Wang Fen, Chang Cai, Gao Yi, Chen Ya Ling, Chen Min, Feng Li Qing
Department of Ultrasonography, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China.
J Ultrasound Med. 2016 Nov;35(11):2397-2404. doi: 10.7863/ultra.15.09009. Epub 2016 Oct 25.
We aimed to determine whether the integration of shear wave elastography (SWE) with conventional ultrasonography (US) improves diagnostic performance for suspicious thyroid lesions.
For 215 thyroid lesions in 185 patients classified as Thyroid Imaging Reporting and Data System category 4 or 5 according to the findings of conventional US, SWE elasticity indices were automatically calculated. A receiver operating characteristic curve analysis was used to determine the threshold. Thyroid Imaging Reporting and Data System categories were upgraded for high-stiffness nodules and unchanged for low- and normal-stiffness nodules. The diagnostic performances were assessed and compared with histologic findings. Intraobserver and interobserver variability of SWE was assessed.
Elasticity indices were significantly higher in malignant versus benign nodules (P≤ .001). The minimum elasticity index (cutoff, 40.7 kPa) of the stiffest part combined with conventional US showed the highest area under the curve (0.774; 95% confidence interval, 0.682-0.866) but was not superior to conventional US (0.791; 95% confidence interval, 0.706-0.876; P = .48). Combined with the standard deviation of the elasticity index for the whole lesion (cutoff, 6.8 kPa), US yielded the highest sensitivity (95.5%; P < .001) and lowest specificity (42.1%; P < .001). Sensitivity increased and specificity decreased by adding any other SWE elasticity index. The intraobserver and interobserver reliability of SWE was fair to excellent according to the interclass correlation coefficients, with correlation coefficients of 0.765 to 0.846 (all P < .001).
The SWE elasticity indices of malignant thyroid nodules were significantly high. Adding SWE to conventional US did not improve diagnostic performance.
我们旨在确定剪切波弹性成像（SWE）与传统超声（US）相结合是否能提高可疑甲状腺病变的诊断性能。
根据传统超声检查结果，对185例患者的215个甲状腺病变进行分类，分为甲状腺影像报告和数据系统（TI-RADS）4类或5类，自动计算SWE弹性指数。采用受试者操作特征曲线分析确定阈值。高硬度结节的TI-RADS分类升级，低硬度和正常硬度结节的分类不变。评估诊断性能并与组织学结果进行比较。评估SWE的观察者内和观察者间变异性。
恶性结节的弹性指数显著高于良性结节（P≤.001）。结合传统超声，最硬部分的最小弹性指数（截断值，40.7 kPa）显示曲线下面积最高（0.774；95%置信区间，0.682 - 0.866），但不优于传统超声（0.791；95%置信区间，0.706 - 0.876；P =.48）。结合整个病变弹性指数的标准差（截断值，6.8 kPa），超声具有最高的敏感性（95.5%；P <.001）和最低的特异性（42.1%；P <.001）。添加任何其他SWE弹性指数后，敏感性增加而特异性降低。根据组内相关系数，SWE的观察者内和观察者间可靠性为中等至优秀，相关系数为0.765至0.846（所有P <.001）。
恶性甲状腺结节的SWE弹性指数显著升高。在传统超声中添加SWE并未提高诊断性能。
