The role of elastography in evaluating thyroid nodules: a literature review and meta-analysis

Abstract

To appraise the literature for studies involving the use of elastography to diagnose thyroid nodule pathology. Two independent reviewers performed a systematic review of the English medical literature for studies involving elastography diagnosing thyroid nodule pathology. Data gleaned from this process was used in a meta-analysis to summarise the results. Thirty-eight studies were used in the meta-analysis totalling 5,942 thyroid nodules examined with elastography. The pooled results were sensitivity = 87.0 % (95 % confidence intervals (CI) = 86.2-87.9 %), specificity = 80.6 % (CI = 79.5-81.6 %), positive predictive value (PPV) = 48.9 % (CI = 47.6-50.2 %), negative predictive value (NPV) = 96.7 % (CI = 96.2-97.1 %), diagnostic accuracy = 81.7 % (CI = 80.7-82.7 %). Subgroup analysis of the data is also presented. Elastography has its limitations in the diagnosis of thyroid nodules; however, its high NPV is increasingly being used as an important investigation and may allow a reduction in the number of hemi-thyroidectomies with benign pathology. Subgroup analysis suggests that elastography techniques where compressive force is performed in a non-user-dependant method results in improved final results.

Porównanie skuteczności elastografii w diagnostyce zmian pęcherzykowych tarczycy i ognisk z jednoznacznym wynikiem BAC

“…The ES1 can be used for the same purpose just like in UC nodules. This conclusion is concordant with the results of the meta-analysis by Veer and Puttagunta [46], which led to the statement that in the case of the low malignancy risk in nodules with an equivocal or non-diagnostic cytology a normal elastogram should indicate conservative treatment.…”

Qualitative elastography can replace thyroid nodule fine-needle aspiration in patients with soft thyroid nodules. A systematic review and meta-analysis

“…Furthermore, all of the previously published meta-analyses missed several papers. For example, the publication of Ferrari et al was missed by all except of Veer et al, while Veer et al, however, missed Trimboli's paper of 498 nodules [8][9][10][11][12]28,34].…”

“…Previously published meta-analyses focused on the diagnostic value of thyroid nodule elastography in a broad sense. Bojunga, Sun and Veer et al analyzed pooled data of difference elastography techniques, like qualitative elastography, strain index elastography and shear wave elastography [8][9][10]. Ghajarzadeh and Razavi specifically analyzed qualitative elastography but pooled data of patients referred for surgery and patients referred for fine needle aspiration (FNA) [11,12].…”

“…Its introduction was soon paced by several studies and meta-analyses reporting promising results. However, these studies compared studies with a mixed group of populations (i.e., patients referred for FNA and patients referred for surgery), color systems, and inclusion and exclusion criteria [8][9][10][11][12]. The role of elastography in cystic, calcified and follicular lesions is still a matter of debate.…”

Ultrasound elastography in thyroid disease

“…A nodule with score 1 may be considered benign and FNAB or surgery may be avoided [120]. In a low risk case with indeterminate or nondiagnostic FNAB, a negative elastographic result may represent a reassuring information to avoid FNAB or surgery and institute follow-up, freeing resources for patients with suspicious nodules [121]. The constantly high negative predictive values of the elastography techniques infer that elastography is useful in determining which nodule may be followed up without FNAB [10].…”