Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, China.
Clin Endocrinol (Oxf). 2019 Jul;91(1):201-208. doi: 10.1111/cen.13992. Epub 2019 May 2.
To evaluate the value of shear wave elastography (SWE) in avoiding repeat fine-needle aspiration of thyroid nodules with nondiagnostic and undetermined cytology.
A total of 232 thyroid nodules with nondiagnostic (n = 132) and undetermined (n = 100) cytology underwent ultrasound (US) and SWE, followed by repeat ultrasound (US)-guided fine-needle aspiration cytology (FNAC). The final diagnosis was based on cytological or pathological findings. The US and SWE characteristics of benign and malignant nodules were compared using the χ -test. The receiver operating characteristic (ROC) curves of the thyroid imaging reporting and data system (TI-RADS) categories from the US and the E and E from the SWE were graphed, and the areas under the curves (AUCs) were compared using a Z test.
There were significant differences between the benign and malignant nodules in terms of the echogenicity, shape, margin, calcification and TI-RADS categories (all P < 0.05). The differences were significant between the malignant and benign nodules for E [(34.57 ± 14.81) kPa vs. (19.18 ± 7.09) kPa] and E [(13.68 ± 13.01) kPa vs. (3.97 ± 2.58) kPa] (both P < 0.001). Though the difference in the AUCs of E (0.864) and E (0.876) was not significant (P = 0.745), they both had higher diagnostic performances in comparison with TI-RADS categories (0.762) (all P < 0.05). Moreover, E attained a sensitivity of 100% with a relatively higher specificity of 49.75% when its cut-off value was 3.3 kPa.
Shear wave elastography is a promising imaging method for reducing repeat FNAC for benign thyroid nodules with nondiagnostic and undetermined cytology when using E as an index.
评估剪切波弹性成像（SWE）在避免对非诊断性和不确定细胞学的甲状腺结节进行重复细针抽吸的价值。
232 个甲状腺结节行超声（US）和 SWE 检查，细胞学结果为非诊断性（n=132）和不确定（n=100），随后行超声引导下细针抽吸细胞学检查（FNAC）。最终诊断基于细胞学或病理学结果。采用卡方检验比较良恶性结节的 US 和 SWE 特征。绘制甲状腺影像报告和数据系统（TI-RADS）类别和 SWE 的 E 和 E 的受试者工作特征（ROC）曲线，并采用 Z 检验比较曲线下面积（AUC）。
良性和恶性结节在回声、形状、边界、钙化和 TI-RADS 类别方面存在显著差异（均 P<0.05）。E[（34.57±14.81）kPa 比（19.18±7.09）kPa]和 E[（13.68±13.01）kPa 比（3.97±2.58）kPa]在恶性和良性结节之间的差异有统计学意义（均 P<0.001）。E 的 AUC（0.864）和 E 的 AUC（0.876）的差异无统计学意义（P=0.745），但与 TI-RADS 类别（0.762）相比，它们均具有更高的诊断效能（均 P<0.05）。此外，当 E 的截断值为 3.3kPa 时，其具有 100%的敏感性和相对较高的 49.75%的特异性。
当以 E 为指标时，剪切波弹性成像可能是一种有前途的成像方法，可减少对非诊断性和不确定细胞学的甲状腺良性结节的重复 FNAC。
