Soonchunhyang Med Sci.  2019 Jun;25(1):10-19. 10.0000/sms.2019.25.1.10.

Differential Diagnosis of Thyroid Follicular Neoplasm from Nodular Hyperplasia by Shear Wave Elastography

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea. mhyoo@schmc.ac.kr
  • 2Elim Thyroid Clinic, Seoul, Korea.
  • 3Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 4Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Abstract


OBJECTIVE
More than 50% of diagnostic surgery in cytologically indeterminate thyroid nodules revealed benign nodules of which nodular hyperplasia (NH) accounted for about half. Preoperative exclusion of NH may decrease diagnostic surgery. We aimed to study the diagnostic performance of shear wave elastography (SWE) to differentiate follicular neoplasm (FN) from NH in follicular lesions of thyroid nodules.
METHODS
We analyzed the data from 61 patients who underwent SWE before ultrasound-guided core-needle biopsy (CNB) from August 2016 to May 2018 and CNB results were FN (n=19) and NH (n=42). We analyzed the magnitude of elasticity index (EI) and patterns of high EI area (EI >36 kPa). The patterns of high EI area was classified as marginal pattern (high EI areas are restricted in the outer 1/3 of the nodule) and traversing pattern (high EI areas approaching further to the center of the nodule within inner 2/3 of the nodule).
RESULTS
The E(Max), E(Mean), E(SD), and percent of high EI area were significantly lower in FN than NH (P<0.001). The diagnostic performance to predict FN showed sensitivity, specificity, and accuracy of 95%, 90%, and 92% by E(Max) <42.1 kPa, and of 95%, 79%, and 84% by E(Mean) <23.5 kPa, and of 89%, 93%, and 92% by marginal pattern of high EI area, respectively.
CONCLUSION
Novel diagnostic criteria of E(Max) less than 42.1 kPa and marginal pattern of high EI area on SWE can predict FN with high diagnostic accuracy, waiving diagnostic surgery of NH in indeterminate cytology.

Keyword

Elastography; Shear wave; Follicular neoplasm; Thyroid nodule
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