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

Area of Science:

• Radiology
• Oncology
• Pathology

Background:

• Thyroid nodules (TNs) with indeterminate cytology (Bethesda Classification III or IV) pose diagnostic challenges.
• Accurate risk stratification is crucial to avoid unnecessary surgeries and ensure timely cancer detection.

Purpose of the Study:

• To compare the diagnostic performance of shear wave elastography (SWE) and Afirma™ gene expression classifier (GEC) for malignancy in indeterminate TNs.
• To evaluate SWE and GEC as independent predictors of malignancy in this patient cohort.

Main Methods:

• A prospective study involving 151 patients with indeterminate TNs (BC III or IV) undergoing fine-needle aspiration biopsy (FNAB).
• B-mode ultrasound, vascularity, and SWE (measuring shear wave velocity - SWV) were performed before FNAB.
• GEC testing was conducted on a separate FNAB sample; surgery was recommended based on GEC results and ultrasound features.

Main Results:

• Surgical pathology confirmed 31 malignant TNs.
• The optimal SWV cut-off for malignancy was ≥3.59 m/s, showing 83.9% sensitivity and 79.2% specificity.
• GEC-suspicious results had 90.3% sensitivity and 74.2% specificity. Both SWV and GEC-suspicious status were significant independent predictors of malignancy.

Conclusions:

• SWE and GEC are valuable, independent predictors of malignancy in thyroid nodules with indeterminate cytology (BC III or IV).
• These techniques can aid in risk stratification and clinical decision-making for managing indeterminate thyroid nodules.