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Vol 68, No 6 (2017)
Original paper
Submitted: 2017-03-26
Accepted: 2017-05-23
Published online: 2017-09-18
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The efficiency of elastography in the diagnostics of follicular lesions and nodules with an unequivocal FNA result

Martyna Wojtaszek-Nowicka1, Dorota Słowińska-Klencka1, Stanisław Sporny2, Bożena Popowicz1, Krzysztof Kuzdak3, Lech Pomorski4, Krzysztof Kaczka4, Jan Sopiński3, Mariusz Klencki1
DOI: 10.5603/EP.a2017.0050
·
Pubmed: 29022643
·
Endokrynol Pol 2017;68(6):610-622.
Affiliations
  1. Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Lodz, Poland
  2. Department and Chair of Pathomorphology, Medical University of Lodz, Lodz, Poland
  3. Department of Endocrinological, General and Oncological Surgery, Chair of Endocrinology, Medical University of Lodz, Lodz, Poland
  4. Department of General and Oncological Surgery, Chair of Surgical Clinical Sciences, Medical University, Lodz, Lodz, Poland

open access

Vol 68, No 6 (2017)
Original Paper
Submitted: 2017-03-26
Accepted: 2017-05-23
Published online: 2017-09-18

Abstract

Introduction: The aim was to assess the usefulness of strain elastography (SEG) in the diagnostics of two groups of thyroid nodules (TNs): follicular lesions (FL) with low malignancy risk (< 20.0%) and low percentage of papillary carcinomas (PTCs) among cancers as well as TNs with unequivocal cytology (UC) and high percentage of PTCs among cancers. Material and methods: 168 TNs were analysed and eventually surgically treated: 100 UC (50 benign and 50 malignant — 90.0% PTCs) and 68 FL (60 benign, 8 malignant — 50.0% PTCs). Elasticity score (ES) and strain ratio (SR) were evaluated, and their effectiveness was compared with the evaluation of the number of ultrasound malignancy risk features (NoUMRFs). Results: In the UC group the evaluation of mean values of SR and ES in both sections (meanSR, meanES) was more efficient than NoUMRFs analysis (AUC: 0.903 and 0.869 vs. 0.754, p < 0.05). The following thresholds: meanSR ≥ 2.01, meanES ≥ 2.5, NoUMRFs ≥ 2, were related to the increased malignancy risk in nodules (OR: 45.0; 23.2; 5.4, respectively), but only meanSR ≥ 2.01 was an independent risk factor (OR: 20.3; SEN: 86.0%, SPC: 88.0%). In the FL group, only the evaluation of tSR (SR assessed in transverse section) had the value of AUC > 0.7, and only the set of features: tSR ≥ 1.7 and NoUMRFs ≥ 1 increased the malignancy risk in nodules (OR: 12.0; SEN: 75.0%, SPC: 75.0%). Conclusions: SEG is more reliable than conventional US in the diagnostics of TNs. The efficacy of SEG decreases with lowering percentage of PTCs among cancers. But in FL nodules SEG may support the selection of nodules for surgical treatment.  

Abstract

Introduction: The aim was to assess the usefulness of strain elastography (SEG) in the diagnostics of two groups of thyroid nodules (TNs): follicular lesions (FL) with low malignancy risk (< 20.0%) and low percentage of papillary carcinomas (PTCs) among cancers as well as TNs with unequivocal cytology (UC) and high percentage of PTCs among cancers. Material and methods: 168 TNs were analysed and eventually surgically treated: 100 UC (50 benign and 50 malignant — 90.0% PTCs) and 68 FL (60 benign, 8 malignant — 50.0% PTCs). Elasticity score (ES) and strain ratio (SR) were evaluated, and their effectiveness was compared with the evaluation of the number of ultrasound malignancy risk features (NoUMRFs). Results: In the UC group the evaluation of mean values of SR and ES in both sections (meanSR, meanES) was more efficient than NoUMRFs analysis (AUC: 0.903 and 0.869 vs. 0.754, p < 0.05). The following thresholds: meanSR ≥ 2.01, meanES ≥ 2.5, NoUMRFs ≥ 2, were related to the increased malignancy risk in nodules (OR: 45.0; 23.2; 5.4, respectively), but only meanSR ≥ 2.01 was an independent risk factor (OR: 20.3; SEN: 86.0%, SPC: 88.0%). In the FL group, only the evaluation of tSR (SR assessed in transverse section) had the value of AUC > 0.7, and only the set of features: tSR ≥ 1.7 and NoUMRFs ≥ 1 increased the malignancy risk in nodules (OR: 12.0; SEN: 75.0%, SPC: 75.0%). Conclusions: SEG is more reliable than conventional US in the diagnostics of TNs. The efficacy of SEG decreases with lowering percentage of PTCs among cancers. But in FL nodules SEG may support the selection of nodules for surgical treatment.  

