ORIGINAL ARTICLE   

Minerva Endocrinologica 2020 March;45(1):3-11

DOI: 10.23736/S0391-1977.19.02945-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Combined use of sonographic and elastosonographic parameters can improve the diagnostic accuracy in thyroid nodules at risk of malignancy at cytological examination

Ilenia MARTURANO ¹, Marco RUSSO ¹ ✉, Pasqualino MALANDRINO ¹, Massimo BUSCEMA ², Giacomo L. LA ROSA ¹, Angela SPADARO ¹, Livia MANZELLA ³, Laura SCIACCA ¹, Luca L’ABBATE ⁴, Leonardo RIZZO ⁵

¹ Department of Experimental and Clinical Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy; ² Center of Diabetology and Endocrine Diseases, Cannizzaro Hospital, Catania, Italy; ³ Center of Experimental Oncology and Hematology, Department of Experimental and Clinical Medicine, Catania University Hospital, Catania, Italy; ⁴ Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy; ⁵ Ultrasound Diagnostic Medical Center, Catania, Italy

BACKGROUND: Thyroid nodules diagnosed as Thy3B at fine-needle aspiration biopsy have a relevant risk of malignancy (15-30%) and are usually addressed to surgery. However surgery will result unnecessary in most cases. The present study aims at evaluating the possible increase of diagnostic accuracy for predicting malignancy using novel sonographic and elastographic parameters.
METHODS: In fifty patients undergoing thyroidectomy because of a Thy3B thyroid nodule, sonographic and elastosonographic evaluation was carried out by single operator before surgery. Five sonographic parameters (echogenicity, irregular margins, microcalcifications, intra-nodule blood flow and its irregularity) and two elastosonographic parameters (intra-nodule stiffness and its extension to adjacent tissue) were considered. After obtaining histological diagnosis, diagnostic accuracy was calculated.
RESULTS: When the two procedures were analyzed separately, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were 100%, 85%, 63% and 100% for ultrasonography and 60%, 92.5%, 67%, 90% for elastrosonography, respectively. The newly introduced evaluation procedures increased sensitivity. When a combined sonographic and elastosonographic evaluation was introduced, diagnostic accuracy was significantly improved: when ≥4 out of the seven parameters indicated were present, the risk of malignancy was very high (sensitivity 100%, specificity 92.55%, PPV 77%, NPV 100%).
CONCLUSIONS: A novel combined sonographic and elastosonographic parameter evaluation improved diagnostic accuracy for identifying thyroid nodules suspicious of malignancy.

KEY WORDS: Elastosonography; Thyroid nodule; Ultrasonography