Multimodality Ultrasound Utilizing Microvascular Flow Imaging and Shear Wave Elastography to Guide Fine-Needle Aspiration of Thyroid Lesions: A Prospective Study Validating Pattern-Based Microvascular Classification
Authors' conclusion
Visual assessment of microvascular morphology patterns may improve differentiation of benign and malignant thyroid nodules and potentially reduce the risk of unnecessary biopsy of benign thyroid nodules.
Study context
- Population
- Consecutive patients with thyroid nodules undergoing multimodality US, September 2022 to December 2023; 793 pathologically confirmed nodules (248 benign, 545 malignant); mean age 43 years ±11 (SD)793 nodules
- Participants
- 599 patients
- Comparison
- Multimodality US model vs ACR TI-RADS
- Outcome
- Discrimination of malignant vs benign nodules (AUC)
Methodological detailsprospective, consecutive patients, internal cross-validation
- Prospective
- Consecutive patients
- Internal cross-validation
Performance
As reported in the abstract
| Test or model | AUC |
|---|---|
| Multimodality US | 0.95 (95% CI: 0.82, 0.97) |
| ACR TI-RADS | 0.62 (95% CI: 0.57, 0.66) |
AUC
Multimodality US0.95 (95% CI: 0.82, 0.97)
ACR TI-RADS0.62 (95% CI: 0.57, 0.66)
- Multimodality US vs ACR TI-RADS: P < 0.001 — higher AUC with multimodality US
Further findings
Malignant vascular signs (convergence, piercing, spoke wheel) and malignancy, univariate
| OR (95% CI) | P value | ||
|---|---|---|---|
| Malignant vascular signs | 10.43 (5.76–18.88) | P < 0.01 | |
| 0.050.21520Odds ratio (log scale) |
Benign vascular signs (ring sign) and malignancy, univariate
| OR (95% CI) | P value | ||
|---|---|---|---|
| Benign vascular signs | 0.10 (0.06–0.16) | P < 0.01 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | Multimodality US | ACR TI-RADS | P value |
|---|---|---|---|
| FNA procedures avoided at 71% risk threshold | 27% (CI 21–34) | 13% (CI 0–38) | P < 0.001 |
Original publication
Multimodality Ultrasound Utilizing Microvascular Flow Imaging and Shear Wave Elastography to Guide Fine-Needle Aspiration of Thyroid Lesions: A Prospective Study Validating Pattern-Based Microvascular Classification. Thyroid. Published 21 April 2025. doi:10.
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