2D-Shear Wave Elastography Increases the Diagnostic Accuracy of the TIRADS-ACR and ATA Classification Systems in Thyroid Nodule Selection: Cytological and Histological Correlation

Pedro Henrique Moraes; Maria Cristina Chammas; Felipe Brasileiro Vanderlei; Marcelo Violi Schelini; Carolina De Marqui Milani; Danielle Azevedo Chacon

doi:10.1055/a-2551-7774

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Ultraschall Med
DOI: 10.1055/a-2551-7774

Original Article

2D-Shear Wave Elastography Increases the Diagnostic Accuracy of the TIRADS-ACR and ATA Classification Systems in Thyroid Nodule Selection: Cytological and Histological Correlation

Die 2D-Scherwellen-Elastografie erhöht die diagnostische Genauigkeit der TIRADS-ACR- und ATA-Klassifizierungssysteme bei der Auswahl von Schilddrüsenknoten: Korrelation mit Zytologie und Histologie

Pedro Henrique Moraes

¹Ultrasound Division, Radiology Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil (Ringgold ID: RIN28133)

,

Maria Cristina Chammas

¹Ultrasound Division, Radiology Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil (Ringgold ID: RIN28133)

,

Felipe Brasileiro Vanderlei

²Head and Neck Surgery Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil (Ringgold ID: RIN28133)

,

Marcelo Violi Schelini

¹Ultrasound Division, Radiology Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil (Ringgold ID: RIN28133)

,

Carolina De Marqui Milani

³Reseach Department, Faculty Ceres, São Jose do Rio Preto, Brazil

,

Danielle Azevedo Chacon

⁴Pathology Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil (Ringgold ID: RIN28133)

› Institutsangaben

Abstract

Purpose

The aim was to evaluate whether elastography changes the accuracy of thyroid nodule malignancy risk classification using the TI-RADS ACR and ATA systems.

Materials and Methods

This was a prospective study with 191 nodules (180 patients). Nodule assessments by B-mode ultrasonography (US) and 2-dimensional shear wave elastography (2D-SWE) were compared with a) fine-needle aspiration biopsy cytological (Bethesda II) and b) post-resection histology results (Bethesda III–VI). Nodules were divided into benign and malignant. B-mode US evaluated echogenicity, composition, dimensions, contours, limits, and presence of halo and echogenic foci. Elastography classified nodules from I (completely softened) to IV (completely hard). The mean nodule deformation value (assessed in m/s and kPa), the deformation ratio between nodule and thyroid parenchyma (TDR), and the deformation ratio between nodule and pre-thyroid musculature (MDR) were calculated.

Results

The significant univariate parameters for B-mode were hypoechogenicity, halo, microcalcifications, irregular contours, and ill-defined limits. All parameters were significant for elastography. The MDR (in kPa) was the best elastographic parameter: nodules with MDRs> 1.53 exhibited a higher chance of malignancy (AUC-ROC=0.831). B-mode ACR-TIRADS had an AUC of 0.678; 95% CI: 0.596–0.760, while ATA had an AUC of 0.680; 95%: 0.597–0.763. Multivariable analysis indicated that the combination of prognostic models with any elastographic parameter increased performance. ATA classification, combined with elastogram pattern and MDR (in kPa), increased the AUC to 0.892; 95% IC: 0.845–0.939.

Conclusion

2D-SWE can increase the accuracy of the most widespread B-mode prognostic models: TI-RADS ACR and ATA.

Zusammenfassung

Ziel

Es sollte untersucht werden, ob die Elastografie die Genauigkeit der Klassifizierung des Malignitätsrisikos von Schilddrüsenknoten mittels TI-RADS-ACR- und ATA-Systemen verbessert.

Material und Methoden

Es handelte sich um eine prospektive Studie mit 191 Knoten (180 Patienten). Die Beurteilung der Knoten mittels der B-Mode-Sonografie (US) und 2-dimensionaler Schallwellen-Elastografie (2D-SWE) wurde a) mit den zytologischen Befunden der Feinnadel-Punktion (Bethesda II) und b) mit den histologischen Befunden nach Resektion (Bethesda III–VI) verglichen. Die Knoten wurden in benigne und maligne unterteilt. Im B-Mode-US wurden Echogenität, Zusammensetzung, Abmessungen, Konturen, Grenzen und das Vorhandensein von Halo und echogenen Foci untersucht. Die Elastografie klassifizierte die Knoten von I (vollständig weich) bis IV (vollständig hart). Der mittlere Knoten-Verformungswert (in m/s und kPa), das Verhältnis der Verformbarkeit zwischen Knoten und Schilddrüsen-Parenchym (TDR) und das Verformungsverhältnis zwischen Knoten und präthyreoidaler Muskulatur (MDR) wurden berechnet.

Ergebnisse

Die signifikanten univariaten Parameter für den B-Mode waren Hypoechogenität, Halo, Mikroverkalkungen, unregelmäßige Konturen und unklare Grenzen. Für die Elastografie waren alle Parameter signifikant. Der MDR (in kPa) war der beste elastografische Parameter: Knoten mit einem MDR >1,53 entsprachen einem höheren Risiko für Malignität (AUC-ROC=0,831). B-Mode-ACR-TIRADS hatte eine AUC von 0,678 (95%-KI: 0,596–0,760), während ATA eine AUC von 0,680 (95%-KI: 0,597–0,763) hatte. Die multivariable Analyse zeigte, dass die Kombination von prognostischen Modellen mit einem beliebigen elastografischen Parameter die Leistung erhöhte. Die ATA-Klassifizierung in Kombination mit dem Elastogramm-Muster und dem MDR (in kPa) erhöhte die AUC auf 0,892 (95%-KI: 0,845–0,939).

Schlussfolgerung

Die 2D-SWE kann die Genauigkeit der am weitesten verbreiteten B-Mode-Prognosemodelle TI-RADS-ACR und -ATA erhöhen.

Keywords

thyroid - ultrasound - ACR TI-RADS (American College of Radiology Thyroid Imaging Reporting and Data System) - thyroid nodules - shear wave elastography

Volltext

Referenzen

References
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