Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography

A Preliminary Two-plane View Study

Adriana Gregory, Mahdi Bayat, Viksit Kumar, Max Denis, Bae Hyung Kim, Jeremy Webb, Duane D. Meixner, Mabel Ryder, John M. Knudsen, Shigao D Chen, Mostafa Fatemi, Azra Alizad

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Rationale and Objectives: Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. Materials and Methods: A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5–68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. Results: Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. Conclusions: The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P <.0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.

Original languageEnglish (US)
JournalAcademic Radiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Elasticity Imaging Techniques
Comb and Wattles
Thyroid Nodule
Elasticity
Goiter
Fine Needle Biopsy
Thyroid Gland
Vascular Calcification
ROC Curve
Area Under Curve
Blood Vessels
Technology
Sensitivity and Specificity
Neoplasms

Keywords

  • cancer
  • elastography
  • Shear wave
  • thyroid nodules
  • ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography : A Preliminary Two-plane View Study. / Gregory, Adriana; Bayat, Mahdi; Kumar, Viksit; Denis, Max; Kim, Bae Hyung; Webb, Jeremy; Meixner, Duane D.; Ryder, Mabel; Knudsen, John M.; Chen, Shigao D; Fatemi, Mostafa; Alizad, Azra.

In: Academic Radiology, 01.01.2018.

Research output: Contribution to journalArticle

Gregory, Adriana ; Bayat, Mahdi ; Kumar, Viksit ; Denis, Max ; Kim, Bae Hyung ; Webb, Jeremy ; Meixner, Duane D. ; Ryder, Mabel ; Knudsen, John M. ; Chen, Shigao D ; Fatemi, Mostafa ; Alizad, Azra. / Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography : A Preliminary Two-plane View Study. In: Academic Radiology. 2018.
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abstract = "Rationale and Objectives: Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. Materials and Methods: A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5–68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. Results: Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45{\%}, specificity of 86.61{\%}, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92{\%} and 93{\%}, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. Conclusions: The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P <.0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.",
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AU - Bayat, Mahdi

AU - Kumar, Viksit

AU - Denis, Max

AU - Kim, Bae Hyung

AU - Webb, Jeremy

AU - Meixner, Duane D.

AU - Ryder, Mabel

AU - Knudsen, John M.

AU - Chen, Shigao D

AU - Fatemi, Mostafa

AU - Alizad, Azra

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N2 - Rationale and Objectives: Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. Materials and Methods: A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5–68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. Results: Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. Conclusions: The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P <.0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.

AB - Rationale and Objectives: Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. Materials and Methods: A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5–68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. Results: Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. Conclusions: The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P <.0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.

KW - cancer

KW - elastography

KW - Shear wave

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