Abstract
Purpose
Ultrasound elastography (USE) is a newly developed technique for the evaluation of tissue stiffness. It is known that malignancies often show a low-strain value. So far, only limited data for thyroid nodules is available.
Methods
This study included 309 prospective evaluated patients with dominant, nontoxic thyroid nodules. All patients were referred to surgery. USE was performed preoperatively. Three measuring groups were formed: hard (< 0.15), intermediate (0.16–0.3), and soft (> 0.31). The measurements were correlated to the final histological findings.
Results
The strain rated from 0.01 to 0.84 (mean 0.26 ± 0.13). A total of 50 thyroid malignancies (35 papillara carcinoma, 9 medullary carcinoma, and 6 follicular carcinoma) were observed. Patients (81) were within the hard group, 35 of them (43.2%) had thyroid cancer (TC) in final histology. Out of 132 patients in the intermediate group, 15 patients had TC (11.4%). All 96 patients from the soft group showed benign histological results (NPV 100%). Seventy percent of patients with TC were within the hard group (PPV 42%). These results were highly significant (p < 0.001). Coarse calcifications and cystic nodules were not connected with reliable measurements and therefore are not suitable for USE.
Conclusion
USE is a useful adjunctive tool in the workup of thyroid nodules. A low strain value needs surgical intervention, whereas a high strain value predicts a benign histology. It might substitute fine-needle aspiration cytology in the future.
Similar content being viewed by others
References
Reiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitzky R, Schumm-Draeger PM (2004) Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96, 278 unselected employees. Thyroid 14(11):926–932
Dralle H (2007) Thyroid incidentaloma. Overdiagnosis and overtreatment of healthy persons with thyroid illness? Chirurg 78(8):677–686
Dralle H, Sekulla C (2005) Thyroid surgery: generalist or specialist? Zentralbl Chir 130(5):428–432
Tamsel S, Demirpolat G, Erdogan M, Nart D, Karadeniz M, Uluer H, Ozgen AG (2007) Power Doppler US patterns of vascularity and spectral Doppler US parameters in predicting malignancy in thyroid nodules. Clin Radiol 62(3):245–251
Ivanac G, Brkljacic B, Ivanac K, Huzjan R, Skreb F, Cikara I (2007) Vascularisation of benign and malignant thyroid nodules: CD US evaluation. Ultraschall Med 28(5):502–506
Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al (2006) Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Ultrasound Q 22(4):231–8; discussion 239–40.
Rago T, Santini F, Scutari M, Pinchera A, Vitti P (2007) Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 92(8):2917–2922
Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F, Zoppo A (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18(5):523–531
Rubaltelli L, Corradin S, Dorigo A, Stabilito M, Tregnaghi A, Borsato S, Stramare R (2009) Differential diagnosis of benign and malignant thyroid nodules at elastosonography. Ultraschall Med 30(2):175–179
Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z (2009) Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med 28(7):861–867
Ghassi D, Donato A (2009) Evaluation of the thyroid nodule. Postgrad Med J 85(1002):190–195
Tan GH, Gharib H, Reading CC (1995) Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch Intern Med 155(22):2418–2423
Thomas A, Degenhardt F, Farrokh A, Wojcinski S, Slowinski T, Fischer T (2010) Significant differentiation of focal breast lesions calculation of strain ratio in breast sonoelastography. Acad Radiol 18
Miyagawa T, Tsutsumi M, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T (2009) Real-time elastography for the diagnosis of prostate cancer: evaluation of elastographic moving images. Jpn J Clin Oncol 39(6):394–398
Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ et al (2005) Thyroid gland tumor diagnosis at US elastography. Radiology 237(1):202–211
Chow LS, Gharib H, Goellner JR, van Heerden JA (2001) Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas. Thyroid 11(12):1147–1151
Yang J, Schnadig V, Logrono R, Wasserman PG (2007) Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer 25;111(5):306–15
Rago T, Vitti P, Chiovato L, Mazzeo S, De Liperi A, Miccoli P (1998) Role of conventional ultrasonography and color flow-Doppler sonography in predicting malignancy in ‘cold’ thyroid nodules. Eur J Endocrinol 138(1):41–46
Rago T, Vitti P (2008) Role of thyroid ultrasound in the diagnostic evaluation of thyroid nodules. Best Pract Res Clin Endocrinol Metab 22(6):913–928
Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, Marqusee E (2002) Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87(11):4924–4927
Dighe M, Bae U, Richardson ML, Dubinsky TJ, Minoshima S, Kim Y (2008) Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology 248(2):662–669
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vorländer, C., Wolff, J., Saalabian, S. et al. Real-time ultrasound elastography—a noninvasive diagnostic procedure for evaluating dominant thyroid nodules. Langenbecks Arch Surg 395, 865–871 (2010). https://doi.org/10.1007/s00423-010-0685-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-010-0685-3