title: Does Shear Wave Elastography Provide Additional Value in the Evaluation of Thyroid Nodules That Are Suspicious for Malignancy?
abstract: OBJECTIVE
  We aimed to determine whether the integration of shear wave elastography (SWE) with conventional ultrasonography (US) improves diagnostic performance for suspicious thyroid lesions.
  
  
  METHODS
  For 215 thyroid lesions in 185 patients classified as Thyroid Imaging Reporting and Data System category 4 or 5 according to the findings of conventional US, SWE elasticity indices were automatically calculated. A receiver operating characteristic curve analysis was used to determine the threshold. Thyroid Imaging Reporting and Data System categories were upgraded for high-stiffness nodules and unchanged for low- and normal-stiffness nodules. The diagnostic performances were assessed and compared with histologic findings. Intraobserver and interobserver variability of SWE was assessed.
  
  
  RESULTS
  Elasticity indices were significantly higher in malignant versus benign nodules (P≤ .001). The minimum elasticity index (cutoff, 40.7 kPa) of the stiffest part combined with conventional US showed the highest area under the curve (0.774; 95% confidence interval, 0.682-0.866) but was not superior to conventional US (0.791; 95% confidence interval, 0.706-0.876; P = .48). Combined with the standard deviation of the elasticity index for the whole lesion (cutoff, 6.8 kPa), US yielded the highest sensitivity (95.5%; P < .001) and lowest specificity (42.1%; P < .001). Sensitivity increased and specificity decreased by adding any other SWE elasticity index. The intraobserver and interobserver reliability of SWE was fair to excellent according to the interclass correlation coefficients, with correlation coefficients of 0.765 to 0.846 (all P < .001).
  
  
  CONCLUSIONS
  The SWE elasticity indices of malignant thyroid nodules were significantly high. Adding SWE to conventional US did not improve diagnostic performance.
authors: Department of Ultrasonography, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Fen
authors: F
authors: Wang
authors: Department of Ultrasonography, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Cai
authors: C
authors: Chang
authors: Department of Ultrasonography, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Yi
authors: Y
authors: Gao
authors: Department of Ultrasonography, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Ya Ling
authors: YL
authors: Chen
authors: Department of Ultrasonography, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China mickey7216@hotmail.com.|Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China mickey7216@hotmail.com.
authors: Min
authors: M
authors: Chen
authors: Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.|Department of Pathology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
authors: Li Qing
authors: LQ
authors: Feng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: head and neck ultrasound; shear wave elastography; thyroid nodule; ultrasonography