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The Role of Elastography in the Management of Thyroid Nodules

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The Thyroid and Its Diseases

Abstract

A high frequency of thyroid nodules, a low frequency of thyroid cancers, and their very good prognosis have encouraged and enabled us to develop a very accurate selection of the nodules to be treated in a specific manner.

Ultrasound (US) examination/aspiration cytology pairing is capable of assessing the precise nature of a nodule in approximately 80% of cases provided that the clinicians are experienced and work with TIRADS and Bethesda systems.

Since 2005, elastography has been used for the evaluation of thyroid nodules due to the fact the stiffness of a lesion may indicate its malignancy. Quasi-static elastography (QSE) (or Strain E.) and shear wave elastography (SWE) are incorporated in most of the ultrasound devices, elastographic scores thus now numbering among the other signs of nodular characterization.

However, after a period of enthusiasm, came a time of doubt which has now brought us to a time of reasoning.

Thus currently, QSE and SWE are feasible and useful, painless, and not too time-consuming techniques. Both provide us with precise data and good reproducibility, promising to significantly improve positive and negative predicting values. SWE indicates values in kPa and is feasible when QSE is inoperable. Elastography should never be a substitute for the other US data, while its efficacy is negatively correlated with the US expertise of the operator. Since it may detect tissue stiffness, it is useful for the detection of stiff cancers (papillary), though its efficacy for evaluating soft cancers (follicular) is not yet clear. Combining it with other diagnostic techniques (contrast-enhanced US, molecular biology, miRNA, etc.) is likely to resolve the problem.

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Author information

Authors and Affiliations

  1. American Hospital of Paris, Neuilly-sur-Seine, France

    Hervé Monpeyssen & Jean Tramalloni

Authors
  1. Hervé Monpeyssen
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  2. Jean Tramalloni
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Editor information

Editors and Affiliations

  1. Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany

    Markus Luster

  2. Unit of Endocrinology Diabetes and Metabolism, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Leonidas H. Duntas

  3. Georgetown University School of Medicine, Washington, DC, USA

    Leonard Wartofsky

Glossary

AIT

Autoimmune thyroiditis

ARFI

Acoustic radiation force impulse

AUS

Atypia of undetermined significance

CEUS

Contrast-enhanced ultrasound

ETA

European Thyroid Association

EFSUMB

European Federation of Societies for Ultrasound in Medicine and Biology

FNA

Fine needle aspiration cytology

IgG4

Immunoglobulin G4

kPa

Kilopascal

miRNA

Micro-RNA

NPV

Negative predicting value

PPV

Positive predicting value

QSE

Quasi-static elastography

RD

Research and development

ROI

Region of interest

SE

Strain elastography

SWE

Shear wave elastography

TE

Transient elastography

TIRADS

Thyroid imaging reporting and data system

TM

Time motion

VTq

Virtual touch quantification

2D

Two dimensional = B-mode = Gray scale

US

Ultrasound

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Monpeyssen, H., Tramalloni, J. (2019). The Role of Elastography in the Management of Thyroid Nodules. In: Luster, M., Duntas, L., Wartofsky, L. (eds) The Thyroid and Its Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-72102-6_12

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