The diagnostic value of elastography score and strain index for the evaluation of thyroid micronodules

Erman Çakal,İlknur Öztürk Ünsal,Bekir Uçan,Mustafa Şahi̇n,Melia Karaköse,Mustafa Özbek

doi:10.3906/sag-1802-195

Abstract

Background/aim: In the general population, the frequency of thyroid micronodules is increasing, and the prevalence of malignancy is higher for such nodules. Ultrasonography findings of these nodules are neither specific nor sensitive. The aim of this study was to investigate the diagnostic value of elastography in patients with thyroid micronodules. Materials and methods: A total of 224 patients with thyroid micronodules were recruited in this prospective study. All patients underwent a thyroid fine-needle aspiration biopsy. Elastography scores (ESs) and strain indexes (SIs) were measured with real-time ultrasound elastography. Results: Malignant micronodules had higher ES and SI values than those of benign micronodules (P < 0.001). When ES was used to diagnose malignancy, scores of >3 showed sensitivity of 79.4% and specificity of 98.1%. The area under the curve (AUC) for ES was 0.888 (P < 0.001). The optimal SI cutoff value that differentiated benign from malignant micronodules was 3.06 (98% sensitivity; 91% specificity). The AUC for SI was 0.970 (P < 0.001). Conclusions: ES and SI are beneficial markers for detecting malignant thyroid micronodules. We showed that SI is better than ES when assessing the malignancy of thyroid micronodules.

Highlights

Thyroid nodules are frequently discovered in clinical practice, either during physical examination or incidentally during imaging procedures
We showed that strain indexes (SIs) is better than Elastography scores (ESs) when assessing the malignancy of thyroid micronodules
fine-needle aspiration biopsy (FNAB) results of our study showed that 44 (19.6%) nodules were malignant, 19 (8.5%) were suspicious for malignancy, 43 (19.2%) had atypia of undetermined significance (AUS), 108 (48.2%) were benign, and 10 (4.5%) had nondiagnostic (ND) cytology

Summary

Introduction

Thyroid nodules are frequently discovered in clinical practice, either during physical examination or incidentally during imaging procedures. Up to 50%–60% of healthy individuals have thyroid nodules [1]. Fine-needle aspiration (FNA) is considered the most accurate method for distinguishing benign thyroid nodules from malignant ones [4]. It is not appropriate to evaluate all thyroid nodules with FNA because of the high prevalence of such nodules. Thyroid ultrasonography (US) is a valuable imaging method widely used for the evaluation of thyroid nodules. It is an inexpensive and noninvasive procedure, it provides important information about the nodules, such as the dimensions and parenchymal changes and structure.

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