Ultrasound Real-Time Tissue Elastography Improves the Diagnostic Performance of the ACR Thyroid Imaging Reporting and Data System in Differentiating Malignant from Benign Thyroid Nodules: A Summary of 1525 Thyroid Nodules

Background. To explore the correlation between the ultrasound elasticity score (ES) of real-time tissue elastography (RTE) and the malignant risk stratification of the Thyroid Imaging Reporting and Data System (TI-RADS) and to evaluate the added value of RTE to TI-RADS in differentiating malignant nodules from benign ones. Methods. A total of 1,498 patients (885 women and 613 men; mean age of 43.5？±？12.4 years) with 1,525 confirmed thyroid nodules (D？=？maximum diameter, D？≤？2.5？cm) confirmed by fine-needle aspiration (FNA) and/or surgery were included. The nodules were divided into four groups based on their sizes (D？≤？0.5？cm, 0.5？<？D？≤？1.0？cm, 1.0？<？D？≤？2.0？cm, and 2.0？<？D？≤？2.5？cm). We assigned an ES of RTE and malignant risk stratification of the TI-RADS category to each nodule. The correlation between the ES of RTE and the malignant risk stratification of TI-RADS category was analyzed by the Spearman’s rank correlation. The diagnostic performances of RTE, TI-RADS, and their combination were compared by the receiver operator characteristic (ROC) analysis. Results. The ES of RTE and the malignant risk stratification of TI-RADS showed a strong correlation in the size intervals of 0.5？<？D？≤？1.0？cm, 1.0？<？D？≤？2.0？cm, and 2.0？<？D？≤？2.5？cm (r？=？0.768, 0.711, and 0.743, respectively). The diagnostic performance of their combination for each size interval was always better than RTE or TI-RADS alone (for all, ). Conclusions. Overall, The ES of RTE was strongly correlated with the malignant risk stratification of TI-RADS. The diagnostic performance of the combination of RTE and TI-RADS outperformed RTE or TI-RADS alone. Therefore, RTE may be an adjunctive tool to the current TI-RADS system for differentiating malignant from benign thyroid nodules