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Keywords

elastography, thyroid, follicular lesion, fine-needle aspiration biopsy, thyroid cancer

About this article
Title

The efficiency of elastography in the diagnostics of follicular lesions and nodules with an unequivocal FNA result

Journal

Endokrynologia Polska

Issue

Vol 68, No 6 (2017)

Article type

Original paper

Pages

610-622

Published online

2017-09-18

Page views

1377

Article views/downloads

1106

DOI

10.5603/EP.a2017.0050

Pubmed

29022643

Bibliographic record

Endokrynol Pol 2017;68(6):610-622.

Keywords

elastography
thyroid
follicular lesion
fine-needle aspiration biopsy
thyroid cancer

Authors

Martyna Wojtaszek-Nowicka
Dorota Słowińska-Klencka
Stanisław Sporny
Bożena Popowicz
Krzysztof Kuzdak
Lech Pomorski
Krzysztof Kaczka
Jan Sopiński
Mariusz Klencki

References (54)
  1. Haugen BR, Alexander EK, Bible KC, 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; 26(1): 1–133.
    CrossRefPubMed
  2. Cibas ES, Ali SZ. The Bethesda System For Reporting Thyroid Cytopathology. Thyroid. 2009; 19: 1159–1165.
    CrossRef
  3. Słowińska-Klencka D, Wojtaszek-Nowicka M, Sporny S, et al. Analysis of clinical significance of equivocal thyroid cytology with a special consideration for FLUS category - five years of new classification of FNA results. Endokrynol Pol. 2016; 67(1): 23–34.
    CrossRefPubMed
  4. Jarząb B, Dedecjus M, Handkiewicz-Junak D, et al. Diagnostyka i leczenie raka tarczycy. Endokrynol Pol. 2016; 67(1): 74–145.
    CrossRef
  5. Bernstein JM, Shah M, MacMillan C, et al. Institution-specific risk of papillary thyroid carcinoma in atypia/follicular lesion of undetermined significance. Head Neck. 2016; 38 Suppl 1: 1210–1215.
    CrossRefPubMed
  6. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009: 195–202.
    CrossRefPubMed
  7. VanderLaan PA, Marqusee E, Krane JF. Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations. Am J Clin Pathol. 2011; 135(5): 770–775.
    CrossRefPubMed
  8. Słowińska-Klencka D, Woźniak E, Wojtaszek M, et al. Low malignancy risk of thyroid follicular lesion of undetermined significance in patients from post-endemic areas. Eur J Endocrinol. 2013; 168(4): 621–630.
    CrossRefPubMed
  9. Theoharis CGA, Schofield KM, Hammers L, et al. The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. Thyroid. 2009; 19(11): 1215–1223.
    CrossRefPubMed
  10. Ho AS, Sarti EE, Jain KS, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid. 2014; 24(5): 832–839.
    CrossRefPubMed
  11. Ferris RL, Baloch Z, Bernet V, et al. American Thyroid Association Statement on Surgical Application of Molecular Profiling for Thyroid Nodules: Current Impact on Perioperative Decision Making. Thyroid. 2015; 25(7): 760–768.
    CrossRefPubMed
  12. Słowińska-Klencka D, Wojtaszek-Nowicka M, Sporny S, et al. The predictive value of sonographic images of follicular lesions - a comparison with nodules unequivocal in FNA - single centre prospective study. BMC Endocr Disord. 2016; 16(1): 69.
    CrossRefPubMed
  13. Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011; 260(3): 892–899.
    CrossRefPubMed
  14. Moon WJ, Jung SoL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008; 247(3): 762–770.
    CrossRefPubMed
  15. Jeh Sk, Jung SoL, Kim BS, et al. Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol. 2007; 8(3): 192–197.
    CrossRefPubMed
  16. Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005; 237(1): 202–211.
    CrossRefPubMed
  17. Azizi G, Keller J, Lewis M, et al. Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid. 2013; 23(6): 734–740.
    CrossRefPubMed
