The role of elastography in the assessment of thyroid nodules and its future direction
Jake Wheater, Ultrasound, Radiology York NHS Hospitals,
Ultrasound (US) assessment of the thyroid is becoming increasingly in demand, with the prevalence of thyroid nodules being estimated at 67% of the population1. Currently, US assessment through B-mode scanning with a view to fine-needle aspiration biopsy (FNAB) is considered the gold standard in thyroid nodule characterisation9. However, the non-invasive evaluation of tissue stiffness through elastographic assessment is trying to change this. Several studies have shown elastography to have a significant role in the accurate discrimination of benign lesions from malignant5,6,7,8, allowing for both quantifiable and qualitative thyroid nodule assessment. High sensitivity and specificity values of 98.5% and 99.8% respectively, have been noted when elastography is combined with B-mode US, suggesting a potential decrease in the need for FNAB of up to 34%2,4. Nevertheless, utilisation of elastography to guide FNAB to increase cytopathological effectiveness has also been documented as a step forward. The role of thyroid elastography may also be extended into a surveillance capacity for negative FNAB nodules3. Future advances should include establishing a solid role for elastography in a clinical setting, and that of uniform standardisation of an elastography grading criteria by way of converting B-mode and elastographic results into an estimate of malignant risk. This work aims to demonstrate the current and future role of elastography in the assessment of thyroid nodules.
1Mehanna H M, Jain A, Morton R P, Watkinson J, Shaha A. Investigating the thyroid nodule BMJ 2009; 338 :b733 [online} Available at: https://www.bmj.com/content/338/bmj.b733/rapid-responses
2Zhang, B., Ma, X., Wu, N., Liu, X., Zhang, J., Yang, J. and Niu, T. 2013. Shear wave elastography for differentiation of benign and malignant thyroid nodules: a meta-analysis. Journal of ultrasound medicine. 32(12): 2163-9. [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmed?term=24277899
3Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja O et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. part 2: clinical applications. Europ J Ultrasound 34:238–253
4Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L (2013) Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 168:649–655
5Moon HJ, Sung JM, Kim EK, Yoon JH, Youk JH, Kwak JY (2012) Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 262:1002–1013
6Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L (2013) Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 168:649–655
7Shweel M, Mansour E (2013) Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules. Eur J Radiol 82:995–1001
8Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah N et al (2012) Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab 97:4524–4530
9Hambleton, C. and Kandil, E. 2013. Appropriate and accurate diagnosis of thyroid nodules: a review of thyroid fine-needle aspiration. Int J Clin Exp Med. 6(6):413-422. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703111/