Diagnostic Utility Of Shear Wave Elastography And BEAF Mutation Analysis For The Differentiation Of Benign And Malignant Thyroid Nodules

OBJECTIVE:1?To evaluate the role of shear wave elastography in the diagnosis of thyroid nodules,and compare it with conventional ultrasound.2?To investigate the maximum Young's modulus(Emax)of thyroid nodules using two-dimensional Shear Wave Elastography(2D-SWE).And propose a scheme to diagnose thyroid nodules on the basis of Emax.3?To evaluate the utility of shear wave elastography in diagnosing papillary thyroid carcinoma with braf mutation.METHODS:A total of 244 patients with 289 nodules schedules for thyroid operation or fineneedle aspiration were recruited in our study.2D-SWE examinations were performed after the grey-scale ultrasound to get the maximum Young's modulus of thyroid nodules,which were then correlated with pathology results.Then we investigate the distribution of the SWE-max by using logarithmic normal distribution.Finally wepresented the association in differentiation the quality of thyroid nodules with the nodule's SWE-max.We recruited a total of 118 patients with 123 thyroid nodules were scheduled for thyroid operation in this study.Finally a group of 73 malignant nodules getting BRAF mutation test results were enrolled in our research.We performed grey-scale ultrasound and 2D-SWE examinations before operation.According to the results of genetic tests,all the nodules were divided into two groups.Then we used statistical software to investigate different parameters between two groups.RESULTS:The mean age was 45.58 ± 12.15 years old.Of all these 244 patients,18(7.4%)exhibited with multiple nodules and 226(92.6%)presented with single nodules were included in this study.The mean diameter of 289 nodules was 12.7 ± 6.4 cm.If SWE-max ? 120 k Pa,the nodule was highly suspicious for malignancy.If120>SWE-max ? 69 k Pa,the nodule was suspicious for malignancy.It indicated that the possibility for malignancy was higher than benignancy.69 k Pa was considered as the expected value for malignant nodules.If 69 k Pa>SWE-max ? 45 k Pa,the nodule was indeterminate.If 45 k Pa>SWE-max,the nodule was suspicious for benignancy.BRAF mutation were found in 91.8%(67/73)thyroid papillary carcinoma nodules.Parameters of grey-scale sonography between two groups were not statistically significant.SWE measurements were significantly different between two categories.The maximum Young's modulus value with positive results was 82.3±43.5k Pa,as compared with 42.1±15.6k Pa in negative results(p<0.05).On ROC curve,the area under the curve(AUC)of the maximum Young's modulus value was 0.858.Taking40.8k Pa as the threshold of maximum Young's modulus value,the sensitivity was92.5% and specificity was 66.7%.CONCLUSIONS:1?2D-SWE imaging can provide quantitative information about thyroid nodules' stiffness.2?The quantitative parameters are effective in differentiating benign and malignant thyroid nodules.3?The maximum Young's modulus value of PTC nodules is correlated with BRAF genetic testing results.