  18. Bojunga J, Herrmann E, Meyer G, et al. Real-time elatrography for the differentiation of benign and malignant nodules: a meta-analysis. Thyroid. 2010; 20(10): 1145–1150.
    CrossRefPubMed
  19. Gietka-Czernel M, Kochman M, Bujalska K, et al. Real-time ultrasound elastography - a new tool for diagnosing thyroid nodules. Endokrynol Pol. 2010; 61(6): 652–657.
    PubMed
  20. Hong Yr, Wu Yl, Luo Zy, et al. Impact of nodular size on the predictive values of gray-scale, color-Doppler ultrasound, and sonoelastography for assessment of thyroid nodules. J Zhejiang Univ Sci B. 2012; 13(9): 707–716.
    CrossRefPubMed
  21. Xing P, Wu L, Zhang C, et al. Differentiation of benign from malignant thyroid lesions: calculation of the strain ratio on thyroid sonoelastography. J Ultrasound Med. 2011; 30(5): 663–669.
    CrossRefPubMed
  22. Szczepanek-Parulska E, Woliński K, Stangierski A, et al. Comparison of diagnostic value of conventional ultrasonography and shear wave elastography in the prediction of thyroid lesions malignancy. PLoS One. 2013; 8(11): e81532.
    CrossRefPubMed
  23. Ruchała M, Szmyt K, Sławek S, et al. Ultrasound sonoelastography in the evaluation of thyroiditis and autoimmune thyroid disease. Endokrynol Pol. 2014; 65(6): 520–526.
    PubMed
  24. Dobruch-Sobczak K, Zalewska EB, Gumińska A, et al. Diagnostic Performance of Shear Wave Elastography Parameters Alone and in Combination with Conventional B-Mode Ultrasound Parameters for the Characterization of Thyroid Nodules: A Prospective, Dual-Center Study. Ultrasound Med Biol. 2016; 42(12): 2803–2811.
    CrossRefPubMed
  25. Bhatia KSS, Rasalkar DP, Lee YP, et al. Cystic change in thyroid nodules: a confounding factor for real-time qualitative thyroid ultrasound elastography. Clin Radiol. 2011; 66(9): 799–807.
    CrossRefPubMed
  26. Moon HJ, Sung JiM, Kim EK, et al. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology. 2012; 262(3): 1002–1013.
    CrossRefPubMed
  27. Unlütürk U, Erdoğan MF, Demir O, et al. Ultrasound elastography is not superior to grayscale ultrasound in predicting malignancy in thyroid nodules. Thyroid. 2012; 22(10): 1031–1038.
    CrossRefPubMed
  28. Migda B, Słapa R, Bierca J, et al. Differentiation of thyroid nodules in multinodular goiter with the application of technical ultrasound advances - initial results. Endokrynol Pol. 2016; 67(2): 157–165.
    CrossRefPubMed
  29. Woliński K, Szczepanek-Parulska E, Stangierski A, et al. How to select nodules for fine-needle aspiration biopsy in multinodular goitre. Role of conventional ultrasonography and shear wave elastography - a preliminary study. Endokrynol Pol. 2014; 65(2): 114–118.
    CrossRefPubMed
  30. Cakir B, Ersoy R, Cuhaci FN, et al. Elastosonographic strain index in thyroid nodules with atypia of undetermined significance. J Endocrinol Invest. 2014; 37(2): 127–133.
    CrossRefPubMed
  31. Rago T, Scutari M, Santini F, et al. Real-time elastosonography: useful tool for refining the presurgical diagnosis in thyroid nodules with indeterminate or nondiagnostic cytology. J Clin Endocrinol Metab. 2010; 95(12): 5274–5280.
    CrossRefPubMed
  32. Cantisani V, Maceroni P, D'Andrea V, et al. Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience. Eur Radiol. 2016; 26(5): 1441–1449.
    CrossRefPubMed
  33. Lippolis PV, Tognini S, Materazzi G, et al. Is elastography actually useful in the presurgical selection of thyroid nodules with indeterminate cytology? J Clin Endocrinol Metab. 2011; 96(11): 1826–1830.
    CrossRefPubMed
  34. Vidal-Casariego A, López-González L, Jiménez-Pérez A, et al. Accuracy of ultrasound elastography in the diagnosis of thyroid cancer in a low-risk population. Clin Endocrinol Diabetes. 2012; 120(10): 635–638.
