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Endocrine. 2018 Mar;59(3):573-584. doi: 10.1007/s12020-017-1509-9. Epub 2018 Jan 19.

Shear wave elastography and Afirma™ gene expression classifier in thyroid nodules with indeterminate cytology: a comparison study.

Author information

1
Wilmington Endocrinology, 1717 Shipyard Boulevard, Wilmington, NC, 28403, USA. azizi@wilmingtonendo.com.
2
Wilmington Pathology Associates, 1915 South 17th Street, Suite 100, Wilmington, NC, 28401, USA.
3
Wilmington Endocrinology, 1717 Shipyard Boulevard, Wilmington, NC, 28403, USA.
4
Beth Israel Deaconess Medical Center, 109 Brookline, Suite 200, Boston, MA, 02215, USA.
5
Carolina Arthritis, 1710 South 17th Street, Wilmington, NC, 28401, USA.
6
UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA.

Abstract

PURPOSE:

To compare shear wave elastography (SWE) and Afirma™ gene expression classifier (GEC) for diagnosis of malignancy in thyroid nodules (TNs) with Bethesda Classification (BC) III or IV indeterminate cytology.

METHODS:

This preliminary single-center prospective study was approved by the Institutional Review Board. We evaluated 151 consented patients with 151 indeterminate TNs (123 BC III, 28 BC IV) on fine-needle aspiration biopsy (FNAB). B-mode ultrasound, vascularity, and SWE were performed prior to FNAB. TN stiffness was measured as shear wave velocity (SWV) in meters per second (m/s). The stiffest area of the TN was selected for SWV measurement. GEC testing was performed with a second FNAB. Surgery was recommended for GEC-suspicious TNs, or GEC-benign TNs with two or more worrisome B-mode US features.

RESULTS:

Surgical pathology confirmed 31 malignant TNs. Among the GEC-suspicious group, 28 of 59 TNs were malignant. The SWV value of ≥3.59 m/s was the best cut-off for malignancy risk based on the receiver operating curve (ROC). Twenty-six malignant TNs had SWV ≥ 3.59 m/s. The sensitivity and specificity for SWV ≥ 3.59 m/s were 83.9 and 79.2%, respectively. Positive predictive value (PPV) was 51.0% and negative predictive value (NPV) was 95.0%. For the GEC-suspicious group, sensitivity, specificity, PPV, and NPV were 90.3, 74.2, 47.5, and 96.7%, respectively. In multivariate analysis, SWV and GEC-suspicious were significant predictors of malignancy, but B-mode features and vascularity were not.

CONCLUSION:

This preliminary study indicates that SWE and GEC are independent predictors of malignancy in TNs with BC III or IV.

KEYWORDS:

GEC testing; Indeterminate FNAB; Shear wave elastography; Thyroid nodule; Ultrasound

PMID:
29350311
PMCID:
PMC5847162
DOI:
10.1007/s12020-017-1509-9
[Indexed for MEDLINE]
Free PMC Article

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