Ultrasound elastography in the diagnostic evaluation of indeterminate thyroid nodules

Abstract

Objective: To assess the accuracy of US-elastography in the evaluation of indeterminate thyroid nodules, using the cytological/histopathological analysis as the reference. Patients and methods: Fifty patients with 73 indeterminate thyroid nodules were enrolled in this prospective study. They were examined using US features and elastography scoring according to Rago criteria; then, fine-needle or postoperative biopsy was taken and diagnosis was made. Results: Fifty patients with 73 indeterminate thyroid nodules were included, 16 nodules were malignant and 57 were benign. On US elastography, all 57 nodules diagnosed as benign had a score of 1-3, while 15 of 16 (93.75%) diagnosed as carcinoma had a score of 4-5, with 93.3% sensitivity, 100% specificity and 97.8% accuracy. Combined US findings with elastography revealed that hypoechogenicity/score 4-5 was most predictive of malignancy with sensitivity 80%, specificity 100%; and accuracy 93.4%. The strain ratio cutoff value for malignant nodules was determined as 2.3. Five nodules out of sixteen had SR between 2.31 and 4 (sensitivity 96% and specificity 83%). Conclusion: Thyroid nodules with suspicious US criteria can be evaluated by US elastography that seems to be a useful addition for the assessment of such indeterminate nodules. It may reduce FNAC or select a nodule for aspiration.

Comparison of Conventional Ultrasound, Doppler, Elastography and Contrast Enhanced Ultrasonography Parameters with Histopathology Findings in the Differential Diagnosis of Benign and Malignant Thyroid Nodules

“…The elasticity ratio method had a better diagnostic performance than the Ueno elasticity scoring system ( Figure 2). Consistent with our results, Abdelrahaman and his group reported a similar cut-off of >2.3 strain ratio predictive for malignancy [17].…”

“…In this study, we aim to discuss the comparison of various conventional, elastographic and contrast enhancement features in differentiating benign and malignant thyroid nodules. In the current study, all the patients underwent USG guided FNAC to avoid false negative cases [17]. The malignancy rate in our study was strikingly high, 49.7% cytologically and 61.8% histologically.…”

“…On ROC analysis the AUC for differentiating malignant from benign thyroid nodules on Ueno elastography scoring was 0.86 (sensitivity=92.6%, specificity=82.4%) with a cut-off of >3. As per the literature a known cut-off of >2.3 from literature was applied for elasticity ratio evaluation [17]. Using the ROC analysis, the best cutoff value obtained using elasticity ratio method was >2.2.…”

Diagnostic Accuracy of Strain Ultrasound Elastography in Thyroid Lesions Compared to Fine-Needle Aspiration Cytology

“…Abdelrahman et al studied 73 indeterminate thyroid nodules and found that 16 nodules were malignant and 57 were benign. On USE, all 57 nodules diagnosed as benign had a score of one to three, while 15 of 16 (93.75%) diagnosed as carcinoma had scores of four to five, with 93.3% sensitivity, 100% specificity, and 97.8% accuracy [ 17 ]. USE revealed that hypoechogenicity scores of four to five were most predictive of malignancy with a sensitivity of 80%, specificity of 100%, and accuracy of 93.4%.…”

Update on Ultrasound Diagnosis for Thyroid Cancer

“…A recent study found that SWE was 93.3% sensitive and 100% specific with an overall diagnostic accuracy of 97.8% for thyroid nodules with indeterminate cytology. 81 Therefore, SWE may be useful in the diagnosis of thyroid nodules with indeterminate cytology.…”