Role of real time elastography in preoperative diagnostic of solitary thyroid nodules

Background: In the presence of a solid thyroid nodule, the therapeutically approach is imposed by the probability of a malignancy. Ultrasound is considered to be “the” imagistic diagnostic tool, and the golden standard is represented by the FNAB. US elastography is currently used in differentiation of malignant from benign lesions.

Method: This prospective study included 112 patients, mean age 52.08 ± 11.43 years, 65 females and 47 men, with solitary thyroid nodules on conventional US, with a volume higher than 0.50 ml. Complete ultrasound evaluation was performed for each case: gray scale, Doppler and strain elastography. All patients underwent surgery after complete evaluation. Extemporaneous and postsurgical histopathological exam were performed in all cases.

Results: We identified 19 cases with cancer and 93 benign lesions. We calculated the diagnostic value for each ultrasound parameter, and we saw that some parameters are significant in diagnosing thyroid malignancy: irregular margins (AUC = 0.761, p = 0.00001), taller than wide (AUC = 0.723, p = 0.0001), positive calcification (AUC = 0.7416, p = 0.0001), absent halo sign (AUC = 0.717, p = 0.0001), extracapsular invasion (AUC = 0.684, p = 0.0012). Presence of 4 suspect signs increases diagnostic quality (AUC = 0.8529, p = 0.000), and combined evaluation US-2B and Doppler have even better results (AUC = 0.8985, p = 0.00001.

Nevertheless, diagnostic quality of RTE is higher than all separate or combine conventional ultrasound evaluation: AUC = 0.99, p = 0.0001

Conclusion: RTE color map screen is a useful tool in discriminating solitary thyroid masses.