Using Elastographic Stiffness to Improve Risk Stratification in Medullary Thyroid Carcinoma

Area of Science:

• Medical Imaging
• Oncology
• Endocrinology

Background:

• Medullary thyroid carcinoma (MTC) diagnosis is challenging due to overlapping sonographic features with benign nodules.
• Conventional ultrasound (US) and TIRADS classification have limited sensitivity for MTC risk stratification.
• Elastography techniques (strain elastography [SE] and shear-wave elastography [SWE]) show potential for thyroid nodule assessment.

Purpose of the Study:

• To investigate if elastographic stiffness measurements can improve diagnostic precision for MTC.
• To compare elastography findings with conventional US, TIRADS, and clinical parameters in MTC.

Main Methods:

• Retrospective analysis of 20 MTC nodules evaluated with conventional US, SE, and SWE.
• Comparison of elasticity scores (ES) and stiffness values (Emean/Emax) with US features, TIRADS, calcitonin levels, nodule size, and lymph node status.
• Analysis of qualitative SE scores and quantitative SWE Emean values against established cutoffs.

Main Results:

• Most MTC nodules exhibited increased stiffness: mean SE score of 3.2 and 87.5% exceeding SWE Emean cutoff of 30.5 kPa.
• Elastography outperformed TIRADS, identifying more high-risk nodules (87.5% vs. 60%).
• Moderate correlations found between calcitonin and nodule size, and between SE score and nodule size; no correlation between calcitonin and SE score.

Conclusions:

• Elastography demonstrates increased stiffness in MTC, contradicting the 'soft' nodule classification and enhancing risk stratification beyond TIRADS.
• Integrating elastography with TIRADS may improve fine-needle aspiration guidance for MTC.
• Further multicenter prospective studies are required to validate elastography thresholds for MTC.