Integration of Sonoelastography Into the TIRADS Lexicon Could Influence the Classification.

Aim: Numerous TIRADS (Thyroid Image Reporting and Data System) classifications have been developed, and various ultrasound (US) parameters are employed in different countries. The aim of our study was to introduce risk classification and management in a native population based on the Guidelines of Polish National Societies Diagnostics and Treatment of Thyroid Carcinoma but with the addition of sonoelastography. Materials and Methods: We examined prospectively 208 patients with 305 thyroid lesions employing B-mode ultrasound and sonoelastography (SE). Nodule composition, echogenicity, margins, shape, presence or absence of calcifications, thyroid capsule, nodule size were assessed using B-mode ultrasound. Moreover, sonoelastography results were presented using the Asteria scale. Results: In univariate analysis, the following US features were significantly associated with malignancy: >50% solid /solid component, marked hypoechogenicity, ill-defined margins, micro and macrocalcification, taller-than wide shape, no/partial halo pattern, infiltration of the capsule and an Asteria score of 4. Multivariate logistic regression analysis of B-mode features revealed that ill-defined margins (OR 10.77), markedly hypoechogenicity (OR 5.12), microcalcifications (OR 4.85), thyroid capsule infiltrations (OR 3.2), macrocalcifications (OR 3.01), and hard lesion in SE (OR 6.85) were associated with a higher Odds Ratio (OR) for malignancy. Multivariate logistic regression analysis revealed that combining two features increases the OR and the best combination was irregular margins and Asteria scale 4 (OR 20.21). Adding a third feature did not increase the OR. Conclusions: Sonoelastography increases the value risk of predicted malignancy, with consequent different approach to further clinical investigation and management. A solitary feature (Asteria 4) in a solid tumor can result in its categorization as TIRADS 4, but coexistence with high risk features allows it to be upgraded to TIRADS 5. The irregular margin was the strongest single feature which allowed for the assignment of a solid tumor into TIRADS 5 category. The highest accuracy was found by combining the features of age, margin, echogenicity (markedly hypoechoic), capsule infiltration, microcalcifications and sonoelastography (Asteria 3,4) of the tumors.

Diagnostic Performance of Shear Wave Elastography Parameters Alone and in Combination with Conventional B-Mode Ultrasound Parameters for the Characterization of Thyroid Nodules: A Prospective, Dual-Center Study.

The aims of our study were to determine whether shear wave elastography (SWE) can improve the conventional B-mode differentiation of thyroid lesions, determine the most accurate SWE parameter for differentiation and assess the influence of microcalcifications and chronic autoimmune thyroiditis on SWE values. We examined 119 patients with 169 thyroid nodules who prospectively underwent B-mode ultrasound and SWE using the same ultrasound machine. The parameters assessed using SWE were: mean elasticity within the entire lesion (SWE-whole) and mean (SWE-mean) and maximum (SWE-max) elasticity for a 2-mm-diameter region of interest in the stiffest portion of the lesion, excluding microcalcifications. The discriminant powers of a generalized estimating equation model including B-mode parameters only and a generalized estimation equation model including both B-mode and SWE parameters were assessed and compared using the area under the receiver operating characteristic curve, in association with pathologic verification. In total, 50 and 119 malignant and benign lesions were detected. In generalized estimated equation regression, the B-mode parameters associated with higher odds ratios (ORs) for malignant lesions were microcalcifications (OR = 4.3), hypo-echogenicity (OR = 3.13) and irregular margins (OR = 10.82). SWE-max was the only SWE independent parameter in differentiating between malignant and benign tumors (OR = 2.95). The area under the curve for the B-mode model was 0.85, whereas that for the model combining B-mode and SWE parameters was 0.87. There was no significant difference in mean SWE values between patients with and without chronic autoimmune thyroiditis. The results of the present study suggest that SWE is a valuable tool for the characterization of thyroid nodules, with SWE-max being a significant parameter in differentiating benign and malignant lesions, independent of conventional B-mode parameters. The combination of SWE parameters and conventional B-mode parameters does not significantly improve the diagnosis of malignant thyroid nodules. The presence of microcalcifications can influence the SWE-whole value, whereas the presence of chronic autoimmune thyroiditis may not.

Advantages and disadvantages of 3D ultrasound of thyroid nodules including thin slice volume rendering.

BACKGROUND: The purpose of this study was to assess the advantages and disadvantages of 3D gray-scale and power Doppler ultrasound, including thin slice volume rendering (TSVR), applied for evaluation of thyroid nodules. METHODS: The retrospective evaluation by two observers of volumes of 71 thyroid nodules (55 benign, 16 cancers) was performed using a new TSVR technique. Dedicated 4D ultrasound scanner with an automatic 6-12 MHz 4D probe was used. Statistical analysis was performed with Stata v. 8.2. RESULTS: Multiple logistic regression analysis demonstrated that independent risk factors of thyroid cancers identified by 3D ultrasound include: (a) ill-defined borders of the nodule on MPR presentation, (b) a lobulated shape of the nodule in the c-plane and (c) a density of central vessels in the nodule within the minimal or maximal ranges. Combination of features provided sensitivity 100% and specificity 60-69% for thyroid cancer.Calcification/microcalcification-like echogenic foci on 3D ultrasound proved not to be a risk factor of thyroid cancer.Storage of the 3D data of the whole nodules enabled subsequent evaluation of new parameters and with new rendering algorithms. CONCLUSIONS: Our results indicate that 3D ultrasound is a practical and reproducible method for the evaluation of thyroid nodules. 3D ultrasound stores volumes comprising the whole lesion or organ. Future detailed evaluations of the data are possible, looking for features that were not fully appreciated at the time of collection or applying new algorithms for volume rendering in order to gain important information. Three-dimensional ultrasound data could be included in thyroid cancer databases. Further multicenter large scale studies are warranted.