title: Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of shear-wave elastography (SWE) for the diagnosis of malignancy in follicular lesions and to identify the optimal SWE measurement plane.
  
  
  METHODS
  The institutional review board approved this HIPAA-compliant, single-institution, prospective pilot study. Subjects scheduled for surgery after a previous fine-needle aspiration report of "atypia of undetermined significance" or "follicular lesion of undetermined significance," "suspicion for follicular neoplasm," or "suspicion for Hurthle cell neoplasm," were enrolled after obtaining informed consent. Subjects underwent conventional ultrasonography (US), Doppler evaluation, and SWE preoperatively, and their predictive value for thyroid malignancy was evaluated relative to the reference standard of surgical pathologic findings.
  
  
  RESULTS
  Thirty-five patients (12 men, 23 women) with a mean age of 55 years (range, 23-85 years) and a fine-needle aspiration diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (n = 16), suspicion for follicular neoplasm (n = 14), and suspicion for Hurthle cell neoplasm (n = 5) were enrolled in the study. Male sex was a statistically significant (P = .02) predictor of malignancy, but age was not. No sonographic morphologic parameter, including nodule size, microcalcification, macrocalcification, halo sign, taller than wide dimension, or hypoechogenicity, was associated with malignancy. Similarly, no Doppler feature, including intranodular vascularity, pulsatility index, resistive index, or peak-systolic velocity, was associated with malignancy. Higher median SWE tissue Young modulus estimates from the transverse insonation plane were associated with malignancy, yielding an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.62, 1.00) for differentiation of malignant from benign nodules. At a cutoff value of 22.3 kPa, sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 88%, 75%, and 91%, respectively, were observed.
  
  
  CONCLUSIONS
  This prospective pilot study indicates that SWE may be a valuable tool in preoperative malignancy risk assessment of follicular-patterned thyroid nodules.
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Samir
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: Manish
authors.initials: M
authors.lastname: Dhyani
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: Arash
authors.initials: A
authors.lastname: Anvari
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: Jason
authors.initials: J
authors.lastname: Prescott
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: William C
authors.initials: WC
authors.lastname: Faquin
authors.affiliation: From the Department of Radiology (A.E.S., M.D., A.A.), Institute for Technology Assessment (E.F.H.), Department of Pathology (W.C.F.), and Department of Surgery (A.S.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; and Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md (J.P.).
authors.forename: Antonia
authors.initials: A
authors.lastname: Stephen
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000473:pathology; D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D013959:Thyroid Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology