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Keywords:
Thyroid / Parathyroids, Ear / Nose / Throat, Oncology, Ultrasound, Diagnostic procedure, Biopsy, Tissue characterisation, Pathology
Authors:
B. Raghavan, D. Sundaram; Chennai/IN
DOI:
10.1594/ecr2015/B-0877
Conclusion
IMPACT OF VTQ AND VTI ON TIRADS:
28 nodules were grouped under TIRADS category 4 and 5 as per ultrasound findings.
Out of these 28 nodules,
9 nodules (33 %) were found to be malignant on cytology.( Fig. 9 )
Fig. 9: Impact of ARFI on TIRADS.The ARFI data has much better concordance with cytology than B-Mode based TIRADS categorization especially in malignant nodules.
All 4 cytologically malignant nodules in TIRADS 5 were correctly categorized as malignant by ARFI also.
When VTQ values of these nodules were analysed only 14 out of the 28 nodules were identified as malignant .
3 out of 7 nodules in TIRADS category 4A and 11 out of 17 nodules in category 4B were down staged by VTQ ( Fig. 10, Fig. 11).
When VTI images of these nodules were analysed 16 nodules were correctly down staged by their soft VTI images.
4 out of 7 nodules in TIRADS category 4A and 12 out of 17 nodules in category 4B were down staged by VTI (Fig. 12, Fig. 13).
Thus,
VTQ and VTI methods can reduce the false positive rate of ultrasound and thereby can reduce the number of unnecessary FNAC or biopsies.
6 papillary carcinoma were wrongly identified as benign by ultrasound.
5 out of the 6 nodules were correctly upstaged either by VTQ and VTI (Fig. 14,
Fig. 15 ).
LIMITATIONS OF THE STUDY
- As the VTQ values higher than the maximum VTQ value of the machine were represented by X.XX m/s,
the exact numerical value for the nodules with X.XX m/s could not be evaluated.
- Most of the thyroid nodules were round in shape but the ROI cursor in VTQ method was square shaped which included some of the adjacent normal parenchyma.
- The ROI cursor in VTQ method was fixed size so the the adjacent normal parenchyma could not be avoided especially in evaluation of a small nodule (< 10 mm)
CONCLUSION:
- ARFI can reduce the false negative and false positive rate of conventional ultrasound based TIRADS.
- It reduces the number of unnecessary FNAC or biopsies .
- ARFI can be used to select a nodule in a patient ( especially in the presence of multiple nodules ) for FNAC or biopsy or follow up as the concordance with cytology improves .
- In terms of risk stratification of thyroid nodules,
there is a future of ARFI in the TIRADS reporting system.