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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

1
Department of Radiology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
2
Department of Endocrinology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
3
Department of Endocrine Surgery, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
4
Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India.
5
Department of Surgery, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India.
6
Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India.

Abstract

Introduction:

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.

Results:

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.

Conclusion:

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

KEYWORDS:

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

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