Pathology of thyroid tumours

The value of ultrasound elastography in differentiation of malignancy in thyroid nodules

We aimed to determine the value of ultrasound elastography (US-E) using carotid artery pulsation in differentiation of malignant and benign thyroid nodules. One hundred ten nodules were evaluated by US-E, and stiffness scores were compared to biopsy results. When cutoff for malignancy was determined as score 4, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 95%, 40%, and 100%, respectively. We suggest fine needle aspiration biopsy to be performed in all score 4 nodules, while biopsy may be unnecessary in score 1 nodules. Benign biopsy result in a score 4 nodule should suggest radiological-pathological disagreement, and repeat biopsy should be recommended.

Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules

OBJECTIVE

The purpose of this study was to evaluate the diagnostic utility of real-time ultrasound elastography in differentiating benign from malignant thyroid nodules.

METHODS

A total of 90 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. One hundred forty-five nodules in these patients were examined by B-mode ultrasound, color Doppler ultrasound, and ultrasound elastography. The final diagnosis was obtained from histologic findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 6 (high stiffness over the entire nodule and surrounding tissue).

RESULTS

On real-time ultrasound elastography, 86 of 96 benign nodules (90%) had a score of 1 to 3, whereas 43 of 49 malignant nodules (88%) had a score of 4 to 6 (P <.001), with sensitivity of 88%, specificity of 90%, a positive predictive value of 81%, and a negative predictive value of 93%. The predictivity of ultrasound elastographic measurement was independent of the nodule size. High sensitivity (88%) and specificity (93%) were also observed in 68 nodules that had a greatest diameter of 1 cm or less.

CONCLUSIONS

Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer.