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Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):589-596. doi: 10.4103/ijem.IJEM_634_17.

Ultrasound Elastography is a Useful Adjunct to Conventional Ultrasonography and Needle Aspiration in Preoperative Prediction of Malignancy in Thyroid Nodules: A Northern India Perspective.

Author information

Department of Radiology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
Department of Endocrinology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
Department of Endocrine Surgery, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India.
Department of Surgery, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India.



Data on ultrasound elastography (USE) are scant from India. This study aimed to compare the sensitivity and specificity of USE with thyroid ultrasonography (USG) and fine-needle aspiration (FNA) as preoperative predictor of malignancy, using postoperative histopathology as gold standard.

Materials and Methods:

Consecutive patients with thyroid swelling/goiter underwent thyroid USG followed by USE. Patients with pure cystic nodules or eggshell calcification were excluded. Patients with nodules >10 mm with one or more high-risk USG features underwent FNA. Patients with no USG high-risk features, benign score on USE, and benign FNA were conservatively followed. All other patients underwent thyroidectomy.


246 consecutive patients underwent USG. Data from 97 patients (117 nodules) were analyzed. Median age of patients was 43 years with 85.4% females. All patients with USE score-1 had benign USG and FNA characteristics. Of 86 nodules having USE score-2, 18.6% nodules were hypoechoic and 16.28% had microcalcification. Hypoechogenicity and microcalcifications were observed in 66.67% nodules with USE score-3. All nodules with USE score-4 and 5 were hypoechoic and had microcalcifications. Histopathology was benign in 84 and malignant in 33 patients. Occurrence of malignancy in USE scores 1-5 was 0, 4.65, 100, 90.5, and 100%, respectively. All eight nodules with diagnosis of follicular adenoma had preoperative USE score-2. The sensitivity of preoperative USG, USE, and FNA in picking up malignancy was 66.67, 87.88, and 69.70%, respectively. Specificity of USG, USE, and FNA in detecting thyroid malignancy was 88.10, 100, and 97.6%, respectively. False positivity rates for USG, USE, and FNA in diagnosing thyroid malignancy was 11.9, 0, and 2.4%, respectively. The overall diagnostic accuracy of USG, USE, and FNA cytology in this study was 82.05, 96.58, and 89.74%, respectively.


USE may be better than USG for preoperative detection of malignancy in thyroid nodules.


Elastography; malignancy; needle aspiration; nodule; thyroid; ultrasonography

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