Diagnostic performance of ACR-TIRADS combined with superb microvascular imaging for differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas

Jiali Tian; Jinlei Liang; Yuhong Lin; Liping Wang; Xiaobo Chen

doi:10.1530/EC-23-0388

Diagnostic performance of ACR-TIRADS combined with superb microvascular imaging for differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas

Endocr Connect. 2024 Feb 7;13(3):e230388. doi: 10.1530/EC-23-0388. Print 2024 Mar 1.

Authors

Jiali Tian¹, Jinlei Liang², Yuhong Lin¹, Liping Wang³, Xiaobo Chen¹

Affiliations

¹ Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.
² Ultrasound Department, Zhuhai People's Hospital, Zhuhai, China.
³ Ultrasound Department, Zhuhai Xiangzhou District People's Hospital, Zhuhai, China.

Abstract

Objective: The aim was to investigate the ability of superb microvascular imaging (SMI) to improve the differential diagnosis of mummified thyroid nodules (MTNs) and papillary thyroid carcinomas (PTCs) using the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS).

Materials and methods: We enrolled 110 cases of MTNs and 110 cases of PTCs confirmed by fine needle aspiration (FNA) or surgery. Conventional ultrasound (US) and the quantity of microvessels detected by SMI were analyzed for all nodules. Thyroid nodules were initially categorized by ACR-TIRADS based on US imaging features and then reclassified based on ACR-TIRADS combined with SMI blood-flow grade (SMI-TIRADS). We compared the diagnostic performances of ACR-TIRADS and SMI-TIRADS by receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

Results: US-detected margin, shape, and echogenic foci differed between MTNs and PTCs (P < 0.05). The SMI blood-flow grade was significantly greater in PTCs compared with MTNs (Χ2 = 158.78, P < 0.05). There was no significant difference in ACR-TIRADS indicators between MTNs and PTCs (Χ2 = 1.585, P = 0.453); however, reclassification by SMI-TIRADS showed significant differences between the groups (Χ2 = 129.521, P < 0.001). The area under the curve was significantly lower for ACR-TIRADS compared with SMI-TIRADS (0.517 vs 0.887, P < 0.05). SMI-TIRADS had significantly higher diagnostic value for distinguishing MTNs and PTCs than ACR-TIRADS (sensitivity: 91.82% vs 74.55%, P < 0.05; specificity: 84.55% vs 21.82%, P < 0.05; accuracy: 88.18% vs 48.18%, P < 0.05; PPV: 85.59% vs 48.81%, P < 0.05; and NPV: 91.18% vs 46.15%, P < 0.05).

Conclusion: The detection of microvascular flow and large vessels in thyroid nodules by SMI resulted in high diagnostic specificity and sensitivity. ACR-TIRADS combined with SMI could effectively distinguish between MTNs and PTCs, to avoid unnecessary FNA or surgical excision.

Keywords: diagnostic value; mummified thyroid nodule; papillary thyroid carcinoma; superb microvascular imaging; thyroid imaging reporting and data system.