Evaluation of the effectiveness of real-time elastography in the differential diagnosis of benign and malignant thyroid nodules

Abstract

Aim: The aim of this study was to evaluate the efficiency of real-time elastography (RTE) in the differential diagnosis of thyroid nodules. Materials and Methods: Fifty-two patients with 60 thyroid nodules were included in this study. Real-time elastography examinations were performed on the axial and longitudinal planes. Elastography images were classified between score 1 (whole nodule is soft) and score 5 (hardness in whole nodule and surrounding tissues). Nodules with scores of 1, 2 and 3 were considered benign, and nodules with scores of 4 and 5 were considered malignant. Nodule-to-sternocleidomastoid and thyroid tissue-to-nodule strain ratios (SR) were calculated. The nodules were evaluated by means of size, echogenicity, border, presence of halo and microcalcifications. Elasticity scores and mean strain ratios of all nodules were compared with the cytological or histopathological diagnosis. Results: Forty-three of all cases were benign, and seventeen were malignant. Hypoechogenicity, microcalcifications and absence of halo were statistically related but irregular margins, and a high elasticity score were not statistically related to malignancy. The diagnostic performance of strain ratio was found insignificant. Nodule echogenicity had the highest accuracy among all nodule characteristics. Conclusion: Diagnostic performance of real-time elastography in the differentiation of benign and malignant thyroid nodules is suboptimal. Real-time elastography is not an alternative to gray scale ultrasound.