Revista Sextante

Diagnostic Performance of Strain Elastography and Shear Wave Elastography in Characterization of Thyroid Nodules in Adults

Ayesha Hameed

Department of Radiology, TIMES University, Multan, Pakistan

Muhammad Talha

Department of Radiology, TIMES University, Multan, Pakistan

Keywords: Diagnostic accuracy, strain elastography, shear wave elastography, tissue stiffness, thyroid nodules, ultrasonography

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Abstract

The aim of the present study was to objectively evaluate the diagnostic value of strain elastography (SE) and shear wave elastography (SWE) for characterization of thyroid nodules in adults. This was a cross sectional study that included 196 consecutive patients (aged 18 to 44 years) visiting a tertiary care hospital of Multan over four months. Participants had gone through conventional thyroid ultrasonography, SE and SWE. Elasticity scores, strain ratios, mean and maximum SWE elasticity were used to assess against final ultrasound classification. Sensitivity and specificity, predictive values, accuracy and receiver operating characteristic analysis were used for the determination of diagnostic performance. Of 196 participants, 156 (79.6%) were classified as benign and 40 (20.4%) as malignant; 71.4% were women. SE demonstrated sensitivity of 87.50%, specificity of 71.79%, and accuracy of 75.00%, whereas SWE yielded corresponding values of 82.50%, 88.46%, and 87.24%. The negative predictive values for SE and SWE were 95.73% and 95.17%, respectively. All three elasticity variables were greater in the malignant classification group, in comparison to the non-cancer group, mean strain ratio, mean SWE elasticity, and maximum SWE elasticity, p < 0.001 for all. The area under the curve (AUC) scores were highest for maximum SWE elasticity (0.967) followed by strain ratio (0.951), mean SWE elasticity (0.922), and SE ordinal score (0.800). Both SWE and SE had higher descriptive specificity and SWE had higher sensitivity. Quantitative elastography measures demonstrated good discrimination of ultrasound classification groups. The measurements, however, are based on ultrasound classification, and not on pathologically confirmed diagnosis. Before a conclusion can be drawn as to cancer detectability, independent reference-standard validation and reproducibility of classification thresholds and confirmation of concurrent statistical comparisons are necessary.