2077111 Is Real-Time Elastography Using Manual Compression A Viable Method For Providing A Differential Diagnosis Of Benign And Malignant Thyroid Nodules?

Abstract

The aim of this systematic review was to assess the effectiveness of real-time ultrasound elastography using manual compression in providing differential diagnosis of benign and malignant thyroid nodules. The review aims to establish whether this imaging technique can be used as an alternative to a FNA biopsy. In order to standardise elastography findings and help classify thyroid nodules, various scoring systems have been developed. This review focusses on a 5 point scoring system developed by Ueno and Ito for the assessment of breast lesions, but which is now being used for assessment of thyroid nodules. A comprehensive search of the literature related to thyroid elastography using the 5 point scoring system was undertaken. Studies relevant to the review were critically analysed and summated in order to answer the review question. There is unanimous agreement in the general findings between the included studies. These studies show that for the nodules they examined, real-time elastography and assessment using the 5-point scoring system is a highly sensitive (86-97%) and specific (89.5-100%) method for providing a differential diagnosis of benign and malignant thyroid nodules. Meta-analysis suggests an elastography score of 1-3 (based on the Ueno and Ito scoring system) is highly indicative of a benign nodule, and an elastography score of 4-5 (based on the Ueno and Ito scoring system) is highly indicative of a malignant nodule. In the combined studies, real-time elastography was shown to be unsuitable for nodules that are mostly cystic or those that contain large calcifications. The results from these studies are largely comparable with those described in the general literature. Real-time elastography using manual compression has the potential to be a viable method for providing a differential diagnosis of benign and malignant thyroid nodules. However, there is still a lack of comprehensive large scale studies into the technique. Until further studies have been carried out, elastography should be used as an additional tool in the assessment of thyroid nodules, to compliment conventional ultrasound and FNA cytology.