Sonographic Evaluation of Thyroid Nodules with Elastography and Cytopathological Correlation

A BSTRACT Background: Thyroid nodules are commonly detected with high-resolution ultrasonography. While most are benign, a significant minority are malignant, necessitating accurate risk stratification. Conventional ultrasound is sensitive but has limited specificity due to overlapping features. Aim: To assess the diagnostic accuracy of ultrasound elastography in thyroid nodules by correlating elastography findings with cytopathology. Materials and Methods: This analytical cross-sectional study included 100 patients (20–60 years) with thyroid nodules evaluated using B-mode ultrasound and TI-RADS classification. Shear wave elastography was performed to assess tissue stiffness. Nodules with suspicious features underwent ultrasound-guided FNAC, reported using the Bethesda system. Statistical analysis was done using SPSS v26.0, with significance set at P < 0.05. Results: The mean age was 39.16 ± 12.24 years, with female predominance. Most nodules were hypoechoic, and 22% were TI-RADS 5. Elastography identified 28% of nodules as stiff. Cytopathology showed 56% benign and 44% malignant lesions. A weak but statistically significant negative correlation was observed between elastography findings and cytopathology ( P = 0.05). Conclusion: The combined use of ultrasonography, shear wave elastography, and cytopathology enhances thyroid nodule characterization. Elastography is a valuable adjunct to conventional ultrasound and FNAC, supporting improved risk stratification and clinical decision-making.