Abstract
ABSTRACT BACKGROUND AND AIMS Thyroid nodules occur in more than 50% of populations over 50 years, and only 5% of thyroid nodules are malignant. This study was aimed to evaluate Doppler ultrasonography (US) combined with elastography in the diagnosis of the malignant thyroid nodules with suspicious fine needle aspiration cytological (FNAC) results. METHODS From August 2012 to March 2013, 107 consecutive patients eligible for thyroid surgery enrolled in the study. All patients underwent FNAC study followed by conventional US, color Doppler US, and US elastography with a real-time instrument. Thyroid nodules ultrasonographic parameters were evaluated during conventional and color Doppler US study and elastography performed in order to calculate the strain index (SI) by dividing the strain value of the nodule by that of the peripheral normal parenchyma, prior to thyroidectomy. RESULTS Of 161 nodules in 107 patients, 76 (47.2%) were benign lesions and 85 (52.8%) were malignant. The overall Doppler US score depicted a sensitivity of 64% and specificity of 59%. Using a cut of 2.905, the sensitivity and specificity for elastography US were about 54 and 76% respectively, with positive predictive value of 71.8% and negative predictive value of 59.8%. Evaluating quantitative elastography combined with Doppler US, out of 68 nodules with positive peripheral halo ring, 44 had elasticity ≥ 2.905, which was statistically significant (p < 0.001). CONCLUSION Quantitative elastography combined with Doppler US is more accurate in thyroid nodules diagnosis comparing to other methods and can limit the use of FNAC and the subsequent thyroidectomy in patients with nondiagnostic or unsatisfactory cytological findings.
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