Vito Cantisani1, Piero Maceroni2, Vito D'Andrea3, Gregorio Patrizi3, Mattia Di Segni4, Corrado De Vito5, Hektor Grazhdani4, Andrea M Isidori6, Elisa Giannetta6, Adriano Redler3, Fabrizio Frattaroli3, Laura Giacomelli3, Giorgio Di Rocco3, Carlo Catalano4, Ferdinando D'Ambrosio4. 1. Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy. vito.cantisani@uniroma1.it. 2. Department of Diagnostic Imaging for Surgery, Orthopaedics and Traumatology, "Sapienza" University of Rome, Rome, Italy. 3. Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy. 4. Department of Radiology, Anatomical Pathology and Oncology, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy. 5. Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. 6. Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.
Abstract
OBJECTIVES: To assess whether ultrasound elastography (USE) with strain ratio increases diagnostic accuracy of Doppler ultrasound in further characterisation of cytologically Thy3 thyroid nodules. METHODS: In two different university diagnostic centres, 315 patients with indeterminate cytology (Thy3) in thyroid nodules aspirates were prospectively evaluated with Doppler ultrasound and strain ratio USE before surgery. Ultrasonographic features were analysed separately and together as ultrasound score, to assess sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Receiver operating characteristic (ROC) curves to identify optimal cut-off value of the strain ratio were also provided. Diagnosis on a surgical specimen was considered the standard of reference. RESULTS: Higher strain ratio values were found in malignant nodules, with an optimum strain ratio cut-off of 2.09 at ROC analysis. USE with strain ratio showed 90.6% sensitivity, 93% specificity, 82.8% PPV, 96.4% NPV, while US score yielded a sensitivity of 52.9%, specificity of 84.3%, PPV 55.6% and NPV 82.9%. The diagnostic gain with strain ratio was statistically significant as proved by ROC areas, which was 0.9182 for strain ratio and 0.6864 for US score. CONCLUSIONS: USE with strain ratio should be considered a useful additional tool to colour-Doppler US, since it improves characterisation of thyroid nodules with indeterminate cytology. KEY POINTS: • Strain ratio measurements improve differentiation of thyroid nodules with indeterminate cytology • Elastography with strain ratio is more reliable than ultrasound features and ultrasound score • Strain ratio may help to better select patients with Thy 3 nodules candidate for surgery.
OBJECTIVES: To assess whether ultrasound elastography (USE) with strain ratio increases diagnostic accuracy of Doppler ultrasound in further characterisation of cytologically Thy3 thyroid nodules. METHODS: In two different university diagnostic centres, 315 patients with indeterminate cytology (Thy3) in thyroid nodules aspirates were prospectively evaluated with Doppler ultrasound and strain ratio USE before surgery. Ultrasonographic features were analysed separately and together as ultrasound score, to assess sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Receiver operating characteristic (ROC) curves to identify optimal cut-off value of the strain ratio were also provided. Diagnosis on a surgical specimen was considered the standard of reference. RESULTS: Higher strain ratio values were found in malignant nodules, with an optimum strain ratio cut-off of 2.09 at ROC analysis. USE with strain ratio showed 90.6% sensitivity, 93% specificity, 82.8% PPV, 96.4% NPV, while US score yielded a sensitivity of 52.9%, specificity of 84.3%, PPV 55.6% and NPV 82.9%. The diagnostic gain with strain ratio was statistically significant as proved by ROC areas, which was 0.9182 for strain ratio and 0.6864 for US score. CONCLUSIONS: USE with strain ratio should be considered a useful additional tool to colour-Doppler US, since it improves characterisation of thyroid nodules with indeterminate cytology. KEY POINTS: • Strain ratio measurements improve differentiation of thyroid nodules with indeterminate cytology • Elastography with strain ratio is more reliable than ultrasound features and ultrasound score • Strain ratio may help to better select patients with Thy 3 nodules candidate for surgery.
Authors: Harley De Nicola; Jacob Szejnfeld; Angela Flávia Logullo; Angela Maria Borri Wolosker; Luis Ronan Marquez F Souza; Valcir Chiferi Journal: J Ultrasound Med Date: 2005-07 Impact factor: 2.153
Authors: Christoph F Dietrich; Richard G Barr; André Farrokh; Manjiri Dighe; Michael Hocke; Christian Jenssen; Yi Dong; Adrian Saftoiu; Roald Flesland Havre Journal: Ultrasound Int Open Date: 2017-12-07
Authors: C Di Dato; D Gianfrilli; E Greco; M Astolfi; S Canepari; A Lenzi; A M Isidori; E Giannetta Journal: J Endocrinol Invest Date: 2017-04-09 Impact factor: 4.256