title: Is the reproducibility of shear wave elastography of thyroid nodules high enough for clinical use? A methodological study.
abstract: OBJECTIVE
  To systematically assess the reproducibility of thyroid ultrasonographic shear wave elastography (SWE).
  
  
  BACKGROUND
  SWE has been suggested as a potential tool for thyroid nodule evaluation, but assessment of its reproducibility has been insufficiently addressed.
  
  
  METHODS
  SWE examinations were performed prospectively by two investigators.
  
  
  METHODS
  Seventy-two patients (male/female: 19/53; mean age: 53 ± 14 years; malignant/benign 17/55) undergoing thyroid surgery were enrolled in the study.
  
  
  METHODS
  Repeated and blinded measurements of elasticity index (EI) in predefined regions of interest (ROI) were collected. The inter- and intrarater agreement, along with the day-to-day agreement, was evaluated in terms of the 95% limits of agreement (LOA). Results are presented as a ratio, by which 1·0 indicates perfect agreement.
  
  
  RESULTS
  The interrater, intrarater and day-to-day LOA showed ratios between repeated measurements of 1·7-3·6, 1·8-3·7 and 2·2-2·9, respectively. These values reflect a low to moderate degree of agreement for all EI outcomes. The interrater LOA was higher for malignant nodules compared with benign nodules for six of seven EI outcomes (P < 0·001-0·03). The proportion of agreement calculated from the optimum cutoff point for differentiating malignant from benign nodules was 63-88% for the investigated EI outcomes.
  
  
  CONCLUSIONS
  In this methodological study, EI measured by thyroid SWE seems suboptimal for clinical use, due to a low inter- and intrarater agreement. That EI varies from day to day furthermore jeopardizes the validity of the method. Although the proportion of agreement was acceptable for some EI parameters, it is questionable whether EI assessments can reliably differentiate malignant from benign nodules in the individual patient.
authors.affiliation: Department of Otorhinolaryngology and Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kristine Zøylner
authors.identifier: http://orcid.org/0000-0003-2958-5279
authors.initials: KZ
authors.lastname: Swan
authors.affiliation: Department of Otorhinolaryngology and Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Viveque Egsgaard
authors.initials: VE
authors.lastname: Nielsen
authors.affiliation: Department of Biostatistics, Aarhus University, Aarhus, Denmark.
authors.forename: Bo Martin
authors.initials: BM
authors.lastname: Bibby
authors.affiliation: Department of Endocrinology, Odense University Hospital, Aarhus, Denmark.
authors.forename: Steen Joop
authors.initials: SJ
authors.lastname: Bonnema
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology