Shear wave elastography for solid breast masses evaluation: Quantitative measurement of mean elasticity value and elasticity ratio.

Purpose: Shear wave elastography (SWE), an ultrasonographic technique to measure the elasticity of mass lesions to evaluate breast mass. This study aimed to find out the cutoff values identifying breast malignancy using the mean elasticity (E-mean) and elasticity ratio (E-ratio) of breast masses. Methods: This retrospective study included women underwent SWE and US-guided biopsy of breast masses. During conventional US, the SWE mode was also performed, determining elasticity measurements, E-mean and E-ratio. Histopathological reports were obtained to identify mass status. The optimal and alternative cutoff values for E-mean and E-ratio to determine malignancy were assessed by receiver operating characteristic (ROC) curve analysis and Youden's index score. Results: Among 147 benign and 93 malignant masses, the median of E-means were 26.20 (IQR 15.70-56.60) and 141.60 (IQR 119.80-154.60) kPa and the median E-ratios were 3.11 (IQR 1.83-5.23) and 9.24 (IQR 6.76-12.44), respectively. Using Youden's index, the optimal cutoff values for E-mean and E-ratio were 90.35 and 5.89, with sensitivity of 87.1 % and 82.8 %, specificity of 89.1 % and 83.7 %, positive predictive value (PPV) of 83.5 % and 76.2 %, negative predictive value (NPV) of 91.6 % and 88.5 %, positive likelihood ratio (LR+) of 8.00 and 5.07, and negative likelihood ratio (LR-) of 0.14 and 0.21, respectively. Conclusion: This study revealed that SWE is useful in predicting malignancy. With the optimal cutoff values of E-mean and E-ratio at 90.35 kPa and 5.89, the sensitivity was nearly 90 % with E-mean and slightly over 80 % with E-ratio, respectively. These findings could be used in conjunction with conventional US.

Comparison of the diagnostic accuracy of K-TIRADS and EU-TIRADS guidelines for detection of thyroid malignancy on ultrasound.

INTRODUCTION: This retrospective study compared the diagnostic accuracy of histopathologically proven thyroid nodules between the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) guidelines for the management of thyroid nodules characterized by ultrasonography. MATERIAL AND METHODS: For thyroid nodules resected from 2018 to 2021 at our institution, static ultrasound images of each nodule were reviews and stratify into both systems. Agreement between above two classifications was compared based on histopathological results. RESULTS: A total 403 thyroid nodules from 213 patients were evaluated. Each nodule was characterized by ultrasonography and stratified into K-TIRADS and EU-TIRADS classifications. The diagnostic accuracy was as follows: K-TIRADS sensitivity 85.3% (95% CI, 78.7-91.9) specificity 76.8% (95% CI, 72.1-81.7), positive predictive value 57.8% (95% CI, 50.1-65.4) negative predictive value 93.4% (95% CI, 90.3-96.5); EU-TIRADS sensitivity 86.2% (95% CI, 79.7-92.7), specificity 75.5% (95% CI, 70.6-80.4), positive predictive value 56.6% (95% CI, 49.1-64.2), negative predictive value 93.7% (95% CI, 90.6-96.8). Excellent agreement in risk stratifications between both systems was found (kappa 0.86). CONCLUSIONS: Ultrasound thyroid nodules categorized by either by K-TIRADS or EU-TIRADS are useful to predicting malignancy and perform risk stratification with similar results. IMPLICATIONS FOR PRACTICE: This study confirmed that both K-TIRADS and EU-TIRADS have high diagnostic accuracy and both guidelines may be used as an effective tool for management planning of patients with thyroid nodules in daily clinical practice.