A Combination of Ultrasonography and Real Time Elastography (RTE) in Differentiating benign and Malignant Thyroid Nodules, Does It Help?

This is the authors' abstract. We don't add key points for this paper.

Introduction: Thyroid nodule is an abnormal growth of cells within the thyroid gland which can be benign or malignant. 5%-15% of thyroid nodules are malignant. Aim of this study was to evaluate the diagnostic accuracy of Grey scale ultrasonography, elastography and a combination of both and compare the same with histopathology, to reduce unnecessary FNACs of benign nodules. Settings and Design: 50 patients were evaluated in a tertiary referral hospital. This was a prospective, observational study. Material and Methods: TIRADS classification was used for evaluating patients using ultrasonography. Tsukuba scoring was used for qualitative sonoelastographic scoring. FNAC reports/histopathology reports were compared. Results: Sensitivity, specificity, NPV and PPV in differentiating benign and malignant nodules were 90, 97, 90, and 97% respectively. Sensitivity and accuracy of the combination was statistically superior to the gray-scale alone. The accuracy of USG alone was 94% and combination of elastography and grey scale USG was 96%. The ROC curve analysis for elastographic strain indices revealed area under curve to be 0.9. The cut-off value was 0.8. The sensitivity and specificity was 100% and 94.9% respectively with positive likelihood ratio of 19.5. Nodules that scored 1 and 2 on elastography could be safely monitored without need for FNAC. We considered that 35% nodules grow in time and the reduction of FNACs based on our study was 39%. Conclusion: Study showed significant sensitivity and accuracy of ultrasonography and sonoelastography in differentiating benign from malignant nodules. Sonoelastography further increased the sensitivity and specificity when done in conjunction with ultrasonography.