Abstract
Objective
Evaluation of the diagnostic efficacy and interobserver agreement of Q-elastography in the differentiation of benign from malignant thyroid nodules.
Methods
A total of 344 thyroid nodules in 288 patients were examined with grey-scale and colour Doppler ultrasound (CDUS) and Q-elastography by two independent operators. Nodules with hypoechogenicity, poorly defined margins, microcalcifications, and intralesional vascularity were classified as suspicious. Diagnostic performances of CDUS features and Q-elastography for predicting thyroid malignancy were estimated using ROC analysis. Cytology or histopathology was the reference standard. Interobserver agreement in the evaluation of CDUS and Q-elastography was assessed using Cohen's k-statistic.
Results
Q-elastography showed excellent diagnostic performance for the prediction of thyroid malignancy, with sensitivity of 93 % and specificity of 92 % for operator 1 (best cutoff at 2.02), and sensitivity of 84 % and specificity of 79 % for operator 2 (best cutoff at 1.86). Performance of Q-elastography was superior to that of CDUS. Reproducibility of the findings was excellent for both Q-elastography and CDUS features as assessed with Cohen's k, which was highest for strain ratio measurements (0.95) and lowest for the echogenicity score (0.83).
Conclusions
Q-elastography showed excellent performance. It is a valid and reproducible diagnostic method as well as a promising tool for identifying suspicious solid thyroid nodules needing cytological assessment and surgery.
Key Points
• Elastography is an additional tool for optimal characterisation of malignant thyroid nodules.
• The use of semiquantitative elastographic evaluation increases the diagnostic performance,
• The interobserver agreement of quantitative elastography can be considered to be good.
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References
Wiest PW, Hartshorne MF, Inskip PD et al (1998) Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. J Ultrasound Med 17:487–496
Tomimori E, Pedrinola F, Cavaliere H, Knobel M, Medeiros-Neto G (1995) Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid 5:273–276
Brander A, Viikinkoski P, Nickels J, Kivisaari L (1991) Thyroid gland: US screening in a random adult population. Radiology 181:683–687
Tumbridge WM, Evered DC, Hall R et al (1997) The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf) 7:481–93
Fish SA, Langer JE, Mandel SJ (2008) Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin N Am 37:401–17
Cappelli C, Castellano M, Pirola I et al (2007) The predictive value of ultrasound findings in the management of thyroid nodules. QJM 100:29–35
Hoang JK, Lee WK, Lee M, Johnson D, Farrell S (2007) US features of thyroid malignancy: pearls and pitfalls. Radiographics 27:847–860
Kim MJ, Kim EK, Park SI et al (2008) US-guided fine-needle aspiration of thyroid nodules: indications, techniques, results. Radiographics 28:1869–86
Gharib H, Papini E, Valcavi R, AACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi et al (2006) Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102
Cai XJ, Valiyaparambath N, Nixon P, Waghorn A, Giles T, Helliwell T (2006) Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules. Cytopathology 17:251–256
Garra BS (2011) Elastography: current status, future prospects, and making it work for you. Ultrasound Q 27:177–86
Lyshchik A, Higashi T, Asato R et al (2005) Thyroid gland tumor diagnosis at US elastography. Radiology 237:202–211
Lyshchik A, Higashi T, Asato R et al (2007) Cervical lymph node metastases: diagnosis at sonoelastography – initial experience. Radiology 243:258–67
Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–50
Dighe M, Unmin B, Richardson ML et al (2008) Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology 248:662–669
Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z (2009) Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med 28:861–867
Luo S, Kim EH, Dighe M, Kim Y (2011) Thyroid nodule classification using ultrasound elastography via linear discriminant analysis. Ultrasonics 51:425–431
Rago T, Santini F, Scutari M, Pinchera A, Vitti P (2007) Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 92:2917–2922
Friedrich-Rust M, Sperber A, Holzer L et al (2010) Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes 118:602–9
Asteria C, Giovanardi A, Pizzocaro A et al (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18:523–531
Rubaltelli L, Corradin S, Dorigo A et al (2008) Differential diagnosis of benign and malignant thyroid nodules at elastography. Ultraschall Med 30:175–179
Tranquart F, Bleuzen A, Pierre-Renoult P, Chabrolle C, Sam GM, Lecomte P (2008) Elastography of thyroid lesions. J Radiol 89:35–39
Dighe M, Bae U, Richardson ML, Dubinsky TJ, Minoshima S, Kim Y (2008) Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology 248:662–669
Cantisani V, D'Andrea V, Biancari F et al (2012) Prospective evaluation of multiparametric ultrasound and quantitative elastography in the differential diagnosis of benign and malignant thyroid nodules: Preliminary experience. Eur J Radiol 81:2678–83
Cantisani V, Ulisse S, Guaitoli E, De Vito C, Caruso R et al (2012) Q-Elastography in the presurgical diagnosis of thyroid nodules with indeterminate cytology. PLoS ONE 7:e50725
Park SH, Kim SJ, Kim EK, Kim MJ, Son EJ, Kwak JY (2009) Interobserver agreement in assessing the sonographic and elastographic features of malignant thyroid nodules. AJR Am J Roentgenol 193:W416–23
Cooper D, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 1911:1167–214
Landis J, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Fleiss JL (1986) The design and analysis of clinical experiments. Wiley, New York, pp 1–32
Bojunga J, Herrmann E, Meyer G et al (2010) Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 20:1145–1150
Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY (2012) Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 262:1002–13
Merino S, Arrazola J, Càrdenas A et al (2011) Utility and interobserver agreement of ultrasound elastography in the detection of malignant thyroid nodules in clinical care. Am J of Neuroradiol 32:2142–2148
Ragazzoni F, Deandrea M, Mormile A et al (2012) High diagnostic accuracy and interobserver reliability of real-time elastography in the evaluation of thyroid nodules. Ultrasound Med Biol 38:1154–1162
Lim DJ, Luo S, Kim MH, Ko SH, Kim Y (2012) Interobserver agreement and intraobserver reproducibility in thyroid ultrasound elastography. Am J Roentgenol 198:896–901
Acknowledgements
The authors would like to thank Dr. Corrado De Vito for his evaluable contribution to the statistical elaboration of our results.
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Cantisani, V., Grazhdani, H., Ricci, P. et al. Q-Elastosonography of Solid Thyroid Nodules: Assessment of Diagnostic Efficacy and Interobserver Variability in a Large Patient Cohort. Eur Radiol 24, 143–150 (2014). https://doi.org/10.1007/s00330-013-2991-y
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DOI: https://doi.org/10.1007/s00330-013-2991-y