Determining the accuracy of elastography in differentiating benign from malignant nodules with fine needle aspiration cytology/ histopathological examination as the gold standard

Abstract

Background: Thyroid nodules are very common and are found in 4% to 8% of adults by palpation, 41% by ultrasound, particularly among iodine-deficient individuals. Most nodules are benign, with less than 5% of them being malignant. Aims and Objectives: To determine the accuracy of elastography in differentiating benign from malignant nodules with Fine Needle Aspiration Cytology/ Histopathological examination as the gold standard. To determine the strain ratio of benign and malignant thyroid nodules. Material and Methods: The study was done at the Batra hospital & medical research centre (BMHRC), New Delhi. In this study 37 patients of thyroid swelling with total 43 nodules were evaluated finally during the study period. A prospective observational study of patient population who undergo grey-scale ultrasound (US) and real time ultrasound elastography (USE) for thyroid nodules and subsequently go for fine needle aspiration cytology/ histopathological examination for same. Results: The study comprises of 37 patients having 43 thyroid nodules. All patients underwent gray scale USG and ultrasound elastography followed by FNAC/histopathology examination. Conclusion: This prospective observational study shows that ultrasound elastography is a promising imaging technique and that in expert hands, it is a useful complement to US, enhancing its accuracy for thyroid malignancy detection and risk stratification. Elastography may be used to guide the follow up of lesions negative for malignancy at cytology or histopathology. Given the high prevalence of thyroid nodules and the substantial costs related to their workup and management, the use of USE could be a valuable tool for a better selection of nodules that need cytological evaluation. Large multicenter studies and periodic evaluation by international experts consensus panels are necessary to establish the role of USE in the diagnostic workup of thyroid nodules.