A multimodal ultrasound approach: quantitative speed-of-sound, elastography, and B-mode imaging for predicting...

Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid gland, and its aggressiveness determines distinct therapeutic and management strategies. This study aimed to evaluate the diagnostic performance of quantitative speed-of-sound (QSOS), elastography, and B-mode imaging in assessing the aggressiveness of PTC.

A total of 157 patients with solitary PTC were enrolled and classified into two groups based on pathological findings: an invasive group (n=118) and a non-invasive group (n=39). All patients underwent B-mode imaging, QSOS imaging, and elastography. Speed-of-sound (SOS)1, SOS2, and SOS3 represent the SOS measurements at different regions of the nodule, and the difference refers to the value of SOS1 minus SOS3.

Our results demonstrated that the maximum diameter of PTC in the invasive group was significantly larger than that in the non-invasive group {9.5 [interquartile range (IQR), 7.1-12.3] vs. 6.2 (IQR, 5.2-8.5) mm}. Additionally, the invasive group exhibited a lower SOS2 compared to the non-invasive group [1,570.1 (IQR, 1,565.3-1,576.5) vs. 1,591.1 (IQR, 1,582.8-1,594.4) m/s]. Furthermore, maximum elasticity (Emax) was higher in the invasive group [52.7 (IQR, 41.1-66.0) vs. 45.9 (IQR, 35.7-58.1) kPa], whereas the difference was smaller in the invasive group (6.5±13.2 vs. 11.6±11.9 m/s). Binary logistic regression analysis identified SOS2, maximum diameter, and the difference as independent predictors of PTC invasiveness. Their odds ratios (ORs) were 0.857, 1.274, and 0.945, respectively (all P<0.05). A multiple logistic regression model was developed based on these three variables, which as a combined predictor demonstrated high accuracy in diagnosing the aggressiveness of PTC, with an area under the curve (AUC) of 0.91, a sensitivity of 0.924, and a specificity of 0.816.

Our study is the first to examine the invasiveness of PTC using QSOS technology. To predict PTC invasiveness, a combined predictor integrating SOS, elastography, and B-mode imaging parameters of thyroid nodules was developed. This indicator provides physicians with valuable guidance for the early diagnosis and treatment of PTC due to its excellent accuracy, sensitivity, and specificity.