Diagnostic Performance of Shear Wave Elastography Parameters Alone and in Combination with Conventional B-Mode Ultrasound Parameters for the Characterization of Thyroid Nodules: A Prospective, Dual-Center Study.
The aims of our study were to determine whether shear wave elastography (SWE) can improve the conventional B-mode differentiation of thyroid lesions, determine the most accurate SWE parameter for differentiation and assess the influence of microcalcifications and chronic autoimmune thyroiditis on SWE values. We examined 119 patients with 169 thyroid nodules who prospectively underwent B-mode ultrasound and SWE using the same ultrasound machine. The parameters assessed using SWE were: mean elasticity within the entire lesion (SWE-whole) and mean (SWE-mean) and maximum (SWE-max) elasticity for a 2-mm-diameter region of interest in the stiffest portion of the lesion, excluding microcalcifications. The discriminant powers of a generalized estimating equation model including B-mode parameters only and a generalized estimation equation model including both B-mode and SWE parameters were assessed and compared using the area under the receiver operating characteristic curve, in association with pathologic verification. In total, 50 and 119 malignant and benign lesions were detected. In generalized estimated equation regression, the B-mode parameters associated with higher odds ratios (ORs) for malignant lesions were microcalcifications (OR = 4.3), hypo-echogenicity (OR = 3.13) and irregular margins (OR = 10.82). SWE-max was the only SWE independent parameter in differentiating between malignant and benign tumors (OR = 2.95). The area under the curve for the B-mode model was 0.85, whereas that for the model combining B-mode and SWE parameters was 0.87. There was no significant difference in mean SWE values between patients with and without chronic autoimmune thyroiditis. The results of the present study suggest that SWE is a valuable tool for the characterization of thyroid nodules, with SWE-max being a significant parameter in differentiating benign and malignant lesions, independent of conventional B-mode parameters. The combination of SWE parameters and conventional B-mode parameters does not significantly improve the diagnosis of malignant thyroid nodules. The presence of microcalcifications can influence the SWE-whole value, whereas the presence of chronic autoimmune thyroiditis may not.
Department of Ultrasound, Cancer Center and Institute of Oncology, M. Sklodowska-Curie Memorial, Warsaw, Poland. Electronic address: kdsobczak@gmail.com.
Katarzyna
K
Dobruch-Sobczak
Department of Pathology, Cancer Center and Institute of Oncology, M. Sklodowska-Curie Memorial, Warsaw, Poland.
Elwira Bakuła
EB
Zalewska
Department of Oncological Endocrinology and Nuclear Medicine, Cancer Centre and Institute of Oncology, M. Sklodowska-Curie Memorial, Warsaw, Poland.
Anna
A
Gumińska
Department of Imaging Diagnostics, Medical University of Warsaw, Warsaw, Poland.
Rafał Zenon
RZ
Słapa
Department of Imaging Diagnostics, Medical University of Warsaw, Warsaw, Poland.
Krzysztof
K
Mlosek
Department of Imaging Diagnostics, Medical University of Warsaw, Warsaw, Poland.
Paweł
P
Wareluk
Department of Imaging Diagnostics, Medical University of Warsaw, Warsaw, Poland.
Wiesław
W
Jakubowski
Department of Oncological Endocrinology and Nuclear Medicine, Cancer Centre and Institute of Oncology, M. Sklodowska-Curie Memorial, Warsaw, Poland.
Marek
M
Dedecjus
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
B-Mode ultrasound; Benign; Diagnostic performance; Malignant; Shear wave elastography; Thyroid nodules