Clinical Research Papers:

Calcification of thyroid nodules increases shear-wave speed (SWS) measurement: using multiple calcification-specific SWS cutoff values outperforms a single uniform cutoff value in diagnosing malignant thyroid nodules

Bao-Ding Chen _, Hui-Xiong Xu, Yi-Feng Zhang, Bo-Ji Liu, Le-Hang Guo, Dan-Dan Li, Chong-Ke Zhao, Xiao-Long Li, Dan Wang and Shuang-Shuang Zhao

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Oncotarget. 2016; 7:66149-66159. https://doi.org/10.18632/oncotarget.11710

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Bao-Ding Chen1,2,3,4,5, Hui-Xiong Xu1,2,3,4, Yi-Feng Zhang1,2,3,4, Bo-Ji Liu1,2,3,4, Le-Hang Guo1,2,3,4, Dan-Dan Li1,2,3,4, Chong-Ke Zhao1,2,3,4, Xiao-Long Li1,2,3,4, Dan Wang1,2,3,4 and Shuang-Shuang Zhao5

1 Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China

2 Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Clinical College of Nanjing Medical University, Shanghai, China

3 Thyroid Institute, Tongji University School of Medicine, Shanghai, China

4 Shanghai Center of Thyroid Diseases, Shanghai, China

5 Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China

Correspondence to:

Hui-Xiong Xu, email:

Keywords: thyroid nodule, calcification, ultrasound, shear-wave elastography, point shear-wave measurement

Received: June 30, 2016 Accepted: August 26, 2016 Published: August 31, 2016


Conventional ultrasound cannot satisfactorily distinguish malignant and benign thyroid nodules. Shear-wave elastography (SWE) can evaluate tissue stiffness and complement conventional ultrasound in diagnosing malignant nodules. However, calcification of nodules may affect the results of SWE. The purposes of this study are to compare the differences of shear-wave speed (SWS) measurement among different calcification groups and compare the diagnostic performance between using a single uniform SWS cutoff value and multiple individual calcification-specific cutoff values using technique of point SWS measurement. We retrospectively identified 517 thyroid nodules (346 benign and 171 malignant nodules) examined by conventional ultrasound and point SWS measurement. There were 177 non-calcified, 159 micro-calcified and 181 macro-calcified nodules. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) was computed. The mean SWS in malignant nodules more than doubled that of benign nodules (4.81±2.03 m/s vs. 2.29±0.99 m/s, p<0.001). The mean SWS of nodules progressively increased from the non-calcification (2.60±1.49 m/s), to micro-calcification (3.27±1.85 m/s) and to macro-calcification (3.68±2.26 m/s) groups (p<0.001), which was true in both the benign and malignant nodules. If we used individual SWS cutoff values for non- (SWS >2.42 m/s), micro- (SWS >2.88 m/s) and macro-calcification (SWS >3.59 m/s) nodules in the whole group, the AUC was 0.859 (95% confidence interval [CI], 0.826-0.888), which was significantly better than the AUC of 0.816 (95% CI, 0.780-0.848) if a single uniform cutoff value (SWS >2.72 m/s) was applied to all the nodules regardless of calcification status (p=0.011). The cutoff values of SWS for different calcified nodules warrant future prospective validation.

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