Combination of ultrasound elastography with TI-RADS in the diagnosis of small thyroid nodules (≤ 10 mm): A new method to increase the diagnostic performance

Objective: To evaluate the diagnostic performance of a new method of combined ultrasound elastography (UE) and thyroid imaging-reporting and data system (TI-BADS) in the differential diagnosis of small thyroid nodules. Methods: Ultrasonography(US), TI-BADS, Elasticity Imaging (EI), Virtual Touch Tissue Imaging (VTI) and Virtual Touch Tissue Quantification (VTQ) features of 142 thyroid nodules (maximum diameter <= 10mm according to conventional ultrasound measurement) confirmed by surgery or FNA were retrospectively analyzed. Different elastographic methods in small benign and malignant thyroid nodules were compared. The diagnostic efficiency of three adjustment methods of conventional ultrasound TI-RADS classification and ultrasound elastography (VTI and/or VTQ) were compared. Results: The pathological examination showed that 70 thyroid nodules were benign and 72 were malignant. The differential ability of UE to diagnose the small benign and malignant thyroid nodules alone is not better than that of conventional ultrasound TI-BADS classification. The sensitivity of conventional ultrasound TI-RADS classification were higher than that of VTI and equal to VTQ(91.67% vs 83.33%, 91.67%), while the specificity of VTI was much higher than that of TI-RADS and VTQ(91.43% vs 75.71%, 60.00%). The diagnostic sensitivity and specificity of TI-RADS classification plus UE (VTI + VTQ) were 94.44% and 87.14% respectively. TI-RADS classification combined with UE (VTI + VTQ) was the highest diagnostic efficiency. Conclusion: Conventional ultrasound TI-BADS classification is the basis for the diagnosis of small thyroid nodules. The combination of TI-BADS with VTI and VTQ can significantly improve the differential diagnosis of small benign and malignant thyroid nodules. It may provide a new and reliable method for the clinical diagnosis of small thyroid nodules.