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Ultraschall Med 2015; 36(02): 162-167
DOI: 10.1055/s-0034-1366467
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic Accuracy and Interobserver Agreement of Quasistatic Ultrasound Elastography in the Diagnosis of Thyroid Nodules

Diagnostische Genauigkeit und Interobserver-Übereinstimmung der Quasistatischen-Ultraschall-Elastografie bei der Diagnose von Schilddrüsenknoten
V. Cantisani
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
P. Lodise
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
G. Di Rocco
2   Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
,
H. Grazhdani
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
D. Giannotti
2   Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
,
G. Patrizi
2   Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
,
E. Medvedyeva
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
M. Olive
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
C. Fioravanti
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
L. Giacomelli
2   Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
,
C. Chiesa
2   Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
,
A. Redler
2   Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
,
C. Catalano
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
F. D’Ambrosio
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
,
P. Ricci
1   Department of Radiology, “Sapienza” University of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

14 January 2013

26 March 2014

Publication Date:
23 June 2014 (online)

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Abstract

Purpose: To assess the best technique and the diagnostic accuracy of Quasistatic Ultrasound Elastography (QUE) in thyroid nodules. Interobserver agreement was also evaluated.

Materials and Methods: A preliminary study of 50 patients with 54 thyroid nodules was performed with quantitative software in order to define the best cut-off value of different imaging methods. All patients underwent total thyroidectomy and histopathology findings served as the standard of reference. Thereafter, 154 nodules in 137 consecutive patients were prospectively evaluated by three operators. Findings at fine-needle aspiration cytology and histopathology (N = 60) served as the standard of reference.

Results: The most accurate technique was the axial peri-intranodular measurement method which achieved an area under the ROC curve of 0.961 (95 %CI 0.848 – 1.00) and had an optimal cut-off value of 3.00. QUE in the differentiation of thyroid nodules showed for operator 1: sensitivity 90 % (95 %CI 73.5 – 97.9 %), specificity 92.7 % (95 %CI 86.7 – 96.6 %), LR+ 12.40 (6.54 – 23.50), LR- 0.11 (0.04 – 0.32) and accuracy 91.4 % (95 %CI 85.4 – 97.3 %); for operator 2: sensitivity 86.7 % (95 %CI 69.3 – 96.2 %), specificity 87.1 % (95 %CI 79.9 – 92.4 %), LR+ 6.72 (4.16 – 10.80), LR- 0.15 (0.06 – 0.38) and accuracy 86.9 % (95 %CI 80.0 – 93.7 %); for operator 3: sensitivity 80 % (95 %CI 61.4 – 92.3 %), specificity 83.9 % (95 %CI 76.2 – 89.9 %), LR+ 4.96 (3.20 – 7.70), LR- 0.24 (0.12 – 0.49) and accuracy 81.9 % (95 %CI 74.0 – 89.9 %). Interobserver agreement values between operator 1 and operator 2 (k = 0.79) (p < 0.05, 95 %CI 0.684 – 0.904), between operator 1 and operator 3 (k = 0.73, 95 %CI: 0.607 – 0.854) and between operator 2 and operator 3 (k = 0.71, 95 %CI: 0.584 – 0.835) were significant.

Conclusion: QUE provides accurate quantitative evaluation of thyroid nodules with low interobserver variability.

Zusammenfassung

Ziel: Die Ermittlung der besten Technik und der diagnostischen Genauigkeit der Quasistatischen-Ultraschall-Elastografie (QUE) von Schilddrüsenknoten. Die Interobserver-Übereinstimmung wurde ebenfalls bewertet.

Material und Methoden: Mit einer quantitativen Software wurde eine Vorstudie an 50 Patienten mit 54 Schilddrüsenknoten durchgeführt, um für verschiedene bildgebende Verfahren die optimalen Grenzwerte festzulegen. Alle Patienten hatten eine Thyreoidektomie und die histopathologischen Befunde dienten als Referenzstandard. Im Anschluss wurden 154 Knoten von 137 Folgepatienten prospektiv von drei Bedienern bewertet. Als Standardreferenz dienten die Befunde der Feinnadelaspirationszytologie und der Histopathologie (N = 60).

Ergebnisse: Die genaueste Technik war die axiale peri-intranoduläre Messmethode, mit der eine Fläche unter der ROC-Kurve von 0,961 (95 %CI 0,848 – 1,00) erzielt wurde und die einen optimalen Grenzwert von 3,00 hatte. Die QUE zeigte bei der Differenzierung von Schilddrüsenknoten für den Bediener 1 folgende Werte: Sensitivität 90 % (95 %CI 73,5 – 97,9 %), Spezifität 92,7 % (95 %CI 86,7 – 96,6 %), LR+ 12,40 (6,54 – 23,50), LR- 0,11 (0,04 – 0,32) und Genauigkeit 91,4 % (95 %CI 85,4 – 97,3 %); für Bediener 2: Sensitivität 86,7 % (95 %CI 69,3 – 96,2 %), Spezifität 87,1 % (95 %CI 79,9 – 92,4 %), LR+ 6,72 (4,16 – 10,80), LR- 0,15 (0,06 – 0,38) und Genauigkeit 86,9 % (95 %CI 80,0 – 93,7 %); für Bediener 3: Sensitivität 80 % (95 %CI 61,4 – 92,3 %), Spezifität 83,9 % (95 %CI 76,2 – 89,9 %), LR+ 4,96 (3,20 – 7,70), LR- 0,24 (0,12 – 0,49) und Genauigkeit 81,9 % (95 %CI 74,0 – 89,9 %). Die Interobserver-Übereinstimmung zwischen Bediener 1 und Bediener 2 (k = 0,79) (p < 0,05; 95 %CI 0,684 – 0,904), zwischen Bediener 1 und Bediener 3 (k = 0,73; 95 %CI: 0,607 – 0,854) und zwischen Bediener 2 und Bediener 3 (k = 0,71; 95 %CI: 0,584 – 0,835) ergab jeweils signifikante Werte.

Schlussfolgerung: Die QUE ermöglicht die genaue quantitative Bewertung von Schilddrüsenknoten bei einer niedrigen Interobserver-Variabilität.

Key words

thyroid nodules - ultrasound elastography - color Doppler ultrasound - thyroid
 

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