Abstract
Background It is crucial to have a clear diagnostic approach to ensure patients presenting with thyroid nodules are managed appropriately. Fine-needle aspiration cytology (FNAC) is the best preoperative test used for differentiating malignant from benign nodules. Cytology has certain limitations that restrict its use as a single diagnostic test. Ultrasound elastography (USE) is a newly developed technique that uses ultrasound to provide an estimation of tissue stiffness under application of external force. The aim of this study was to assess whether USE improves the accuracy of FNAC in predicting malignancy in thyroid nodules. Patients and methods This prospective study included 96 patients with a solitary thyroid nodule or dominant nodule in the setting of multinodular goiter from January 2011 to July 2012. They were examined using USE at the Radiology Department, National cancer Institute, Cairo University. Tissue stiffness was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). All patients were referred for FNAC at the Cytology Unit, Pathology Department. Cytological specimens were evaluated blindly (without knowing the scores of USE) and classified according to the recent Bethesda classification. All the studied patients underwent surgery and were evaluated for the final histopathological diagnoses. Results On FNAC, 46 of 61 cases (75.4%) with a final histopathological diagnosis of benign nodule had a negative diagnosis, whereas 34 of 35 cases (97.1%) with a final histopathological diagnosis of carcinoma had a positive diagnosis (P Conclusion USE is a promising imaging technique that can assist in the differential diagnosis of thyroid nodules with higher sensitivity, specificity, PPV, NPV, and diagnostic accuracy compared with FNAC. Therefore, it may be useful to introduce it into the routine clinical practice in association with FNAC.
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