Comparison of Conventional Ultrasound, Doppler, Elastography and Contrast Enhanced Ultrasonography Parameters with Histopathology Findings in the Differential Diagnosis of Benign and Malignant Thyroid NodulesSanjana Ballal1, Madhav P Yadav1, Arun K Gupta2, Manisha Jana2, Suryanarayana SV Deo3 and Chandrasekhar Bal1*
- Corresponding Author:
- Chandrasekhar Bal
Professor & Head, MD, Department of Nuclear Medicine
AIIMS, Ansari Nagar, New Delhi, 110029
E-mail: [email protected]
Received Date: March 09, 2017 Accepted Date: March 28, 2017; Published Date: April 03, 2017
Citation: Ballal S, Yadav MP, Gupta AK, Jana M, Deo SS , et al. (2017) Comparison of Conventional Ultrasound, Doppler, Elastography and Contrast Enhanced Ultrasonography Parameters with Histopathology Findings in the Differential Diagnosis of Benign and Malignant Thyroid Nodules. Thyroid Disorders Ther 6:213. doi:10.4172/2167-7948.1000213
Copyright: © 2017 Ballal S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Though neck ultrasound is the first line of choice for the screening of thyroid nodules, very few studies have compared the diagnostic performances of both conventional and advanced ultrasound parameters. In this study, we aim to compare various conventional and advanced ultrasound imaging parameters and confirm it with histopathology findings to differentiate between benign and malignant thyroid nodules.
Methods: One hundred and thirty nine patients with 173 thyroid nodules underwent conventional ultrasonography (cUSG) which included gray-scale parameters, colour Doppler (CD) and power Doppler (PD) followed by elastography and contrast enhanced ultrasonography (CEUSG). Post-USG imaging all patients underwent fine needle aspiration cytology followed by surgery if indicated and histopathological results were obtained. Stata 11.2 statistical software was used for the statistical analysis.
Results: Of 173 nodules, 65 were benign and 108 were malignant. cUSG had a sensitivity, specificity, PPV, NPV and accuracy of 94.4%, 90.4%, 94.4%, 90.4%, and 91.9%, respectively with AUC:0.97. On ROC analysis, the cut-off value for differentiating malignant from benign thyroid nodules on Ueno elasticity scoring was >3; AUC: 0.86 versus >2.2 using elasticity ratio method, AUC: 0.90. CEUSG and elastography had sensitivity, specificity, PPV, NPV and accuracy of 93.8%, 95.3%, 97.2%, 89.8%, and 94.2%, respectively with AUC:0.98. On combining and ranking, both conventional and advanced cUSG parameters, the significant indicators for malignancy were heterogeneous contrast enhancement, followed by Type-IV/V PD flow patterns, absence of ring enhancement and elasticity ratio >2.2 patterns with the largest AUC:0.994.
Conclusions: Conjoint analysis of specific features of thyroid nodules on cUSG, elastography and CEUSG will enhance the diagnostic value in the screening of thyroid nodules.