Real-time ultrasound elastography—a noninvasive diagnostic procedure for evaluating dominant thyroid nodules

Abstract

Purpose Ultrasound elastography (USE) is a newly developed technique for the evaluation of tissue stiffness. It is known that malignancies often show a low-strain value. So far, only limited data for thyroid nodules is available. Methods This study included 309 prospective evaluated patients with dominant, nontoxic thyroid nodules. All patients were referred to surgery. USE was performed preoperatively. Three measuring groups were formed: hard (< 0.15), intermediate (0.16-0.3), and soft (> 0.31). The measurements were correlated to the final histological findings. Results The strain rated from 0.01 to 0.84 (mean 0.26±0.13). A total of 50 thyroid malignancies (35 papillara carcinoma, 9 medullary carcinoma, and 6 follicular carcinoma) were observed. Patients (81) were within the hard group, 35 of them (43.2%) had thyroid cancer (TC) in final histology. Out of 132 patients in the intermediate group, 15 patients had TC (11.4%). All 96 patients from the soft group showed benign histological results (NPV 100%). Seventy percent of patients with TC were within the hard group (PPV 42%). These results were highly significant (p<0.001). Coarse calcifications and cystic nodules were not connected with reliable measurements and therefore are not suitable for USE. Conclusion USE is a useful adjunctive tool in the workup of thyroid nodules. A low strain value needs surgical intervention, whereas a high strain value predicts a benign histology. It might substitute fine-needle aspiration cytology in the future.

Ultrasound elastography in thyroid disease

“…Some groups analyzed the diagnostic value of the absolute A value for strain, as displayed by the machine when computing strain ratio [47,77]. However, this approach is highly disputable, since, as discussed above, RTE machines only compute the relative strain in an area and not the absolute strain.…”

Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?

“…The efficacy of USE in distinguishing benign from malignant thyroid nodules varies widely, ranging from 34% to 100% in different studies (Lyshchik et al, 2005;Rubaltelli et al, 2009;Rago et al, 2010;Vorlander et al, 2010;Cakir et al, 2011;Lippolis et al, 2011). USE may be viewed as a form of palpation by means of US and, as such, the examination may be influenced by operator's experience.…”

Elastography: Principles and considerations for clinical research in veterinary medicine cibele

“…In practice, elastography is usually performed as an extension of convencional US and not as an independent test (Kwak and Kim, 2014). Vorländer et al (2010), confirmed the possibility of measuring the increased stiffness in Hashimoto disease by using magnetic resonance elastography and in other study was reported the possible possible usefullness of ARFI to confirm the presence of Graves disease and chronic autoimmune thyroiditis (Zaleska-Dorobisz et al, 2014).…”