Clinical Endocrinology (2014)
doi: 10.1111/cen.12589
ORIGINAL ARTICLE
Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules € ‡ and Jianming Wang‡,§ Jun Shao*,1, Ye Shen†,1, Jieqiong Lu *Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, †Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, Suzhou, ‡Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University and §Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
Summary Objective The aim of this study was to evaluate the value of ultrasound scores obtained by conventional ultrasonography and ultrasound elastography in the differentiation of benign and malignant thyroid nodules in Chinese patients. Methods This study included 297 patients who were referred for surgery for compressive symptoms or suspicion of malignancy. Five hundred and twelve thyroid nodules were examined by ultrasonography. The final diagnosis was based on histological findings. A seven-point ultrasound scoring system based on conventional ultrasonography and a five-point scoring system based on ultrasound elastography were applied independently or in combination. The receiver operating characteristic (ROC) curves were graphed, and the areas under the curves (AUCs) were compared using the v2-test. Results Solid composition, hypo-echoic appearance, an irregular or blurred margin, an aspect ratio ≥1, intranodular blood flow and presence of microcalcifications were significant predictors of malignant thyroid nodules. The AUC (95% CI) was 09067 (08817–09318) for the ultrasound scores based on conventional ultrasonography and 09080 (08842–09317) for the elasticity scores. The combination of these two scoring systems provided good accuracy with an AUC (95% CI) of 09415 (09223–09606), which was significantly higher than that obtained with the conventional ultrasound scores (v2 = 3603, P < 0001) or the elasticity scores (v2 = 1280, P < 0001) individually. When we set the cut-point to ≥5, the sensitivity and specificity were 8522% and 8738%, respectively. Conclusions Elastography in combination with conventional ultrasonography is a promising imaging-based approach that can assist in the differential diagnosis of thyroid cancer.
Correspondence: Jianming Wang, Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. Tel.: 86-25-86868438; E-mail: [email protected] 1
These authors contributed equally to this work.
© 2014 John Wiley & Sons Ltd
(Received 8 June 2014; returned for revision 25 June 2014; finally revised 23 July 2014; accepted 11 August 2014)
Introduction Thyroid nodules represent the most common type of thyroid disease and form as a result of the abnormal growth of thyroid cells within the gland. Thyroid nodules are clinically important primarily because of their malignant potential.1 It is estimated that 4%–8% of adults have thyroid nodules that can be detected by palpation, 10%–41% have nodules that can be detected by thyroid ultrasonography,2,3 and 50% have nodules that can be detected by pathologic examination at autopsy.4 Thyroid nodules are most common in women and older populations.1 Most of the nodules are benign, with
doi: 10.1111/cen.12589
ORIGINAL ARTICLE
Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules € ‡ and Jianming Wang‡,§ Jun Shao*,1, Ye Shen†,1, Jieqiong Lu *Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, †Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, Suzhou, ‡Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University and §Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
Summary Objective The aim of this study was to evaluate the value of ultrasound scores obtained by conventional ultrasonography and ultrasound elastography in the differentiation of benign and malignant thyroid nodules in Chinese patients. Methods This study included 297 patients who were referred for surgery for compressive symptoms or suspicion of malignancy. Five hundred and twelve thyroid nodules were examined by ultrasonography. The final diagnosis was based on histological findings. A seven-point ultrasound scoring system based on conventional ultrasonography and a five-point scoring system based on ultrasound elastography were applied independently or in combination. The receiver operating characteristic (ROC) curves were graphed, and the areas under the curves (AUCs) were compared using the v2-test. Results Solid composition, hypo-echoic appearance, an irregular or blurred margin, an aspect ratio ≥1, intranodular blood flow and presence of microcalcifications were significant predictors of malignant thyroid nodules. The AUC (95% CI) was 09067 (08817–09318) for the ultrasound scores based on conventional ultrasonography and 09080 (08842–09317) for the elasticity scores. The combination of these two scoring systems provided good accuracy with an AUC (95% CI) of 09415 (09223–09606), which was significantly higher than that obtained with the conventional ultrasound scores (v2 = 3603, P < 0001) or the elasticity scores (v2 = 1280, P < 0001) individually. When we set the cut-point to ≥5, the sensitivity and specificity were 8522% and 8738%, respectively. Conclusions Elastography in combination with conventional ultrasonography is a promising imaging-based approach that can assist in the differential diagnosis of thyroid cancer.
Correspondence: Jianming Wang, Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. Tel.: 86-25-86868438; E-mail: [email protected] 1
These authors contributed equally to this work.
© 2014 John Wiley & Sons Ltd
(Received 8 June 2014; returned for revision 25 June 2014; finally revised 23 July 2014; accepted 11 August 2014)
Introduction Thyroid nodules represent the most common type of thyroid disease and form as a result of the abnormal growth of thyroid cells within the gland. Thyroid nodules are clinically important primarily because of their malignant potential.1 It is estimated that 4%–8% of adults have thyroid nodules that can be detected by palpation, 10%–41% have nodules that can be detected by thyroid ultrasonography,2,3 and 50% have nodules that can be detected by pathologic examination at autopsy.4 Thyroid nodules are most common in women and older populations.1 Most of the nodules are benign, with
