239 Diagnostic utility of molecular and imaging biomarkers 2 exclusion criteria USE Technique USE scoring system coarse calcifications, cystic nodule qualitative real-time USE, standardized free-hand compression elasticity score 1-3 n.s. qualitative real-time USE, standardized free-hand compression elasticity score 1-4 >10% cystic, eggshell calcification, TN larger than 80% of lobe, TN in isthmus semi-quantitative USE, free-hand compression, off-line processing stain ratio (SR) = normal tissue to lesion strain ratio, ROC analysis, cutoff for positive test SR >2.05 >30% cystic, eggshell calcification, TN not distinguishable from surrounding parenchyma qualitative real-time USE, free-hand compression elasticity score 1-4 macrocalcifications, size <5mm or >30mm, anechoic or complex US appearance, coalescent TN, Hashimoto's thyroiditis, hot TN at radioisotope scan qualitative real-time USE, standardized free-hand compression elasticity score 1-4 size <5mm or >40 mm; >20% cystic, eggshell calcification, coalescent TN, spongiform US appearance qualitative real-time USE, standardized free-hand compression elasticity score 1-3 cystic content, eggshell calcification, coalescent TN qualitative real-time USE, standardized free-hand compression elasticity score 1-5 n.s. semi-quantitative real-time USE, standardized free-hand compression strain value (definition n.s.), ROC analysis, cutoff for positive test <0.045 coalescent, haemorrhagic or cystic TN, eggshell calcification, history thyroid surgery, percutaneous intervention or radiotherapy to head and neck qualitative (1) and semi-quantitative (2) real-time USE, standardized free-hand compression (1) elasticity score 1-5. (2) strain index (SI) = ratio of nodule strain to parenchyma strain, ROC analysis, cutoff for positive test >6.66 TN >40mm, >50% cystic, eggshell calcification, no suspicious US features qualitative (1) and quantitative (2) shearwave USE (1) elasticity score 1-5. (2) strain ratio (SR) = normal tissue to lesion strain ratio, ROC analysis, cutoff for positive test >2.3 >50% cystic, >10% calcifications, collapsed TN, insufficient unaffected thyroid tissue to perform USE quantitative USE, standardized free-hand compression stain ratio (SR) = normal tissue to lesion strain ratio. ROC analysis. Cutoff for positive test SR >2.09 cystic, calcified, coalescent or large TN qualitative real-time USE, standardized free-hand compression elasticity score 1-4 n.s. quantitative shearwave USE, offline processing Shear wave velocity (Young modulus), measured in 3 planes in kilopascals (kPa), ROC analysis, cutoff for positive test >22.30 kPa. n.s. qualitative real-time USE qualitative dichotomous: hard or soft. of 17.4% (95% CI: 13.0%-23.0%) and 98.5% (95% CI: 88.8%-99.8%), 28.5% (95% CI: 21.9%-36.1%) and 97.3% (95% CI: 80.8%-99.7%), or 44.4% (95% CI: 36.0%-53.1%) and 94.7% (95% CI: 67.8%-99.3%), respectively (Figure 80). This additional analysis shows that qualitative USE could be very reliable to rule-out malignancy in indeterminate thyroid nodules if a threshold USE score of 1 is upheld.
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