    CrossRefPubMed
  35. Vorländer C, Wolff J, Saalabian S, et al. Real-time ultrasound elastography--a noninvasive diagnostic procedure for evaluating dominant thyroid nodules. Langenbecks Arch Surg. 2010; 395(7): 865–871.
    CrossRefPubMed
  36. Asteria C, Giovanardi A, Pizzocaro A, et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008; 18(5): 523–531.
    CrossRefPubMed
  37. Perros P, Boelaert K, Colley S, et al. British Thyroid Association. Guidelines for the management of thyroid cancer. Clin Endocrinol. 2014; 81 Suppl 1: 1–122.
    CrossRefPubMed
  38. Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009; 94(5): 1748–1751.
    CrossRefPubMed
  39. Ning CP, Jiang SQ, Zhang T, et al. The value of strain ratio in differential diagnosis of thyroid solid nodules. Eur J Radiol. 2012; 81(2): 286–291.
    CrossRefPubMed
  40. Wang H, Brylka D, Sun LN, et al. Comparison of strain ratio with elastography score system in differentiating malignant from benign thyroid nodules. Clin Imaging. 2013; 37(1): 50–55.
    CrossRefPubMed
  41. Sun J, Cai J, Wang X. Real-time ultrasound elastography for differentiation of benign and malignant thyroid nodules: a meta-analysis. J Ultrasound Med. 2014; 33(3): 495–502.
    CrossRefPubMed
  42. Chong Y, Shin JH, Ko ES, et al. Ultrasonographic elastography of thyroid nodules: Is adding strain ratio to colour mapping better? Clin Radiol. 2013; 68(12): 1241–1246.
    CrossRefPubMed
  43. Mehrotra P, McQueen A, Kolla S, et al. Does elastography reduce the need for thyroid FNAs? Clin Endocrinoly. 2013; 78(6): 942–949.
    CrossRefPubMed
  44. Shuzhen C. Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol. 2012; 81(8): 1806–1811.
    CrossRefPubMed
  45. Wang HL, Zhang S, Xin XJ, et al. Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules. Cancer Biol Med. 2012; 9(2): 124–127.
    CrossRefPubMed
  46. Veer V, Puttagunta S. The role of elastography in evaluating thyroid nodules: a literature review and meta-analysis. Eur Arch Otorhinolaryngol. 2015; 272(8): 1845–1755.
  47. Trimboli P, Treglia G, Sadeghi R, et al. Reliability of real-time elastography to diagnose thyroid nodules previously read at FNAC as indeterminate: a meta-analysis. Endocrine. 2015; 50(2): 335–343.
    CrossRefPubMed
  48. Seong M, Shin JH, Hahn SY. Ultrasound Strain Elastography for Circumscribed Solid Thyroid Nodules without Malignant Features Categorized as Indeterminate by B-Mode Ultrasound. Ultrasound Med Biol. 2016; 42(10): 2383–2390.
    CrossRefPubMed
  49. Shao J, Shen Ye, Lü J, et al. Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules. Clin Endocrinol. 2015; 83(2): 254–260.
    CrossRefPubMed
  50. Trimboli P, Guglielmi R, Monti S, et al. Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab. 2012; 97(12): 4524–4530.
    CrossRefPubMed
  51. Garino F, Deandrea M, Motta M, et al. Diagnostic performance of elastography in cytologically indeterminate thyroid nodules. Endocrine. 2015; 49(1): 175–183.
    CrossRefPubMed
  52. Russ G, Royer B, Bigorgne C, et al. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol. 2013; 168(5): 649–655.
    CrossRefPubMed
  53. Friedrich-Rust M, Vorlaender C, Dietrich CF, et al. Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study. Ultraschall Med. 2016; 37(3): 262–270.
    CrossRefPubMed
  54. Koh J, Moon HJ, Park JS, et al. Variability in Interpretation of Ultrasound Elastography and Gray-Scale Ultrasound in Assessing Thyroid Nodules. Ultrasound Med Biol. 2016; 42(1): 51–59.
    CrossRefPubMed

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