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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleHead and Neck Imaging

Utility and Interobserver Agreement of Ultrasound Elastography in the Detection of Malignant Thyroid Nodules in Clinical Care

S. Merino, J. Arrazola, A. Cárdenas, M. Mendoza, P. De Miguel, C. Fernández and T. Ganado
American Journal of Neuroradiology December 2011, 32 (11) 2142-2148; DOI: https://doi.org/10.3174/ajnr.A2716
S. Merino
aFrom the Departments of Radiology (S.M., J.A., A.C., T.G.)
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J. Arrazola
aFrom the Departments of Radiology (S.M., J.A., A.C., T.G.)
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A. Cárdenas
aFrom the Departments of Radiology (S.M., J.A., A.C., T.G.)
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M. Mendoza
bPathology (M.M.)
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P. De Miguel
cEndocrinology (P.D.M.)
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C. Fernández
dPreventive Medicine (C.F.), Hospital Clínico San Carlos, Madrid, Spain.
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T. Ganado
aFrom the Departments of Radiology (S.M., J.A., A.C., T.G.)
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    Flow chart of the study. Three patients were excluded from the sample population because no definite pathologic result was available. A total of 103 patients and 106 nodules were definitively included in the study (analyzed population)

  • Fig 2.
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    Fig 2.

    Classification of nodules (absolute numbers) depending on suspicion of malignancy or benignity of lesions with US elastography for each radiologist and by consensus.

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    Fig 3.

    A predominantly hypoechoic nodule with microcalcifications is seen in conventional B-mode sonography image. US elastography image shows a homogeneously black nodule representing a predominantly rigid lesion, sized similar to that on B-mode image. This nodule corresponded to a papillary carcinoma on FNAB and surgery.

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    Fig 4.

    B-mode sonographic and US elastographic images of a benign nodule are shown. A well-defined heterogeneous nodule on conventional sonography shows a predominantly soft pattern of stiffness on the US elastogram.

Tables

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    Table 1:

    Frequency in absolute numbers and percentage of different variables studied with US elastography combined with nodule location in the thyroid gland

    Total of No. of NodulesNo. of Nodules in Left LobeNo. of Nodules in Right LobeNo. of Nodules in the IsthmusP Value
    Elasticity
        Predominantly rigid16 (15.1%)9 (56.3%)7 (43.7%)0 (0%).436
        Intermediate46 (43.4%)18 (39.1%)26 (56.5%)2 (4.4%)
        Predominantly soft44 (41.5%)22 (50%)19 (43.2%)3 (6.8%)
    Size
        Greater diameter in US elastography than B-mode US15 (14.2%)7 (46.7%)8 (53.3%)0 (0.0%).138
        Same size62 (58.5%)29 (46.8%)32 (51.6%)1 (1.6%)
        Lesser diameter in US elastography than B-mode US29 (27.3%)13 (44.8%)12 (41.4%)4 (13.8%)
    Margins
        Ill-defined or irregular41 (38.7%)20 (48.8%)19 (46.3%)2 (4.9%).905
        Well-defined or regular65 (61.3%)29 (44.6%)33 (50.8%)3 (4.6%)
    • View popup
    Table 2:

    Utility of US elastography: correlation among different variables studied with US elastography and defined by consensus between radiologists and pathologic results (reference standard)

    US Elastography Variables by ConsensusMalignant NodulesBenign NodulesP Value
    Elasticity
        Predominantly rigid (n = 16)6 (37.5%)10 (62.5%).000
        Indeterminate (n = 46)4 (8.7%)42 (91.3%)
        Predominantly soft (n = 44)0 (0%)44 (100%)
    Size
        Greater diameter in US elastography than B-mode image (n = 15)4 (26.7%)11 (73.3%).068
        Same size as B-mode image (n = 62)5 (8.1%)57 (91.9%)
        Lesser diameter in US elastography than B-mode (n = 29)1 (3.4%)28 (96.6%)
    Margins
        Ill-defined or irregular (n = 41)3 (7.3%)38 (92.7%).548
        Well-defined or regular (n = 65)7 (10.8%)58 (89.2%)
    • View popup
    Table 3:

    Utility of classification with US elastography in groups I, II, and III, according to benign or malignant suspicion obtained by consensus: correlation with pathologic results (reference standard)

    Classification of Nodules with US Elastography by ConsensusMalignant NodulesBenign NodulesP Value
    Type I: suspicious for benignity (n = 39)039.001
    Type II: indeterminate (n = 51)546
    Type III: suspicious for malignancy (n = 16)511
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American Journal of Neuroradiology: 32 (11)
American Journal of Neuroradiology
Vol. 32, Issue 11
1 Dec 2011
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Utility and Interobserver Agreement of Ultrasound Elastography in the Detection of Malignant Thyroid Nodules in Clinical Care
S. Merino, J. Arrazola, A. Cárdenas, M. Mendoza, P. De Miguel, C. Fernández, T. Ganado
American Journal of Neuroradiology Dec 2011, 32 (11) 2142-2148; DOI: 10.3174/ajnr.A2716
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Cite this article
S. Merino, J. Arrazola, A. Cárdenas, M. Mendoza, P. De Miguel, C. Fernández, T. Ganado
Utility and Interobserver Agreement of Ultrasound Elastography in the Detection of Malignant Thyroid Nodules in Clinical Care
American Journal of Neuroradiology Dec 2011, 32 (11) 2142-2148; DOI: 10.3174/ajnr.A2716

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