Clinical Research Papers:

Shear wave elastography combined with the thyroid imaging reporting and data system for malignancy risk stratification in thyroid nodules

Zhao Liu, Hui Jing, Xue Han, Hua Shao, Yi-Xin Sun, Qiu-Cheng Wang and Wen Cheng _

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Oncotarget. 2017; 8:43406-43416. https://doi.org/10.18632/oncotarget.15018

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Zhao Liu1, Hui Jing1, Xue Han1, Hua Shao1, Yi-Xin Sun1, Qiu-Cheng Wang1 and Wen Cheng1

1 Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China

Correspondence to:

Wen Cheng, email:

Keywords: thyroid nodules; shear wave elastography (SWE); thyroid imaging reporting and data system (TI-RADS); “tandem” and “parallel”; diagnostic performance

Received: October 13, 2016 Accepted: January 09, 2017 Published: February 02, 2017


To retrospectively evaluate the diagnostic performance of shear wave elastography (SWE) and thyroid imaging reporting and data system (TI-RADS) in differentiating malignant and benign thyroid nodules. A total of 313 thyroid nodules in 227 patients were included. All thyroid nodules were underwent SWE and TI-RADS before fine needle aspiration biopsy and/or surgery. SWE elasticity indices of the maximum (Emax), mean (Emean), minimum (Emin) and elastic ratio (ER) in thyroid nodules were measured. Nodules with solid component, marked hypoechogenicity, poorly defined margins, micro-calcifications, and a taller-than-wide shape were classified as suspicious at gray-scale ultrasonography. The level of TI-RADS was determined according to the number of suspicious ultrasonography features. The combined methods of SWE and TI-RADS in thyroid nodules were calculated. In the 313 nodules, 194 were malignant, and 119 were benign. SWE and TI-RADS were significantly higher in malignant nodules than benign nodules (P < 0.001). The most accurate SWE cut-off value, 51.95 kPa for Emax, achieved a sensitivity of 81.44% and a specificity of 83.19% for discriminating malignant nodules from benign nodules. There are two methods in combination with SWE and TI-RADS. The one is “tandem” method, which has a higher specificity (95.80%), positive likelihood ratio (18.16) and positive predictive value (96.73%). The other one is “parallel” method, which shows sensitivity (94.85%), negative likelihood ratio (0.07) and negative predictive value (90.00%).We believe that the methods could be used as a simple tool to stratify the risk of thyroid nodules accurately.

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