Ultrasound elastography in the diagnostic evaluation of indeterminate thyroid nodules

ObjectiveTo assess the accuracy of US-elastography in the evaluation of indeterminate thyroid nodules, using the cytological/histopathological analysis as the reference.Patients and methodsFifty 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.ResultsFifty 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%).ConclusionThyroid 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.