Clin Exp Otorhinolaryngol.  2020 May;13(2):186-193. 10.21053/ceo.2019.01235.

Diagnostic Performance of a Combination of Shear Wave Elastography and B-Mode Ultrasonography in Differentiating Benign From Malignant Thyroid Nodules

• Yeon EK
• Sohn YM
• Seo M
• Kim EJ
• Eun YG
• Park WS
• Yun SJ

• KMID: 2500292
• DOI: http://doi.org/10.21053/ceo.2019.01235

Abstract

Objectives
. This study was conducted to compare clinicopathologic and radiologic factors between benign and malignant thyroid nodules and to evaluate the diagnostic performance of shear wave elastography (SWE) combined with B-mode ultrasonography (US) in differentiating malignant from benign thyroid nodules.
Methods
. This retrospective study included 92 consecutive patients with 95 thyroid nodules examined on B-mode US and SWE before US-guided fine-needle aspiration biopsy or surgical excision. B-mode US findings (composition, echogenicity, margin, shape, and calcification) and SWE elasticity parameters (maximum [Emax], mean, minimum, and nodule-to-normal parenchymal ratio of elasticity) were reviewed and compared between benign and malignant thyroid nodules. The diagnostic performance of B-mode US and SWE for predicting malignant thyroid nodules was analyzed. The optimal cutoff values of elasticity parameters for identifying malignancy were determined. Diagnostic performance was compared between B-mode US only, SWE only, and the combination of B-mode US with SWE.
Results
. On multivariate logistic regression analysis, age (odds ratio [OR], 0.90; P=0.028), a taller-than-wide shape (OR, 11.3; P=0.040), the presence of calcifications (OR, 15.0; P=0.021), and Emax (OR, 1.22; P=0.021) were independent predictors of malignancy in thyroid nodules. The combined use of B-mode US findings and SWE yielded improvements in sensitivity, the positive predictive value, the negative predictive value, and accuracy compared with the use of B-mode US findings only, but with no statistical significance.
Conclusion
. When SWE was combined with B-mode US, the diagnostic performance was better than when only B-mode US was used, although the difference was not statistically significant.

Keyword

Shear Wave Elastography; Diagnostic Performance; Clinicopathologic and Radiologic Factors; Thyroid; Ultrasound

Figure

• 

  Fig. 1. A 53-year-old woman with surgically proven papillary thyroid carcinoma. B-mode ultrasound showed hypoechoic mass with irregular margin and microcalcifications which was assessed as a high suspicion. Shear wave elastography (SWE) displayed heterogenous color elasticity signal with peripheral high SWE (red). Measured elasticity parameters of Emean of 78.0 kPa, Emax of 82.7 kPa and Emin of 56.8 kPa were obtained.

• 

  Fig. 2. A 36-year-old man with surgically proven papillary thyroid carcinoma. B-mode ultrasound showed mixed echoic mass with well-defined margin and oval shape which was assessed as an intermediate suspicion. Shear wave elastography (SWE) displayed relatively heterogenous color elasticity signal. Measured elasticity parameters of Emean of 40.0 kPa, Emax of 54.7 kPa and Emin of 10.3 kPa were obtained.

• 

  Fig. 3. A 57-year-old woman with surgically proven nodular hyperplasia. B-mode ultrasound showed isoechoic mass with well-defined margin and oval shape which was assessed as a low suspicion. Shear wave elastography (SWE) displayed relatively homogenous color elasticity signal. Measured elasticity parameters of Emean of 39.8 kPa, Emax of 68.4 kPa and Emin of 11.0 kPa were obtained.

Reference

1. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002; Mar. 178(3):687–91.

2. Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, et al. A multicenter prospective validation study for the Korean thyroid imaging reporting and data system in patients with thyroid nodules. Korean J Radiol. 2016; Sep-Oct. 17(5):811–21.

3. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US Features of thyroid malignancy: pearls and pitfalls. Radiographics. 2007; May-Jun. 27(3):847–60.

4. Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med. 2004; Nov. 23(11):1455–64.

5. Alexander EK. Approach to the patient with a cytologically indeterminate thyroid nodule. J Clin Endocrinol Metab. 2008; Nov. 93(11):4175–82.

6. Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract. 2003; Mar-Apr. 9(2):128–36.

7. Cosgrove D, Barr R, Bojunga J, Cantisani V, Chammas MC, Dighe M, et al. WFUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 4: thyroid. Ultrasound Med Biol. 2017; Jan. 43(1):4–26.

8. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991; Apr. 13(2):111–34.

9. Nell S, Kist JW, Debray TP, de Keizer B, van Oostenbrugge TJ, Borel Rinkes IH, et al. Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules: a systematic review and meta-analysis. Eur J Radiol. 2015; Apr. 84(4):652–61.

10. Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F, et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008; May. 18(5):523–31.

11. Monpeyssen H, Tramalloni J, Poiree S, Helenon O, Correas JM. Elastography of the thyroid. Diagn Interv Imaging. 2013; May. 94(5):535–44.

12. Tanter M, Bercoff J, Athanasiou A, Deffieux T, Gennisson JL, Montaldo G, et al. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol. 2008; Sep. 34(9):1373–86.

13. Athanasiou A, Tardivon A, Tanter M, Sigal-Zafrani B, Bercoff J, Deffieux T, et al. Breast lesions: quantitative elastography with supersonic shear imaging--preliminary results. Radiology. 2010; Jul. 256(1):297–303.

14. Liu BX, Xie XY, Liang JY, Zheng YL, Huang GL, Zhou LY, et al. Shear wave elastography versus real-time elastography on evaluation thyroid nodules: a preliminary study. Eur J Radiol. 2014; Jul. 83(7):1135–43.

15. Cantisani V, D’Andrea V, Biancari F, Medvedyeva O, Di Segni M, Olive M, et al. Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur J Radiol. 2012; Oct. 81(10):2678–83.

16. Shuzhen C. Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol. 2012; Aug. 81(8):1806–11.

17. Colakoglu B, Yildirim D, Alis D, Ucar G, Samanci C, Ustabasioglu FE, et al. Elastography in distinguishing benign from malignant thyroid nodules. J Clin Imaging Sci. 2016; Dec. 6:51.

18. Park AY, Son EJ, Han K, Youk JH, Kim JA, Park CS. Shear wave elastography of thyroid nodules for the prediction of malignancy in a large scale study. Eur J Radiol. 2015; Mar. 84(3):407–12.

19. Veyrieres JB, Albarel F, Lombard JV, Berbis J, Sebag F, Oliver C, et al. A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: a reality. Eur J Radiol. 2012; Dec. 81(12):3965–72.

20. Chen M, Zhang KQ, Xu YF, Zhang SM, Cao Y, Sun WQ. Shear wave elastography and contrast-enhanced ultrasonography in the diagnosis of thyroid malignant nodules. Mol Clin Oncol. 2016; Dec. 5(6):724–30.

21. Liu Z, Jing H, Han X, Shao H, Sun YX, Wang QC, et al. Shear wave elastography combined with the thyroid imaging reporting and data system for malignancy risk stratification in thyroid nodules. Oncotarget. 2017; Jun. 8(26):43406–16.

22. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; Jan. 26(1):1–133.

23. Azizi G, Keller JM, Mayo ML, Piper K, Puett D, Earp KM, et al. Thyroid nodules and shear wave elastography: a new tool in thyroid cancer detection. Ultrasound Med Biol. 2015; Nov. 41(11):2855–65.

24. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011; Sep. 260(3):892–9.

25. Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, et al. Thyroid imaging reporting and data system risk stratification of thyroid nodules: categorization based on solidity and echogenicity. Thyroid. 2016; Apr. 26(4):562–72.

26. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 2016; May-Jun. 17(3):370–95.

27. Wang D, He YP, Zhang YF, Liu BJ, Zhao CK, Fu HJ, et al. The diagnostic performance of shear wave speed (SWS) imaging for thyroid nodules with elasticity modulus and SWS measurement. Oncotarget. 2017; Feb. 8(8):13387–99.

28. Bhatia KS, Tong CS, Cho CC, Yuen EH, Lee YY, Ahuja AT. Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. Eur Radiol. 2012; Nov. 22(11):2397–406.