italy
,
Livia Lamartina
6   Department of Internal Medicine and Medical Specialities, Sapienza-University of Rome, Rome, Italy
,
Giorgio Grani
6   Department of Internal Medicine and Medical Specialities, Sapienza-University of Rome, Rome, Italy
,
Ascoli Valeria
7   Department of Pathological Anatomy and Cytodiagnostic, Sapienza-University of Rome, Rome, Italy
,
Daniela Bosco
7   Department of Pathological Anatomy and Cytodiagnostic, Sapienza-University of Rome, Rome, Italy
,
Cira Di Gioia
7   Department of Pathological Anatomy and Cytodiagnostic, Sapienza-University of Rome, Rome, Italy
,
Fabrizio Maria Frattaroli
8   Department of Surgical Sciences, Sapienza-University of Rome, Rome, Italy
,
Vito D'Andrea
8   Department of Surgical Sciences, Sapienza-University of Rome, Rome, Italy
,
Corrado De Vito
9   Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy
,
Daniele Fresilli
10   University Sapienza, Department of Radiological Sciences, Rome, Italy
,
Ferdinando D'Ambrosio
1   Department of Radiology, Sapienza-University of Rome, Rome, Italy
,
Laura Giacomelli
8   Department of Surgical Sciences, Sapienza-University of Rome, Rome, Italy
,
Carlo Catalano
1   Department of Radiology, Sapienza-University of Rome, Rome, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. Dezember 2017

24. Januar 2019

Publikationsdatum:
28. Mai 2019 (online)

Abstract

Purpose To evaluate the diagnostic performance of strain ratio elastography (SRE) and shear wave elastography (SWE) alone and in combination with Thyroid Imaging Reporting and Data System (TIRADS) classification parameters to improve differentiation between benign and malignant thyroid nodules.

Materials and Methods In this prospective study benign (n = 191) and malignant (n = 52) thyroid nodules were examined with high-resolution ultrasound (US) features using the TIRADS lexicon and SRE semiquantitative and SWE quantitative findings using histology or cytology as the gold standard with a 12-month follow-up. Sensitivity (Se), specificity (Sp) and the area under the ROC curve (AUROC) were used to evaluate the diagnostic performance of each feature and combinations of the methods.

Results TIRADS score showed a sensitivity of 59.6 %, a specificity of 83.8 % with an AUROC of 0.717, a PPV of 50.0 % and an NPV of 88.4 %. SRE yielded the highest performance with a sensitivity of 82.7 %, a specificity of 92.7 % with AUROC of 0.877, a PPV 75.4 % and an NPV of 95.2 %. SWE (kPa) had a sensitivity and specificity of 67.3 % and 82.7 %, respectively, with an AUROC of 0.750, a PPV of 51.5 % and an NPV of 90.3 %. Differences were significant for SRE only but not for SWE.

Conclusion Ultrasound elastography may improve thyroid nodule discrimination. In particular, SRE has a better performance than TIRADS classification, while their combination improves sensitivity.

Zusammenfassung

Ziel der Studie Die Studie erfolgte, um die diagnostische Genauigkeit der Kompressionselastografie (SRE) und Scherwellenelastografie (SWE) einzeln und in Kombination mit der Thyroid-Imaging-Reporting-and-Data-System (TIRADS)-Klassifikation zu untersuchen, um eine verbesserte Differenzierung von benignen und malignen Schilddrüsenknoten zu ermöglichen.

Patienten und Methoden In dieser prospektiven Studie wurden gutartige (n = 191) und bösartige (n = 52) Schilddrüsenknoten mittels Ultraschall, SRE und SWE untersucht und die Daten mit der TIRADS-Klassifikation verglichen. Gutartige Läsionen wurden 12 Monate nachbeobachtet. Sensitivität (Se), Spezifität (Sp) und der Bereich unter der ROC-Kurve (Area-under-the-ROC-Curve – AUROC) sowie der positive prädiktive (PPV) und der negative prädiktive Wert (NPV) wurden berechnet, um die diagnostische Genauigkeit der einzelnen und kombinierten Methoden zu vergleichen.

Ergebnisse Der TIRADS-Score zeigte eine Se von 59,6 % und eine Sp von 83,8 % mit einer AUROC von 0,717. Der PPV lag bei 50,0 % und der NPV bei 88,4 %. SRE (in Klammern SWE (kPa)) erreichte die höchste Genauigkeit mit einer Se von 82,7 % (67,3 %) und einer Sp von 92,7 % (82,7 %); die AUROC lag bei 0,877 (0,750). Die Unterschiede zwischen SRE und SWE waren statistisch signifikant (p < 0,05).

Schlussfolgerung Die Ultraschallelastografie kann eine verbesserte Differenzierung von Schilddrüsenknoten ermöglichen. Insbesondere zeigt SRE bessere Ergebnisse als TIRADS, während die kombinierte Anwendung die Sensitivität verbessert.

 
  • References

  • 1 Haugen BR, Alexander EK, Bible KC. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1-133
  • 2 Gharib H, Papini E, Garber JR. et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract 2016; 22: 622-639
  • 3 Shin JH, Baek JH, Chung J. et al. Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2016; 17: 370-395
  • 4 Russ G, Bonnema SJ, Erdogan MF. et al. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6: 225-237
  • 5 Tessler FN, Middleton WD, Grant EG. et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017; 14: 587-595
  • 6 Kwak JY, Han KH, Yoon JH. et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260: 892-899
  • 7 Dietrich CF, Muller T, Bojunga J. et al. Statement and Recommendations on Interventional Ultrasound as a Thyroid Diagnostic and Treatment Procedure. Ultrasound Med Biol 2018; 44: 14-36
  • 8 Tee YY, Lowe AJ, Brand CA. et al. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review. Ann Surg 2007; 246: 714-720
  • 9 Oertel YC, Miyahara-Felipe L, Mendoza MG. et al. Value of repeated fine needle aspirations of the thyroid: an analysis of over ten thousand FNAs. Thyroid 2007; 17: 1061-1066
  • 10 Grani G, Calvanese A, Carbotta G. et al. Intrinsic factors affecting adequacy of thyroid nodule fine-needle aspiration cytology. Clinical Endocrinology 2013; 78: 141-144
  • 11 Grani G, Lamartina L, Ascoli V. et al. Ultrasonography scoring systems can rule out malignancy in cytologically indeterminate thyroid nodules. Endocrine 2017; 57: 256-261
  • 12 He YP, Xu HX, Zhao CK. et al. Cytologically indeterminate thyroid nodules: increased diagnostic performance with combination of US TI-RADS and a new scoring system. Sci Rep 2017; 7: 6906
  • 13 Horvath E, Silva CF, Majlis S. et al. Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol 2017; 27: 2619-2628
  • 14 Cantisani V, Lodise P, Di Rocco G. et al. Diagnostic accuracy and interobserver agreement of Quasistatic Ultrasound Elastography in the diagnosis of thyroid nodules. Ultraschall in Med 2015; 36: 162-167
  • 15 Razavi SA, Hadduck TA, Sadigh G. et al. Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis. Am J Roentgenol 2013; 200: 1317-1326
  • 16 Ghajarzadeh M, Sodagari F, Shakiba M. Diagnostic accuracy of sonoelastography in detecting malignant thyroid nodules: a systematic review and meta-analysis. Am J Roentgenol 2014; 202: W379-W389
  • 17 Nell S, Kist JW, Debray TP. et al. Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules. A systematic review and meta-analysis. Eur J Radiol 2015; 84: 652-661
  • 18 Cantisani V, Grazhdani H, Ricci P. et al. Q-elastosonography of solid thyroid nodules: assessment of diagnostic efficacy and interobserver variability in a large patient cohort. Eur Radiol 2014; 24: 143-150
  • 19 Cosgrove D, Barr R, Bojunga J. et al. WFUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography: Part 4. Thyroid Ultrasound Med Biol 2017; 43: 4-26
  • 20 Bamber J, Cosgrove D, Dietrich CF. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall in Med 2013; 34: 169-184
  • 21 Zhou BG, Wang D, Ren WW. et al. Value of shear wave arrival time contour display in shear wave elastography for breast masses diagnosis. Sci Rep 2017; 7: 7036
  • 22 Milas Z, Shin J, Milas M. New guidelines for the management of thyroid nodules and differentiated thyroid cancer. Minerva Endocrinol 2011; 36: 53-70
  • 23 Nardi F, Basolo F, Crescenzi A. et al. Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Invest 2014; 37: 593-599
  • 24 Dighe M, Barr R, Bojunga J. et al. Thyroid Ultrasound: State of the Art. Part 2 – Focal Thyroid Lesions. Med Ultrason 2017; 19: 195-210 . doi:10.11152/mu-999
  • 25 Friedrich-Rust M, Vorlaender C, Dietrich CF. et al. Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study. Ultraschall in Med 2016; 37: 262-270
  • 26 Tian W, Hao S, Gao B. et al. Comparison of Diagnostic Accuracy of Real-Time Elastography and Shear Wave Elastography in Differentiation Malignant From Benign Thyroid Nodules. Medicine (Baltimore) 2015; 94: e2312
  • 27 Liu BJ, Lu F, Xu HX. et al. The diagnosis value of acoustic radiation force impulse (ARFI) elastography for thyroid malignancy without highly suspicious features on conventional ultrasound. Int J Clin Exp Med 2015; 8: 15362-15372
  • 28 Zhan J, Jin JM, Diao XH. et al. Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules – A meta-analysis. Eur J Radiol 2015; 84: 2181-2186
  • 29 Hu X, Liu Y, Qian L. Diagnostic potential of real-time elastography (RTE) and shear wave elastography (SWE) to differentiate benign and malignant thyroid nodules: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96: e8282
  • 30 Bhatia KS, Cho CC, Tong CS. et al. Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic. Eur Radiol 2012; 22: 957-965
  • 31 Cantisani V, D’Andrea V, Biancari F. et al. Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: Preliminary experience. Eur J Radiol 2012; 81: 2678-2683 . doi:10.1016/j.ejrad.2011.11.056
  • 32 Zhang F, Zhao X, Han R. et al. Comparison of Acoustic Radiation Force Impulse Imaging and Strain Elastography in Differentiating Malignant From Benign Thyroid Nodules. J Ultrasound Med 2017; 36: 2533-2543 . doi:10.1002/jum.14302. Epub 2017 Jun 24
  • 33 Yoon JH, Kim EK, Kwak JY. et al. Application of Various Additional Imaging Techniques for Thyroid Ultrasound: Direct Comparison of Combined Various Elastography and Doppler Parameters to Gray-Scale Ultrasound in Differential Diagnosis of Thyroid Nodules. Ultrasound Med Biol 2018; 44: 1679-1686 doi:10.1016/j.ultrasmedbio.2018.04.006. Epub 2018 May 22