The utility of ultrasound elastography and MicroPure imaging in the differentiation of benign and malignant thyroid nodules.
ABSTRACT The aim of this study was to evaluate the utility of ultrasound elastography and MicroPure imaging in the differential diagnosis of benign and malignant thyroid nodules.
A total of 74 consecutive patients (65 women and nine men; age range, 21-80 years; mean [± SD] age, 51 ± 12.7 years) with thyroid nodules, who were referred for fine-needle aspiration biopsy by endocrinology or general surgery clinics, were prospectively examined using B-mode ultrasound, ultrasound elastography, and MicroPure imaging. The strain value ratio (strain index) of thyroid nodules was calculated. Patients with malignant or intermediate fine-needle aspiration biopsy results underwent thyroid surgery.
Using MicroPure imaging, 17 of 65 benign thyroid nodules (26.6%) and three of nine malignant thyroid nodules (33.3%) were found to contain microcalcifications. The sensitivity, specificity, negative predictive value, positive predictive value, and the accuracy rate of MicroPure imaging were 42.9%, 80.6%, 93.1%, 18.8%, and 77%, respectively. By using receiver operating characteristic analysis, the best cutoff point (2.31) was computed (area under the curve, 0.87; p < 0.001). The sensitivity, specificity, negative predictive value, positive predictive value and accuracy rate of the strain index values were 85.7%, 82.1%, 98.2%, 33.3%, and 82.4%, respectively, when the best cutoff point of 2.31 was used (p = 0.001). The p value (x = malign) was 0.96 for a strain index value higher than 2.31.
This preliminary study indicated that ultrasound elastography and MicroPure imaging can be used for the differentiation of benign and malignant thyroid nodules.
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ABSTRACT: High-resolution ultrasonography has become mandatory while evaluating patients with thyroid nodules. Although B-mode and Doppler ultrasonography are highly sensitive for diagnosis of thyroid lesions, they lack specificity in differentiating benign from malignant nodules. Ultrasound elastography has proven valuable in discriminating these lesions. This review discusses recent findings regarding the use of elastography as a tool in the evaluation of thyroid masses as well as the different methods and scoring systems used to determine tissue elasticity. There are several methods and scores utilized to evaluate the stiffness of normal tissue and solid thyroid lesions, such as strain elastography, acoustic radiation force impulse, and shear wave elastography. Interpretation of data is usually qualitative and subjective obtained with operator-dependent techniques except for shear wave elastography, in which data acquisition is operator-independent with interpretation quantitative and objective in nature. Various software and scoring systems are applied to produce/interpret data resulting in widely variable sensitivity and specificity in differentiating malignant from benign lesions ranging from 73 to 98% and 71 to 100%, respectively. Although elastography seems promising in identifying malignant thyroid nodules with acceptable accuracy, further studies are necessary to change the current management of thyroid lesions. Consequently, elastography should be used as an additional tool in the work-up of thyroid nodules instead of a single predictor of which lesions should be followed without fine-needle aspiration cytology. Therefore, this exciting methodology, so far, is inadequate to guide the management of thyroid lesions.Current opinion in oncology 01/2013; 25(1):1-5. · 4.09 Impact Factor