Zhang Yi-Feng, Xu Jun-Mei, Xu Hui-Xiong, Liu Chang, Bo Xiao-Wan, Li Xiao-Long, Guo Le-Hang, Liu Bo-Ji, Liu Lin-Na, Xu Xiao-Hong
From the Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China (Y-FZ, J-MX, H-XX, CL, X-WB, X-LL, L-HG, B-JL, L-NL); Thyroid Institute, Tongji University School of Medicine, Shanghai, China (Y-FZ, J-MX, H-XX, CL, X-WB, X-LL, L-HG, B-JL, L-NL); and Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China (H-XX, X-HX).
Medicine (Baltimore). 2015 Oct;94(42):e1834. doi: 10.1097/MD.0000000000001834.
To investigate the diagnostic performance of combined use of conventional ultrasound (US) and elastography, including conventional strain elastography such as elasticity imaging (EI) and acoustic radiation force impulse (ARFI) elastography, and to evaluate their usefulness in recommending fine-needle aspiration (FNA).A total of 556 pathologically proven thyroid nodules were evaluated by US, EI, and ARFI examinations in this study. Three blinded readers scored the likelihood of malignancy for 4 datasets (ie, US alone, US and EI, US and virtual touch tissue imaging [VTI], and US and virtual touch tissue quantification [VTQ]). The diagnostic performances of 4 datasets in differentiating malignant from benign thyroid nodules were evaluated. The decision-making changes for FNA recommendation in the indeterminate nodules or the probably benign nodules on conventional US were evaluated after review of elastography.The diagnostic performance in terms of area under the ROC curve did not show any change after adding EI, VTI, or VTQ for analysis; and no differences were found among different readers; however, the specificity and positive predictive value (PPV) improved significantly after adding VTI or VTQ for analysis in the senior reader. For the indeterminate nodules on US that were pathologically benign, VTQ made correct decision-making changes from FNA biopsy to follow-up in a mean of 82.6% nodules, which was significantly higher than those achieved by EI (46.8%) and VTI (54.4%) (both P < 0.05). With regard to the probably benign nodules on US that were pathologically malignant, EI made the highest correct decision-making change from follow-up to FNA biopsy in a mean of 62.6% nodules (compared with 41.5% on VTQ, P < 0.05).The results indicated that ARFI increases the specificity and PPV in diagnosing thyroid nodules. US combined VTQ might be helpful in reducing unnecessary FNA for indeterminate nodules on US whereas US combined EI is useful to detect the false negative nodules that are probably benign on conventional US.
探讨联合应用传统超声（US）与弹性成像技术（包括弹性成像[EI]和声学辐射力脉冲[ARFI]弹性成像等传统应变弹性成像）的诊断性能，并评估其在推荐细针穿刺抽吸活检（FNA）中的作用。本研究共对556个经病理证实的甲状腺结节进行了US、EI和ARFI检查。三位盲法阅片者对4组数据（即单纯US、US与EI、US与虚拟触诊组织成像[VTI]、US与虚拟触诊组织定量[VTQ]）的恶性可能性进行评分。评估4组数据在鉴别甲状腺恶性与良性结节方面的诊断性能。在回顾弹性成像后，评估对传统US检查中不确定结节或可能为良性结节的FNA推荐决策变化。在分析中加入EI、VTI或VTQ后，ROC曲线下面积的诊断性能未显示任何变化；不同阅片者之间也未发现差异；然而，在资深阅片者中加入VTI或VTQ进行分析后，特异性和阳性预测值（PPV）显著提高。对于US检查中病理为良性的不确定结节，VTQ使从FNA活检到随访的正确决策变化平均达82.6%的结节，显著高于EI（46.8%）和VTI（54.4%）（均P<0.05）。对于US检查中病理为恶性的可能良性结节，EI使从随访到FNA活检的正确决策变化最高，平均达62.6%的结节（与VTQ的41.5%相比，P<0.05）。结果表明，ARFI在诊断甲状腺结节时可提高特异性和PPV。US联合VTQ可能有助于减少对US检查中不确定结节的不必要FNA，而US联合EI有助于检测传统US检查中可能为良性的假阴性结节。
