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Open AccessArticle

Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules

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“Victor Babes” University of Medicine and Pharmacy Timisoara, Internal Medicine 2nd Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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“Victor Babes” University of Medicine and Pharmacy Timisoara, Analytical Chemistry Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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“Victor Babes” University of Medicine and Pharmacy Timisoara, Obstetrics-Gynecology Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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“Victor Babes” University of Medicine and Pharmacy Timisoara, Physiopathology Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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“Victor Babes” University of Medicine and Pharmacy Timisoara, Surgery 2nd Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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CFR Clinical Hospital, Pathology Department., 13–15th Tudor Vladimirescu Street, 300173 Timisoara, Romania
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“Pius Branzeu” County Emergency Hospital Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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“Victor Babes” University of Medicine and Pharmacy Timisoara, Toxicology Department, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
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Authors to whom correspondence should be addressed.
Diagnostics 2019, 9(3), 119; https://doi.org/10.3390/diagnostics9030119
Received: 27 July 2019 / Revised: 10 September 2019 / Accepted: 12 September 2019 / Published: 13 September 2019
(This article belongs to the Special Issue Elastography)
Fine needle aspiration (FNA) is considered the gold standard in the diagnostic of thyroid nodules. Using the recommended BETHESDA reporting system, up to 20% of results are classified as intermediate cytology. As there is no consensus whether ultrasound evaluation, lobectomy or surgery is the best treatment option, intermediate cytology results are considered a grey zone of the FNA. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in the process of diagnosis and evaluation of the intermediate cytology cases after FNA. We evaluated 54 consecutive cases with intermediate cytology on FNA, using conventional B-mode ultrasound (2B), and strain elastography, using a linear multifrequency 6–13 MHz linear probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All nodules were classified with our Thyroid Imaging Report and Data System (TI-RADS) proposed model, considering: vertical appearance, with antero-posterior diameter bigger than the transvers diameter, the so called taller than wide shape, irregular borders, intranodular inhomogeneity, marked hypoecogenicity, micro calcifications, the presence of suspect lymph nodes, and increased stiffness as suspicious for malignancy. The classification outcomes were compared with the pathology results, considered the gold standard diagnosis. The prevalence of cancer was 28.8%, with 13/45 cases having a clear diagnostic of cancer. Six cases were diagnosed with borderline follicular neoplasia, a category with unclear evolution, also considered as malignant in the analysis of the imaging results. In total, 16/19 cancer cases had increased stiffness on elastography. The cancer prevalence increased with TI-RADS category, being 25% in TI-RADS 4b category and 92.8% in TI-RADS 5 category. The AUROC (Area Under Receiver Operating Curve) of elastography alone, in differentiation of malignant thyroid nodules was 74.9%; the combination of elastographic and conventional ultrasound characteristics generated an even better AUROC, of 84.5%. The combined conventional ultrasound and elastography identified thyroid cancer in cases with intermediate cytology with a sensitivity of 89.5% with a specificity of 50%. High risk thyroid nodules, identified by combined high risk conventional ultrasound characteristics and increased stiffness, on strain elastography, are highly predictive for malignancy, in the intermediate cytology cases. View Full-Text
Keywords: Bethesda III category; cancer risk; modified TI-RADS; strain elastography Bethesda III category; cancer risk; modified TI-RADS; strain elastography
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MDPI and ACS Style

Stoian, D.; Borcan, F.; Petre, I.; Mozos, I.; Varcus, F.; Ivan, V.; Cioca, A.; Apostol, A.; Dehelean, C.A. Strain Elastography as a Valuable Diagnosis Tool in Intermediate Cytology (Bethesda III) Thyroid Nodules. Diagnostics 2019, 9, 119.

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