Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization

Vito Cantisani; Emanuele David; Hektor Grazhdani; Antonello Rubini; Maija Radzina; Christoph F. Dietrich; Cosimo Durante; Livia Lamartina; Giorgio Grani; Ascoli Valeria; Daniela Bosco; Cira Di Gioia; Fabrizio Maria Frattaroli; Vito D'Andrea; Corrado De Vito; Daniele Fresilli; Ferdinando D'Ambrosio; Laura Giacomelli; Carlo Catalano

doi:10.1055/a-0853-1821

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2019; 40(04): 495-503
DOI: 10.1055/a-0853-1821

Original Article

Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization

Prospektive Evaluierung der semiquantitativen Kompressionselastografie und der quantitativen 2D-Scherwellenultraschallelastografie (SWE) in Verbindung mit der TIRADS-Klassifikation zur Charakterisierung von Schilddrüsenknoten

Vito Cantisani

¹Department of Radiology, Sapienza-University of Rome, Rome, Italy

,

Emanuele David

²Radiology Unit, Papardo-Hospital, Messina, Italy

,

Hektor Grazhdani

³Poliambulatorio Roma Eur, Associazione dei Cavalieri Italiani Sovrano Militare Ordine di Malta, Rome, Italy

,

Antonello Rubini

¹Department of Radiology, Sapienza-University of Rome, Rome, Italy

,

Maija Radzina

⁴Diagnostic Radiology Institute, P. Stradina Clinical University-Hospital, Riga, Latvia

,

Christoph F. Dietrich

⁵Innere Medizin 2, Caritas-Krankenhaus, Bad Mergentheim, Germany

,

Cosimo Durante

⁶Department of Internal Medicine and Medical Specialities, Sapienza-University of Rome, Rome, Italy

,

Livia Lamartina

⁶Department of Internal Medicine and Medical Specialities, Sapienza-University of Rome, Rome, Italy

,

Giorgio Grani

⁶Department of Internal Medicine and Medical Specialities, Sapienza-University of Rome, Rome, Italy

,

Ascoli Valeria

⁷Department of Pathological Anatomy and Cytodiagnostic, Sapienza-University of Rome, Rome, Italy

,

Daniela Bosco

⁷Department of Pathological Anatomy and Cytodiagnostic, Sapienza-University of Rome, Rome, Italy

,

Cira Di Gioia

⁷Department of Pathological Anatomy and Cytodiagnostic, Sapienza-University of Rome, Rome, Italy

,

Fabrizio Maria Frattaroli

⁸Department of Surgical Sciences, Sapienza-University of Rome, Rome, Italy

,

Vito D'Andrea

⁸Department of Surgical Sciences, Sapienza-University of Rome, Rome, Italy

,

Corrado De Vito

⁹Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy

,

Daniele Fresilli

¹⁰University Sapienza, Department of Radiological Sciences, Rome, Italy

,

Ferdinando D'Ambrosio

¹Department of Radiology, Sapienza-University of Rome, Rome, Italy

,

Laura Giacomelli

⁸Department of Surgical Sciences, Sapienza-University of Rome, Rome, Italy

,

Carlo Catalano

¹Department of Radiology, Sapienza-University of Rome, Rome, Italy

› Author Affiliations

Abstract

Purpose To evaluate the diagnostic performance of strain ratio elastography (SRE) and shear wave elastography (SWE) alone and in combination with Thyroid Imaging Reporting and Data System (TIRADS) classification parameters to improve differentiation between benign and malignant thyroid nodules.

Materials and Methods In this prospective study benign (n = 191) and malignant (n = 52) thyroid nodules were examined with high-resolution ultrasound (US) features using the TIRADS lexicon and SRE semiquantitative and SWE quantitative findings using histology or cytology as the gold standard with a 12-month follow-up. Sensitivity (Se), specificity (Sp) and the area under the ROC curve (AUROC) were used to evaluate the diagnostic performance of each feature and combinations of the methods.

Results TIRADS score showed a sensitivity of 59.6 %, a specificity of 83.8 % with an AUROC of 0.717, a PPV of 50.0 % and an NPV of 88.4 %. SRE yielded the highest performance with a sensitivity of 82.7 %, a specificity of 92.7 % with AUROC of 0.877, a PPV 75.4 % and an NPV of 95.2 %. SWE (kPa) had a sensitivity and specificity of 67.3 % and 82.7 %, respectively, with an AUROC of 0.750, a PPV of 51.5 % and an NPV of 90.3 %. Differences were significant for SRE only but not for SWE.

Conclusion Ultrasound elastography may improve thyroid nodule discrimination. In particular, SRE has a better performance than TIRADS classification, while their combination improves sensitivity.

Zusammenfassung

Ziel der Studie Die Studie erfolgte, um die diagnostische Genauigkeit der Kompressionselastografie (SRE) und Scherwellenelastografie (SWE) einzeln und in Kombination mit der Thyroid-Imaging-Reporting-and-Data-System (TIRADS)-Klassifikation zu untersuchen, um eine verbesserte Differenzierung von benignen und malignen Schilddrüsenknoten zu ermöglichen.

Patienten und Methoden In dieser prospektiven Studie wurden gutartige (n = 191) und bösartige (n = 52) Schilddrüsenknoten mittels Ultraschall, SRE und SWE untersucht und die Daten mit der TIRADS-Klassifikation verglichen. Gutartige Läsionen wurden 12 Monate nachbeobachtet. Sensitivität (Se), Spezifität (Sp) und der Bereich unter der ROC-Kurve (Area-under-the-ROC-Curve – AUROC) sowie der positive prädiktive (PPV) und der negative prädiktive Wert (NPV) wurden berechnet, um die diagnostische Genauigkeit der einzelnen und kombinierten Methoden zu vergleichen.

Ergebnisse Der TIRADS-Score zeigte eine Se von 59,6 % und eine Sp von 83,8 % mit einer AUROC von 0,717. Der PPV lag bei 50,0 % und der NPV bei 88,4 %. SRE (in Klammern SWE (kPa)) erreichte die höchste Genauigkeit mit einer Se von 82,7 % (67,3 %) und einer Sp von 92,7 % (82,7 %); die AUROC lag bei 0,877 (0,750). Die Unterschiede zwischen SRE und SWE waren statistisch signifikant (p < 0,05).

Schlussfolgerung Die Ultraschallelastografie kann eine verbesserte Differenzierung von Schilddrüsenknoten ermöglichen. Insbesondere zeigt SRE bessere Ergebnisse als TIRADS, während die kombinierte Anwendung die Sensitivität verbessert.

Key words

thyroid nodule characterization - TIRADS - elastography

Full Text

References

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