title: Conventional ultrasound integrated with elastosonography and B-flow imaging in the diagnosis of thyroid nodular lesions.
abstract: The purpose of this study was to evaluate the sonographic features of thyroid nodules suspicious for malignancy with standard examination in B-mode and Color Doppler associated with modern techniques such as ultrasound RTE (Real Time Elastosonography) and BFI (B-flow imaging) in correlation with the results of the sonographically guided fine-needle aspiration to establish their role in predicting the risk of malignancy. Between November 2012 and January 2014, 354 consecutive patients (age range, 18-73 years; mean age ± SD, 41.2 ± 9.2 years; 90 male and 264 female) with 493 suspected nodules (maximum diameter > 9 mm) were enrolled in this prospective study. Sonographic, elastosonographic and BFI examinations were performed with a commercially available real-time ultrasound system, and all patients also underwent a cytologic evaluation. Patients with suspicious or malignant cytologic features underwent surgery. On histologic examination, 71 of 493 nodules were malignant (62 papillary thyroid carcinoma, 1 Hürthle cell carcinoma, and 8 follicular carcinoma). All sonographic characteristics, which were potential predictors of thyroid malignancy (microcalcifications, hypoechogenicity, absence of a halo, and a predominantly solid composition), were found in different percentages in both histologically verified malignant and benign nodules. For BFI, pattern 3 (≥4 signs and distance > 2 mm) was the most predictive factor for malignancy (specificity, 99.6%; sensitivity, 65.2%), whereas pattern 2 (≥4 signs and distance < 2 mm) was a positive factor because it was detected only in benign lesions. For the RTE, scores 1-2 were detected in 68% of benign nodules, while scores 3-4 in 94% of malignant nodules. Our results indicate that Elastosonography and BFI can overcome the limits of the traditional B-mode and color Doppler sonographic features in the diagnosis of thyroid nodules. This techniques provides maximum specificity levels both in the case of benign nodules and in the case of malignant nodules.
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy. Electronic address: alfonso.reginelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Reginelli
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Urraro
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: di Grezia
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Napolitano
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maggialetti
authors.affiliation: Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cappabianca
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.affiliation: Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Squillaci
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D002291:Carcinoma, Papillary; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
keywords: BFI; Elastosonography; Lymph nodes; Nodule; Thyroid