Diagnostic performance of elastography in cytologically indeterminate thyroid nodules

Area of Science:

• Endocrinology
• Radiology
• Oncology

Background:

• Fine-needle aspiration biopsy is standard for thyroid nodule diagnosis but struggles with indeterminate (Thy3) lesions.
• Elastography shows promise for improving indeterminate thyroid nodule risk stratification, but data is limited and conflicting.
• Current ultrasound (US) parameters alone are insufficient for definitive diagnosis of Thy3 nodules.

Purpose of the Study:

• To evaluate the efficacy of real-time elastography (RTE) in refining the diagnosis of indeterminate (Thy3) thyroid nodules.
• To integrate RTE findings with traditional ultrasound (US) parameters for enhanced diagnostic accuracy.

Main Methods:

• 108 patients with Thy3 nodules underwent evaluation using traditional US (hypoecogenicity, margins, calcifications, halo, vascularization) and RTE.
• Nodules were classified using a four-class color scale in RTE.
• Histological examination served as the gold standard for diagnosis (75 benign, 33 malignant).

Main Results:

• Traditional US parameters alone had limited diagnostic power.
• RTE scores 3 and 4 demonstrated significant diagnostic accuracy (84%) with high specificity (88%) and NPV (89%).
• Combining RTE with US parameters (≥2 suspicious factors) achieved 88% sensitivity and 94% NPV, identifying distinct malignancy risk groups (6% vs. 63%).

Conclusions:

• Real-time elastography significantly improves the diagnostic accuracy for indeterminate thyroid nodules when combined with ultrasound.
• The combined approach effectively stratifies patients into low and high malignancy risk groups, potentially guiding surgical decisions.
• Further research is needed to confirm if low-risk groups can avoid thyroidectomy, optimizing patient management.